Feasibility of using risk prompts to prevent falls, dehydration and pulmonary aspiration in nursing homes: a clinical study protocol

Márcia Duarte, Raquel Bouça-Machado, Josefa Domingos, Catarina Godinho, Joaquim J Ferreira, CNS risk prompt display study group, Natália Pona, João Ferreira, Hélder Marques, Tiago Reis, Marta Pires, Ana Monteiro, Eduarda Cabral, Élia Decoroso, José Resende, Margarida Duarte, Matilde Mesquita, Ricardo Gonçalinho, Ricardo Neves, Silvana Costa, Valentina Orghian, Daniela Guerreiro, Alexandra Saúde, Diana Peralta, Francisco Queimado, João Belo, Mariana Leitão, Pedro Nunes, Verónica Caniça, Rita Cardoso, Ana Fernandes, Joana Carvalho, Diana Miranda, Abigail Cascais, Ana Ferreira, Ana Caetano, Ana Santos, Aúrea Filipe, Aurica Gangan, Carmn Vieira, Cátia Franco, Célia Alves Cláudia Marouco, Cristiane Oliveira, Diogo Costa, Dovilé Galdikaite, Elisabete Gonçalves, Elsa Ribeiro, Fátima Carmo, Franclin Oliveira, Gonçalo Louro, Isabel Constantino, Joana Rosa, Joana Maltezinho, Glória Santos, Fátima Gama, Jacinta Louro, Teresa Penetra, Marie Lim, Marília Paulo, Marina Roque, Michele Miranda, Patrícia Elias, Paula Sousa, Rafaela Cordeiro, Sandra Silva, Sandra Santos, Sara Silva, Tatiana Ramos, Márcia Duarte, Raquel Bouça-Machado, Josefa Domingos, Catarina Godinho, Joaquim J Ferreira, CNS risk prompt display study group, Natália Pona, João Ferreira, Hélder Marques, Tiago Reis, Marta Pires, Ana Monteiro, Eduarda Cabral, Élia Decoroso, José Resende, Margarida Duarte, Matilde Mesquita, Ricardo Gonçalinho, Ricardo Neves, Silvana Costa, Valentina Orghian, Daniela Guerreiro, Alexandra Saúde, Diana Peralta, Francisco Queimado, João Belo, Mariana Leitão, Pedro Nunes, Verónica Caniça, Rita Cardoso, Ana Fernandes, Joana Carvalho, Diana Miranda, Abigail Cascais, Ana Ferreira, Ana Caetano, Ana Santos, Aúrea Filipe, Aurica Gangan, Carmn Vieira, Cátia Franco, Célia Alves Cláudia Marouco, Cristiane Oliveira, Diogo Costa, Dovilé Galdikaite, Elisabete Gonçalves, Elsa Ribeiro, Fátima Carmo, Franclin Oliveira, Gonçalo Louro, Isabel Constantino, Joana Rosa, Joana Maltezinho, Glória Santos, Fátima Gama, Jacinta Louro, Teresa Penetra, Marie Lim, Marília Paulo, Marina Roque, Michele Miranda, Patrícia Elias, Paula Sousa, Rafaela Cordeiro, Sandra Silva, Sandra Santos, Sara Silva, Tatiana Ramos

Abstract

Background: Evidence has shown a relationship between dehydration, falls, and pulmonary aspiration among older adults in nursing homes, all of which contribute to loss of independence and quality of life. It is believed that improving communication among healthcare professionals in nursing homes (physicians, nurses, rehabilitation team, psychologist, social workers, dieticians and medical assistants) decreases the number of adverse events in institutionalized patients. This study will evaluate the feasibility of using a set of written signs, designed to caution against the risk of falls, dehydration, and pulmonary aspiration, and will enable the proposal of tailored interventions to manage these events in nursing homes.

