Aged Care Obstetric Analysis

A study was done at a 1,300 bed urban facility over a 13-week period. The purpose of the study was to describe the causes of inpatient falls in hospitals (Hitcho, et al., 2004). All falls were reported except falls in the psychiatry service and during physical therapy sessions. During the 13-week period, a total of 183 patients at an average age of 63.4 years old fell. Of the total number of falls 79% were unassisted, 85% happened in the patient room, 59% occurred during the evening or overnight shift, 19% were while walking, and 50% were elimination related (p. 732). In this study it was identified that many patients did not use their call bell before getting up because they did not believe they needed assistance. It was stated that, “perhaps patients need to be better educated on the effects that a new environment, decreased activity, medications, tests, and treatments can have on patients’ energy and ability to ambulate safely” (p. 737). The findings of this study showed that falls not only happen in the elderly, but in the younger population as well. Patients that fall in hospitals are often unaided and are due to elimination needs. To prevent falls and decrease injury rates, more studies need to be done.

Strategies for preventing falls among elderly people include ensuring that the environment is free from clutters, and it has adequate light. Encourage elderly to participate in activities and ROM to strengthen and preserve their muscles. Provide assistive devices to that resident who needs it such as cane, walker, wheel chairs etc. Review and address medications with increase fall risks. Ensure that those residents with poor vision are screened and are wearing their glasses.

Falls among any individual can cause significant trauma, often leading to an increase in mortality. According to the Centers for Disease Control and Prevention (2012), one in every three adults over the age of 65 falls each year. Long-term care facilities account for many of these falls, with an average of 1.5 falls occurring per nursing home bed annually (Vu, Weintraub, & Rubenstein, 2004). In 2001, the American Geriatric Society, British Geriatric Society, and the American Academy of Orthopaedic Surgeons Panel on Falls Prevention published specific guidelines to prevent falls in long-term

The purpose of this research paper was to examine the latest research and evidence-based practices related to inpatient falls. Falls among the elderly within a hospital setting has increased within the last decade. Inpatient falls have become the second leading cause of death, causing longer hospital stays and indirect costs for the hospital. The research reviewed multiple studies, which discussed the causes of inpatient falls. A few causes included nurses and staff not knowledgeable of current hospital practices, lack of individualized plan of care, and lack of training related to falls. The findings assisted the writer to revise the current fall policy and procedure for Arrowhead Regional Medical Center (ARMC). A fall reduction program

According to the Center for Disease Control and Prevention (CDC) (2016) press release one of the leading cause of accidental deaths of the elderly is falls. This is an issue for our seniors many long-term care (LTC) facilities across the nation. However, one of our primary goals in health care is patient safety. Although, no one can guarantee a patient will never fall, it is our job to maintain a safe environment, prevent falls and injuries. The families of our elders move them into a nursing facility expecting an accident free, uneventful stay for the remainder of their loved ones days. In some cases, frequent calls at various hours of the day to report adverse event which are often falls becomes the reality.

I am going to focus on a particular and an effective intervention for fall prevention in aged care facilities, which is medication review. According to Australian Commission on Safety and Quality in Health Care (2009, p. 72), almost all of residents in aged care facilities are prescribed one medication and more than 60% of residents are prescribed 4 or more medications, 47% taking psychoactive drugs regularly, 11% taking sedatives regularly and 21% taking antidepressants regularly. Polypharmacy is highly common in aged care facilities in this country and has been proven as one of the main factors for falls (Baranzini et al. 2009, p. 228). Certain types of medications are strongly associated with the negative outcomes, such as diuretics, antiarrhythmics,

