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Patient Safety of Older Adults with Cognitive Impairment: Evaluation of a Service Improvement Initiative

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posted on 15.03.2021, 21:52 by Patel, Radhika

The safety of older adults with cognitive impairment is linked to falls and to aggressive incidents, therefore patient safety is an important aspect of care for this group of older adults. Environmental changes to create a more ‘dementia-friendly’ setting can create a safer space for patient care. The Kings Fund Healing the Healthy Environmental tool was used to make small changes to a ward environment. The changes included; large face clocks, identification of bed spaces, lavender oil diffusor, and viewing gardens, to improve patient safety.

Research Objectives

-To assess the impact of environmental changes on patient reportable events (falls and aggression) in older persons’ wards, through a comparative analysis of incidents in the wards – one (Ward A) with environmental changes and the other (Ward B) with usual environment. -To obtain staff perspectives of the changes implemented in the service initiative. Method

A practice-based impact evaluation using mixed methods was undertaken to evaluate the service initiative. The methods included an analysis of data from an established database that captured reported falls and aggressive behaviour (quantitative data), and a survey of healthcare staff about the effectiveness of environmental changes (qualitative data).


The results show that the environmental changes implemented through the service initiative reduced the number of reported falls and aggressive incidents in Ward A in the high visible room. Following the environmental change, the rate of falls per 100 nights in Ward A high visible room was 2.43 compared with a rate of 3.23 times in Ward B. The number of aggressive incidents was 10 in Ward A and 9 in Ward B. The survey findings indicated staff valued the environmental changes particularly the large face clocks.


While the quantitative data results are not statistically significant the results indicate that the environmental changes implemented (large face clocks, identification of bed spaces, lavender oil diffusor, and viewing gardens) led to a lower number of reportable events for falls in Ward A. Any reduction in the numbers of falls and aggressive behaviour is clinically significant given the impact of such events on patient health and length of stay. The dementia-friendly environmental changes implemented were shown to be an effective service initiative.

Clinical and research implications

Wards that cater for older people with cognitive impairment should consider implementing low-cost environmental changes such as introducing large face clocks, clear identification of bed spaces, lavender oil diffusors, and viewing gardens. Further research using a larger patient population (a longer time frame or several wards) is required to obtain an adequately powered study.


Advisor 1

Van Wissen, Kim

Advisor 2

Nelson, Kathy

Copyright Date


Date of Award



Victoria University of Wellington - Te Herenga Waka

Rights License


Degree Discipline


Degree Grantor

Victoria University of Wellington - Te Herenga Waka

Degree Level


Degree Name

Master of Nursing Science

ANZSRC Type Of Activity code


Victoria University of Wellington Item Type

Awarded Research Masters Thesis



Victoria University of Wellington School

School of Nursing, Midwifery, and Health Practice