Methods/design: All patients from Campus Neurológico Sénior (CNS) nursing home, at risk of falls and/ordysphagia and/or dehydration will be invited to participate in the study. Patients will undertake a screeningrisk assessment and the corresponding risk prompts will be attributed. Study duration will be a minimum ofthree months per participant, including daily record of falls, dehydration and pulmonary aspiration eventsand monthly interview assessments, conducted by a member of the research team. Data of the events that occur will be compared with historical data extracted retrospectively from medical and nursing charts. This study has been approved by the Ethics Committee of the Medical Academic Center of Lisbon, Faculty of Medicine, University of Lisbon (Ref. 176/15). All participants will give their written informed consent before entering the study.

Discussion: This study is unique in evaluating the feasibility of a communication system in preventing the three major risks in nursing home. Thoughtful selection and display of proper risk prompts in nursing homes could be an essential step along a path toward efficient communication of risks among healthcare teams. We expect that the displays will be easily applicable given their simplicity, low complexity, and minimal physical requirements.

Trial registration: NCT03123601. March 7, 2017. Retrospectively registered.

Keywords: Choking; Dehydration; Dysphasia; Falls; Nursing homes; Pulmonary aspiration.

Conflict of interest statement

Ethics approval was granted by Ethics Committee of Medical Academic Center of Lisbon, Faculty of Medicine, University of Lisbon, and all procedures will be conducted in accordance with this approved protocol. Written consent for participation in the study will be obtained from all participants prior to their involvement.Not applicable. Individual clinical data will not be used in this study.All authors declare no support from any organization for the submitted work, no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, and no other relationships or activities that could appear to have influenced the submitted work.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Risk prompt displays—coloured bracelets with slogans related with the different risks
Fig. 2
Fig. 2
Risk prompt displays—coloured signposts next to patients’ headboard

