Journal of Rehabilitation Research & Development (JRRD)

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Volume 53 Number 6, 2016
   Pages 881 — 892

Abstract — Sociotechnical probabilistic risk modeling to predict injurious falls in community living centers

Gail Powell-Cope, PhD, ARNP, FAAN;1* Robert Campbell, PhD, JD;2 Bridget Hahm, MA, MPH;1 Tatjana Bulat, MD;3 John Westphal, BS4

1Department of Veterans Affairs Health Services Research and Development Center of Innovation on Disability and Rehabilitation Research, 2Research and Development Service, and 3Veterans Integrated Service Network 8 Patient Safety Center of Inquiry, James A. Haley Veterans' Hospital, Tampa, FL; 4Outcome Engenuity, Plano, TX

Abstract — The goal of this study was to apply sociotechnical probabilistic risk assessment to prioritize risks and prevention strategies for serious injurious falls of residents in nursing homes. Risk modeling teams consisted of 26 clinical and nonclinical staff from three Department of Veterans Affairs community living centers and one state Veterans' nursing home. Participants met in groups several times to identify and assign probabilities to provider and resident at-risk behaviors and equipment failures. They identified prevention strategies for the failures that accounted for the highest levels of risk. Six scenarios were modeled: (1) transferring from bed to wheelchair, (2) propelling from bedside to bathroom, (3) transferring from wheelchair to toilet, (4) transferring from toilet to wheelchair, (5) propelling from bathroom to bedside, and (6) transferring from wheelchair to bed. The greatest paths of risk were for residents with impaired mobility and high fragility. A 26% reduction in injurious falls could be achieved by (1) reducing the number of unassisted transfers through a modest improvement in response time to alarms, (2) installing automatic brake locks on 90% of wheelchairs, (3) making the wheelchair maintenance process highly reliable, and (4) decreasing improper transfer techniques by 10%.

Key words: community living centers, equipment failure, fall risk, fractures, injurious falls, injury prediction, nursing home, patient falls, risk modeling, wheelchair.

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This article and any supplementary material should be cited as follows:
Powell-Cope G???, Campbell R, Hahm B, Bulat T, Westphal J. Sociotechnical probabilistic risk modeling to predict injurious falls in community living centers. J Rehabil Res Dev. 2016;53(6):881–92.
ORCID: Gail Powell-Cope, PhD, ARNP, FAAN: 0000-0002-4608-0128; Robert Campbell, PhD, JD: 0000-0002-6269-9895; Bridget Hahm, MA, MPH: 0000-0001-7454-4471; Tatjana Bulat, MD: 0000-0002-4380-942X; John Westphal, BS: 0000-0001-6330-4712

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