Effects of a fall prevention program in elderly: a pragmatic observational study in two orthopedic departments.

PURPOSE: Falls are a common adverse event experienced by elderly in hospitals. This study assessed the effects of a fall prevention program on the rate of fallers, the patient safety culture, and patient-perceived safety. MATERIALS AND METHODS: Two orthopedic departments in different towns in Norway participated in the study. A comprehensive, multifactorial fall prevention program was implemented in one of the departments, the other one was used for control. The changes in the outcomes in the two departments from before to after the intervention were compared. All patients above 64 years of age admitted to the two departments in a 1-year period before and after the intervention were included. All employees at the two departments were invited to participate in surveys measuring the patient safety culture, and a selection of the patients reported patient-perceived safety. The primary outcome was the rate of fallers. Secondary outcomes were the employees' perceived patient safety culture (measured with the Safety Attitudes Questionnaire) and patient-perceived safety (measured with Norwegian Patient Experience Questionnaire). RESULTS: Falls were registered in 114 out of 3,143 patients (3.6%) with 17,006 days in the hospital. Ten patients had two falls, giving a fall rate of 7.3 falls/1,000 days in the hospital. The number of fallers before and after the intervention in the intervention department were 37/734 (5.04%) and 31/735 (4.22%), P=0.46, and in the control department, 25/811 (3.08%) and 21/863 (2.43%), P=0.46. The difference between the changes in the two departments was not statistically significant; 0.17% (95% CI: -2.49 to 2.84; P=0.90). There were also no significant differences in the changes in patient safety culture and patient-perceived safety. CONCLUSION: The fall prevention program revealed no significant effect on the rate of fallers, the patient safety culture, or patient-perceived safety.

[Use of oxytocin augmentation after spontaneous onset of labor]. / Bruk av oksytocin som ristimulerende medikament etter spontan fødselsstart.

BACKGROUND: Use of oxytocin augmentation during labour is not systematically registered in Norway. We wanted to describe the use of oxytocin augmentation in Hammerfest Hospital from 1996 to 2000. MATERIAL AND METHODS: The patient files of all women who delivered in the study period (n = 2,725) were examined retrospectively. After exclusion because of induction of labour, planned Caesarean section, breech delivery, twin delivery and intrauterine fetal death, 2,122 women were included in the study. RESULTS: 490 of 969 nulliparas (51%) and 233 of 1,153 multiparas (20%) were augmented with oxytocin. 203 of the 239 nulliparas (85%) who had epidural anaesthesia and 287 of the 730 nulliparas (39%) without epidural anaesthesia were augmented, compared to 64 of the 96 multiparas (67%) and 169 of the 1,057 multiparas (16%). INTERPRETATION: In the present study, half of the primiparas and one fifth of the multiparas had their labour augmented with oxytocin. It is not known whether this is representative nationwide. There is a need for more research about dystocia, when intervention is appropriate and which women will benefit from oxytocin augmentation.