The following research question was addressed: What is the effect of falls in the older adults while hospitalized? CINAHL Complete and Google scholar databases were used to search for relevant quantitative research articles. CINAHL Complete was searched using words like “falls in older adults while inpatient”, “impact of falls in older adults while hospitalized”, falls in older adults”, “and falls in the hospital amongst older adults“, ” fall impact in older adults while hospitalized”. Google scholar databases was searched using keywords such as “impact of falls in hospitalized older adults”, “Fall in the older adults during hospitalization”, “effects of fall on older adults while hospitalized”. Quantitative research article published in English, where any author is a nurse, and adult subjects were analyzed; dates of publications for all articles were limited to the years between 2011–2016. The University of Texas at Arlington’s library site titled finding quantitative and qualitative research was used to evaluate the qualities of the research article to ensure quantitative articles were utilized. Research articles that were utilized were those that involve interventions focused on effects of falls in the older adults population while hospitalized. Multifactorial fall prevention programs, environmental, educational

Current nursing practices are based on strict standards and requirements issued by The Center for Medicare and Medicaid Services (CMC) and The Joint Commission on Accreditation of Healthcare Organizations (JCAHO). The CMS requires facilities to provide a safe environment for care and failure to do so risks losing Medicare Medicaid funding. In fact, facilities no longer receive payments for treating injuries caused by in-hospital falls. The JCAHO National Patient Safety Goal (NPSG) requires nursing home to reduce the risk of patient harm resulting from falls and to implement a falls-reduction program. The NPSG has been upgraded to a standard that requires facilities to assess and manage the patient’s risks for falls and implement interventions to reduce falls based on this assessment. The current nursing practice for fall interventions begins with assessment. Patients are assessed and reassessed to identify and address any risks factors including underlying medical or medication conditions. Risk Assessment Tools for predicting falls score each category identified as a potential risk. For example, categories include Medication, Activity/Mobility, Elimination, Previous Falls, Length of Stay, Mental Status, and Age all can influence the

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,

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 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.

Falls in the elderly is a significant health problem, which can lead to severe issues such as morbidity and mortality. The topic of falls within the elderly was chosen so that the many interventions, risks, and awareness strategies can be further explored within this paper. Throughout clinical practice I was intrigued by the number of patients that have fallen and the strategies that health care organizations take to prevent falls. However, I was concerned by the lack of awareness in the community related to falls in the elderly. The topic of falls in the elderly is multifactor in the sense that there are many intersectional factors that can result in falls. The significant impact of falls in the elderly and the consequences that falls have

A fall is a lethal event that results from an amalgamation of both intrinsic and extrinsic factors which predispose an elderly person to the incident (Naqvi et al 2009). The frequency of hospital admission due to falls for older people in Australia, Canada, UK and Northern Ireland range from 1.6 to 3.0 per 10 000 population (WHO 2012). The prevalence of senior citizen’s falls in acute care settings varies widely and the danger of falling rises with escalating age or frailty. Falls of hospitalized older adults are one of the major patient safety issues in terms of morbidity, mortality, and decreased socialization

Method: The study question investigated was; what impact will individualized fall-prevention education, supported by training and feedback for staff reduce have on the number of falls during hospital stays? The study was a pragmatic study of patients admitted to one of 8 rehabilitation units in general hospitals that were over sixty years old, with a projected hospital stay of at least three days, and had basic cognitive functioning. 3,606 patients admitted were admitted to the eight units during the study period, with 1,983 in the control group and 1623 in the intervention group. The pragmatic nature of the study is a strength given the nature of the intervention. However, the investigators do not explain the logic of limiting the study to patients over age 60, with a length of stay of at least three days, and this restricts the extrapolation of the results to these groups.

Risk factors for falls are categorized by intrinsic or extrinsic (Tzeng, & Yin, 2009). According to Tzeng and Yin (2008), intrinsic factors, referring to the patient themselves, are related to their health status and possibly associated with age-related changes: previous falls, reduced vision, unsteady gait, musculoskeletal system deficits, mental status deficits, acute illness, and chronic illness. Extrinsic factors are involved in the patient’s environment, including medications, lack of support equipment, furniture, bathroom designs, small patient rooms, poor lighting, and improper use of and inadequate assistive devices. Tzeng & Yin (2008; 2009) focused on the extrinsic risk factors for the basis of their studies.