References

    1. da Costa FA, Periquito C, Carneiro MC, et al. Potentially inappropriate medications in a sample of Portuguese nursing home residents: does the choice of screening tools matter? Int J Clin Pharm. 2016;38:1103–1111. doi: 10.1007/s11096-016-0337-y.
    1. Young A, Froggatt K, Brearley SG. ‘Powerlessness’ or ‘doing the right thing’—moral distress among nursing home staff caring for residents at the end of life: an interpretive descriptive study. Palliat Med. 2017;31:853–860. doi: 10.1177/0269216316682894.
    1. Kayser-Jones J, Schell ES, Porter C, et al. Factors contributing to dehydration in nursing homes: inadequate staffing and lack of professional supervision. J Am Geriatr Soc. 1999;47:1187–94. . Accessed 9 June 2016.
    1. Pauly L, Stehle P, Volkert D. Nutritional situation of elderly nursing home residents. Zeitschrift für Gerontol und Geriatr. 2007;40:3–12. doi: 10.1007/s00391-007-0430-x.
    1. Wolff A, Stuckler D, McKee M. Are patients admitted to hospitals from care homes dehydrated? A retrospective analysis of hypernatraemia and in-hospital mortality. J R Soc Med. 2015;108:259–265. doi: 10.1177/0141076814566260.
    1. Twersky JI. Falls in the nursing home. Clin Fam Pract. 2001;3:653–666. doi: 10.1016/S1522-5720(05)70119-7.
    1. Kiely DK, Kiel DP, Burrows AB, et al. Identifying nursing home residents at risk for falling. J Am Geriatr Soc. 1998;46:551–555. doi: 10.1111/j.1532-5415.1998.tb01069.x.
    1. Pick N, McDonald A, Bennett N, et al. Pulmonary aspiration in a long-term care setting: clinical and laboratory observations and an analysis of risk factors. J Am Geriatr Soc. 1996;44:763–768. doi: 10.1111/j.1532-5415.1996.tb03731.x.
    1. Ibrahim JE, Bugeja L, Willoughby M, et al. Premature deaths of nursing home residents: an epidemiological analysis. Med J Aust. 2017;206:442–447. doi: 10.5694/mja16.00873.
    1. Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med (ANN INTERN MED) 1994;121:442–451. doi: 10.7326/0003-4819-121-6-199409150-00009.
    1. Mackenzie LA, Byles JE. Circumstances of falls with fractured femur in residents of Australian nursing homes. J Aging Health. 2017:1–20. 10.1177/0898264317690667.
    1. Hollaar V, van der Maarel-Wierink C, van der Putten G-J, et al. Defining characteristics and risk indicators for diagnosing nursing home-acquired pneumonia and aspiration pneumonia in nursing home residents, using the electronically-modified Delphi method. BMC Geriatr. 2016;16:60. doi: 10.1186/s12877-016-0231-4.
    1. Lima Ribeiro SM, Morley JE. Dehydration is difficult to detect and prevent in nursing homes. J Am Med Dir Assoc. 2015;16:175–176. doi: 10.1016/j.jamda.2014.12.012.
    1. Colon-Emeric CS, McConnell E, Pinheiro SO, et al. CONNECT for better fall prevention in nursing homes: results from a pilot intervention study. J Am Geriatr Soc. 2013;61:2150–2159. doi: 10.1111/jgs.12550.
    1. Matinolli M, Korpelainen JT, Korpelainen R, et al. Mobility and balance in Parkinson’s disease: a population-based study. Eur J Neurol. 2009;16:105–111. doi: 10.1111/j.1468-1331.2008.02358.x.
    1. Thurman DJ, Stevens JA, Rao JK, et al. Practice parameter: assessing patients in a neurology practice for risk of falls (an evidence-based review): report of the quality standards Subcommittee of the American Academy of Neurology. Neurology. 2008;70:473–479. doi: 10.1212/01.wnl.0000299085.18976.20.
    1. Chung KA, Lobb BM, Nutt JG, et al. Effects of a central cholinesterase inhibitor on reducing falls in Parkinson disease. Neurology. 2010;75:1263–1269. doi: 10.1212/WNL.0b013e3181f6128c.
    1. Tjaden K. Speech and swallowing in Parkinson’s disease. Top Geriatr Rehabil. 2008;24:115–126. doi: 10.1097/01.TGR.0000318899.87690.44.
    1. Thomas DR, Cote TR, Lawhorne L, et al. Understanding clinical dehydration and its treatment. J Am Med Dir Assoc. 2008;9:292–301. doi: 10.1016/j.jamda.2008.03.006.
    1. Folstein MF, Folstein SE, McHugh PR. ‘Mini-mental state’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–198. doi: 10.1016/0022-3956(75)90026-6.
    1. Bloem BR, Marinus J, Almeida Q, et al. Measurement instruments to assess posture, gait, and balance in Parkinson’s disease: critique and recommendations. Mov Disord. 2016;0:1–14.
    1. Keus S, Munneke M, Graziano M, et al. European physiotherapy guideline for Parkinson’s disease. 1st ed. The Netherlands; 2014.
    1. Savva GM, Donoghue OA, Horgan F, et al. Using timed up-and-go to identify frail members of the older population. Journals Gerontol Med Sci Cite J as J Gerontol A Biol Sci Med Sci. 2013;68:441–446. doi: 10.1093/gerona/gls190.
    1. Cheng K-Y, Lin W-C, Chang W-N, et al. Factors associated with fall-related fractures in Parkinson’s disease. Parkinsonism Relat Disord. 2014;20:88–92. doi: 10.1016/j.parkreldis.2013.09.024.
    1. Cohen JT, Manor Y. Swallowing disturbance questionnaire for detecting dysphagia. Laryngoscope. 2011;121:1383–1387. doi: 10.1002/lary.21839.
    1. Manor Y, Giladi N, Cohen A, et al. Validation of a swallowing disturbance questionnaire for detecting dysphagia in patients with Parkinson’s disease. Mov Disord. 2007;22:1917–1921. doi: 10.1002/mds.21625.
    1. Oates LL, Price CI. Clinical assessments and care interventions to promote oral hydration amongst older patients: a narrative systematic review. BMC Nurs. 2017;16:4. doi: 10.1186/s12912-016-0195-x.
    1. Chan A-W, Tetzlaff JM, Gøtzsche PC, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586. doi: 10.1136/bmj.e7586.
    1. Tickle-Degnen L. Nuts and bolts of conducting feasibility studies. Am J Occup Ther. 2013;67:171–176. doi: 10.5014/ajot.2013.006270.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel