Reducing Patient Falls


Patient fall is an important issue in nursing due to its pre-valanceand the danger it poses to the patients` health. Accidental falls ina hospital setting can result in injuries that can sometimes turn tobe fatal. The Joint Commission International together with theNational Patient Safety Agency has paid attention to the issue due toits prevalence. The Joint Commission International has made reducingpatients falls as one of its international safety goals (Ang et al.,2011). Preventing patient falls remain a challenge to many healthinstitutions. The commonly used approaches to curbing the fallsinclude patient assessment, identification of risk, the mental stateof the patient and their mobility. The multiple universalinterventions are the most common method used in health institutions.Nursing scholarly articles have addressed the subject by proposingthe best methods to curb it and how to respond to the situation whena patient falls. Targeted multiple falls is a method used byclinicians to group patients on the basis of their assumed risk tofall (Ang et al., 2011). The effectiveness of the method, however,has not been established, and researchers are still in the process ofdefining its definite accuracy through randomized and controlledstudies.

Summary of the Research Design

Ang et al. (2011) conducted a study dubbed, Evaluating the use ofa Targeted Multiple Intervention Strategy in in an Acute care Hospital: A Randomized Controlled Trial. The aimof the study was to examine the effectiveness of various interventionmethods in reducing patient falls that clinicians identified to be ata high risk. The study’s design involved applying a prospectiverandomized and controlled trial in an acute hospital located inSingapore between the month of April and December 2006 (Ang et al.,2011). The patients involved in the study were identified as highrisk for falls. The scholars compared the effectiveness of targetedmultiple interventions with usual care with the usual care only for aperiod of 8 months. During the observation period, the researcherscompiled credible data that enabled them to make valid conclusions.

The criteria for recruiting the participants includes having attainedat least 21 years and scored above five in the Hendrich II Fall RiskModel. The patients who were already in the wards at the commencementof the study and those who had taken part in a previous similar studynot take part in the study. The researchers placed the participantsin either the control or intervention groups using the random method(Ang et al., 2011). The participants in the control group were giventhe usual care by the nurses who received training on using theHendrich II Fall Risk Model. The method was compliant with theministry of health’s clinical guidelines. These include fall riskassessment, placing the bell within the reach of the patient and alocker close to the patients’ bed. According to the hospital, therisk factors to fall included the patient’s mental status,seizures, and dizziness, effects of drugs, hearing and visioncomplications. These risk factors rendered all the participants atrisk of falls. Those in the intervention groups received both theusual care and a set of multiple interventions customize to theirindividual risk factors. Besides the usual care, the participantsreceived information on their individual risk factors and make themaware of the simple methods that can reduce their risks (Ang et al.,2011).

The researchers analyzed the results using SPSS. They did theanalysis on the basis of intention-to-treat. The rate of incidence offalls was calculated at a confidence level of 95%. The results werecalculated using the Wilson method and compared them using thechi-square test. The time to the events in the first falls wasconstructed using the Kaplan-Meier method, and the ratio of hazardstood at 95% confidence level. The comparison of the hazard ratio wasdetermined using the long-rank test. The study included 912participants in the control group and 910 patients in theintervention group. In the intervention group, the fall incidence was0.29% and 1.5% in the control group (Ang et al., 2011). Theresearchers concluded that the use of targeted multiple interventionswas effective in reducing the rate cases of falls in patientsreceiving treatment in the acute care setting.

The article’s Hierarchy of Evidence

Ang et al. (2011) used a randomized control trial. According to thehierarchy of evidence in biomedical research, this form of studyranks the highest. A randomized control trial involves studying twogroups of participants selected randomly to participate in either ofthe two selected methods (Polit &amp Beck, 2013). The studyconducted by Ang et al. (2011) involved a group of participantsreceiving the usual care and another receiving usual care alongsidethe multiple intervention strategies. The findings of the researchare therefore valid and credible.

Discussion of whether the Article is Peer-reviewed

The research conducted by Ang et al. (2011) is scholarly and peerreviewed. The criteria used by scholars to identify an article asscholarly and peer reviewed are that it must be authored byprofessional in the area of interest. Also, the articles must passthrough a team of scholars to critique it and pass it for publishing(Ralph, 2016). Ang is the deputy director of oncology nursing at theNational University Cancer Institute. Mordifi, a member of the team,is the assistant director of evidence-based nursing at the NationalUniversity Hospital in Singapore while Bee is a seniorbiostatistician at the ministry of health in Singapore (Ang et al.,2011). The authors hold both academic authority and their positionsare proof that they have a wealth of experience in the nursing field.The article appears in the Journal of Advanced Nursing that publishesarticles only if they have been peer-reviewed. The Journal ofAdvanced Nursing publishes evidence-based practices in nursing, andthe articles pass through a lengthy and credible process of reviewbefore being presented to the public. despite the authors conductingthe research in 2006, The reviewers passed the article for publishingin 2011. It means that it passed through a thorough process of reviewbefore securing a place in the Journal of Advanced Nursing.

Discussion of whether the article is a Primary or a SecondarySource

In determining whether the article written by Ang et al. (2011) is aprimary or a secondary document, it would be imperative to considerthe information collected by the researchers. First, the authorsidentified a problem in the nursing practice that various scholarshave tackled in the past. The authors employed the review of theliterature by summarizing the findings of other scholars in asecondary way. According to the authors, the effectiveness of themultiple intervention methods was not clear (Ang et al., 2011). Theidentification of the primary problem and the gap that exists in theprevious research was a primary approach to the study. However, theyemploy a unique randomized control in which they assess theeffectiveness of the usual methods to prevent patients’ falling andthe application of the usual methods alongside the multipleintervention methods. The researchers went to the wards and trainednurses to collect data, and they recruit participants. The dataanalyzes reflect the actual result of the application of the twomethods and the authors make a conclusion from the results. Thearticle is, therefore, a primary source.


In conclusion, the article authored by Ang et al. (2011) is veryinformative in the nursing practice. The modern nursing practicesadvocate for the use of evidence-based methods. The practices needtesting before being commissioned and identified as the mosteffective in the nursing practice. In the study to determine theeffectiveness of the usual and multiple intervention methods topatients’ falling found out that the multiple intervention methodsare more effective that the application the usual methods. Also, therandomized nature of the study places it in the highest hierarchy ofevidence since it involves exposing the participants to two practicesto determine the effectiveness of one over the other. Also, thenumber of patients recruited for the program is big enough to makevalid conclusions. There were 912 and 910 participants in the controland intervention group respectively. The authors conclude that themultiple [intervention method is more effective that the usual methodrecommended by the ministry of health.


Ang, E., Mordiffi,S. Z., &amp Wong, H. B. (2011). Evaluating the use of a targetedmultiple intervention strategy in reducing patient falls in an acutecare hospital: a randomized controlled trial. Journal of advancednursing, 67(9), 1984-1992.

Polit, D. F., &ampBeck, C. T. (2013). Essentials of nursing research: Appraisingevidence for nursing practice. Philadelphia: Lippincott Williams&amp Wilkins.

Ralph, P. (2016).Practical suggestions for improving scholarly peer review quality andreducing cycle times. Communications of the Association forInformation Systems, 38(1), 13.