Acute Care Patient Falls: A Case Study

During hospitalizations, falls are amongst the highest preventable consistent adverse events. Preventing such undesirable events, enhances patient overall experience, as well as increased trust in the health care professional team (Fragata, 2011). The importance of fall prevention lies with the many serious unfavorable health outcomes it can pose on the patient. Falls have the potential increase length of hospital stay, limit mobility, independence, but can ultimately lead to health deterioration, including death. Worldwide, falls are the second leading cause of accidental death. In addition to the life-threatening health and safety risks falls have to the patient, it also as a financial impact,

Improving the quality of care and patient safety is one of the top priorities of many hospitals and organizations. Likewise, best practice recommendation is a way of advancing measurement and improvement around falls prevention in the hospital. Frailty, Confusion, Dementia, and Co-morbid illnesses of older adults make them susceptible to falls. Evidence practice for falls allows nurses to be more sensitive and play a key role in this component of patient care in order to prevent falls in elderly patients. The first best practice that I found is the hourly rounding. According to Hicks (2015), hourly rounding is a good way of meeting the patient’s needs and improve the patient’s safety and prevent falls in the hospital. Hourly rounding consists of checking the patient’s environment for safety and addressing the four P’s (Pain, position, potty, possession). When hourly rounding is done by staff, they are also informing the patient the time the staff will be back and this tends to alleviate the patient’s anxiety. The second best practice is the safety huddle. Goldenhar et al (2012) states that safety huddles improve patient safety thru staff collaboration, effective communication, and team work. It is completed before the beginning of the shift and post-fall incident to address safety issues and staff concerns. Safety huddle is good way of ensuring that staffs are well aware of the patients, review past events, coordinate patient care, and share plans. The third best practice is bedside reporting. According to Maxson et al (2012), nurse to nurse bedside reporting allows continuity of care and it encourages patients to be more involved in their care. Bedside reporting improves patients’ safety by intercepting errors and prioritizes care when verbal and visual report is given by the previous

Anyone can be at risk for a fall due to their environment, though some are at a greater risk than others. Someone with confusion or cognitive impairment for example, is at greater risk for experiencing a fall both within the community and the home setting. Patients with dementia are three times more likely to fall than

According to the reports published by the Centers for Disease Control and Prevention Injury Centre (2007), falls are the third most common cause of unintentional injury death across all age groups and the first leading cause among people 65 years and older. A hospital can be a dangerous and erratic place for inpatients because of its unfamiliar

An assisted fall is when a staff member witnesses a patient's fall and attempts to minimize the impact of descend. Many patient falls occurring during hospital encounters may cause little or no harm but some can result in serious and even possibly life-threatening consequences for many patients such as hip fractures and head trauma. Even when a fall does not lead to death, it can require prolonged hospitalization. Some could suffer disability, loss of function, and lose their independence or premature death. “Patient falls in hospitals are a common and often preventable adverse event. Nurses routinely conduct fall risk assessment on all patients, but communication of fall risk status and tailored interventions to prevent falls is variable at best.” (Hurley,

Elimination of patient falls is not an easy task otherwise they would have been eliminated by now. Patient falls unfortunately continue to be a challenge and occur within the hospital and nursing home settings at alarming and sometimes deadly rates. The Center for Disease Control estimates that 1,800 older adults living in nursing homes die each year from fall-related injuries. Survivors frequently sustain injuries resulting in permanent disability and reduced quality of life. Annually, a typical nursing home with 100 beds reports 100 to 200 falls and many falls go unreported (CDC, 2015). Falls occur more often in nursing homes because patients are generally weaker, have more chronic illnesses, have difficulty ambulating, memory issues,

Since healthcare organizations throughout the country strive for positive patient outcomes and patient satisfaction, preventing falls among patients in healthcare settings remains a nursing staff priority. Unfortunately, fall prevention is not a new problem. Nurses face the challenge of recognizing patients who may be at high risk for falls and intervening to prevent falls on a daily basis. To identify areas for improvement in fall prevention, a thorough review of the organizational function of the medical unit at Rex Healthcare in Raleigh, North Carolina, utilizing Roussel’s Evaluating Organizational Function Tool was completed (2013, fig 7-51). Interestingly, even with great effort from nursing staff to prevent falls, they appear to continue to occur on the medical unit. Therefore, the purpose of this paper is to review current literature to identify whether or not an association has been found between the rate of falls and hourly rounding.

Patient falls is one of the commonest events within the healthcare facilities that affect the safety of the patients. Preventing falls among patients requires various methods. Recognition, evaluation, and preventing of patient falls are great challenges for healthcare workers in providing a safe environment in any healthcare setting. Hospitals have come together to understand the contributing factors of falls, and to decrease their occurrence and resulting injuries or death. Risk of falls among patients is considered as a safety indicator in healthcare institutions due to this. Falls and related injuries have consistently been associated with the quality of nursing care and are included as a nursing-quality indicator

Elderly people are highly susceptible to falling, as more than one in four people over the age of 65 fall at least once a year, and many will fall more than just once (NSW Health, 2011). More than half of the elderly living in aged care facilities fall at least once a year. In 2009, 26% of NSW residents who were aged 65 or over, fell at least once (NSW Health, 2011). Approximately 27,000 hospital admissions and at least 400 deaths of over 65 year olds were due to falls (NSW Health, 2011). More of these hospitalisations were for aged care residents than other elderly people. As well as this, hospitals generally have over 1400 falls cases per year, and aged care facilities experience reports of falls from 60% of residents (Victorian Quality Council Secretariat, 2014). In hospital and aged care settings, there are a variety of falls risks, and causative factors that may lead to falls. For example, there are environmental (extrinsic) and personal (intrinsic) factors (Victorian

Falls are the second most common adverse event within health care institutions following medication errors, and an estimated 30% of hospital-based falls result in serious injury. The severity of this problem led the Joint Commission to make reducing the risk of patient injuries from falls a national patient safety goal for hospitals in 2009 (AHRQ, 2006). Falls are a leading cause of hospital-acquired injury and frequently prolong and complicate hospital stays and result in poor quality of life, increased costs, and unanticipated admissions to long-term care facilities.

Falls in an acute care setting lead the list of injury related deaths and deaths in the elderly. “A fall is defined as any event which patients are found on the floor (observed or unobserved) or an unplanned lowering of the patient to the floor by staff or visitors” (Kalisch, Tschannen, and Lee, 2012, p. 6). Medicare and Medicaid changes in 2008 list falls as one of the 10 hospital acquired conditions for which hospitals will no longer be reimbursed because falls are considered preventable conditions. Joint Commission accredited hospitals are required to assess for falls risk and implement falls prevention measures.

The evidence indicated that age, narcotic/sedative use, and overnight shift significantly and independently predicted the likelihood of a fall during the hospitalization (Cox et al., 2015). Moreover, cardiovascular comorbidities, neuro/musculoskeletal disease, evening shift, implementation of fall prevention strategies, and a higher RN-to-unlicensed assistive personnel (UAP) staffing ratio (RN/UAP) were significantly and independently associated with a decreased likelihood of a fall during the hospitalization. Additionally, the initiation of fall prevention strategies following a prescribed fall prevention protocol was found to decrease the likelihood of fall occurrence (Cox et al., 2015). From the evidence of the study, results can indicate that evidence-based fall prevention intervention can be effective modalities that can decrease fall occurrence for inpatients and the presence of RNs is indispensable to fall prevention setting (Cox et al., 2015).

On my committee pertaining to patient falls, I would have two night shift and day shift nurse aides, two day shift nurses who have high seniority, and two night shift nurses with low seniority. Nurse aides are extremely involved in this project because they get the patients up often, sometimes more than the nurses. I chose night shift and day shift because I want to be sure the information does not get communicated wrong shift to shift. I chose older nurses and younger nurses to include different generations of nurses.

Studies have shown that in acute care hospitals that fall rates range from 1.3 to 8.9 falls/1000 patient days and that rates are higher in areas that focus on neurology, rehabilitation and eldercare. (QualityMeasures, 2017). Unintentional falls can cause serious injury to the patient which can increase then their length of stay as well as increasing their cost of care. Notably, the most common cause of traumatic brain injuries are falls. (CDC, 2017). In addition, falls can cause bones to fracture and break which could require surgery. Thus, if surgery is required that may require additional rehabilitation after the hospital or a stay a skilled nursing facility or some are left permanently disabled. Consequently, falls can increase

Now, I am aware about the significance of safety measures to avoid falls and have been applying the measures to promote safety to the patients. “Injury preventation is a major concern for older adult. For some, vision is limited, reflexes are slowed, or bone are brittle “(Kozier et al, 2014). It clearly depicts the facts that falls is a major problem in elderly and health care professional need to apply each and every possible safety measures in the health care facility to minimise the incident of fall. It is clear that the bed rails will provide support and act as a barrier that prevents older adults from falling out of bed. In long term care disorder of gait and balance is the main problem of fall for older people. Because of that older