Hip Protectors Case Study

Patient falls in hospitals are a critical problem and are used as a standard metric of nursing care quality. According to the Joint Commission, thousands of patients fall in hospitals each year. Approximately 30-50% of falls result in injuries and prolonged hospital stays. Any patient in a hospital is at risk for falling and certain measures should be in place to prevent this. Preventing falls and injuries are not only important for the patient, but also for their families, the hospital, health care team, and insurance companies. It is estimated the average cost of a hospital admission due to a fall is $20,000 and by 2030, an estimated $54 billion will be spent on health care costs due to falls. The purpose of this paper is to explore the risk factors of falls in hospitals and interventions used to combat this problem.

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

Nurses help to ensure patient safety, which includes preventing falls and fall-related injuries (Quigley, Neily, Watson, Wright, & Strobel, 2017). The general population is at risk for falls and fall-related injuries, more specifically the elderly, 65 and over (Quigley, Neily, Watson, Wright, & Strobel, 2017). Patient falls are one of the top events for hospitals and long-term care facilities due to loss of physical function or cognition (Quigley, Neily, Watson, Wright, & Strobel, 2017). Fall-related injuries are a serious health issue for the elderly population (Quigley, Neily, Watson, Wright, & Strobel, 2017). Nurses make a major contribution to patient safety by assessing fall risk and designing patient-specific fall prevention

Falls are a common and complex geriatric syndrome that cause considerable mortality, morbidity, reduced functioning, and premature nursing home admissions. Falls have multiple precipitating causes and predisposing risk factors, which make their diagnosis, treatment, and prevention a difficult clinical challenge. Identifying effective interventions to prevent falls and fall-related injuries among older adults is a major area of research and policy development in geriatrics. Several published clinical guidelines review the evidence for fall prevention strategies and provide recommendations for assessment and intervention (Rubenstein & Josephson, 2006).

Each year, one out of three elderly people fall (U.S. Centers for Disease Control and Prevention [CDC], 2015). The CDC (2015) also reports that once an individual has fallen, the chance that they will fall again doubles. Falls also contribute to an increase in direct medical costs. The CDC (2015) states, “Direct medical costs for fall injuries are thirty-four billion dollars annually. Hospital costs account for two-thirds of the total.” The amount of elderly people who fall each year along with the economic costs that result from falls indicates that preventing patient falls remains an important goal for healthcare workers including nurses. Nurses can use the nursing process—assessment, diagnosis, planning, intervention, and evaluation—to prevent patient falls and meet the fall prevention standards set by various regulating bodies.

In DC, community based fall prevention programs have been rising to address falls but fall related incident, injuries and the cost has continuously been rising among elderly people (Costello & Edelstein, 2008). In the study conducted by Berland et al. (2012), showed that in home health, not viewing patient safety as primary prevention, lack of investigation causing fall and frailty of elderly adult have been some factors contributing to falls in home health. Falls negatively impacts an individual living in their home by causing them physical, emotional problem, giving rise to additional cost by losing workdays and income.

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.

Broken bones, hip fractures, head injuries, and even death are a serious concern among the elderly in the long-term care setting resulting from falls. Fall prevention in a long-term care facility with dementia residents presents an ongoing challenge to the entire interdisciplinary care team due to their cognitive impairment. Even with significant protocols in place, falls are still to common. There must be other interventions such as distraction techniques that can help reduce the incidence of falls among this population.

Falls are considered a leading cause of mortality and injury among older adults and majority of the falls occurs while hospitalized. One would think being in the hospital would be one of the safest places for older adults as far as fall prevention is concern due to the fact that hospitals provide staffing around the clock for patients but more and more falls have been occurring in the hospital especially in the older adult population. Fall is an unintended descent to the ground. It raises public and family care liability; it also decreases patient’s functioning because it causes pain and suffering, and increases medical costs (Saverino et al, 2015). The Center for Disease Control

The Centers for Medicare and Medicaid Services (CMS) has identified eight adverse conditions, and inpatient injurious falls continues to be the most common adverse condition (as cited in Tzeng, Hu & Yin, 2016). The inpatient falls in the “US hospitals range from 3.3 to 11.5 falls per 1,000 patient days” (as cited in Bouldin et al, 2013, p.13). Roughly 25% of patients are injured when they fall (Bouldin et al, 2013). Since 2005, the USA’s National Patient Safety Goal listed fall prevention as a goal (Bennett, Ockerby, Stinson, Willcocks, & Chalmers, 2014). Since 2008, hospitals no longer receive payments from CMS for health care cost connected to inpatient falls (Bouldin et al, 2013). CMS views inpatient injurious falls as injuries that should never occur (Bouldin et al., 2013). There is no doubt that quality improvement must continue to address inpatient injurious falls. Preventing falls and implementing interventions to lower the rates of falls is a major concern for hospitals and must be included in any quality improvement measure.

Purpose: The purpose of this study is to determine if registered nurses are utilizing evidence-based practice fall-preventative strategies, such as modification of patient-specific risk factors and implementation of a proper physical training program, to reduce and prevent falls and injuries in the elderly population.

Patient falls have been a long debated healthcare issue throughout time and measured as a nursing sensitive issue. The National Quality Forum (NQF) has endorsed patient falls with an injury with the steward of the American Nurses Association (NFQ: Quality Positioning Systems, 2014). All patient falls are documented per 1,000 patient days via the measurement description (NQF: Quality Positioning Systems, 2014). The target population that accounts for the total number of patient falls is in the medical-surgical, step-down, critical care, critical access, surgical, medical and adult rehabilitation units (NQF: Quality Positioning Systems, 2014). The Center for Control and Disease (CDC) has reported that every seventeen seconds, an elderly patient will have a fall in a hospital (Hill & Fauerbach, 2014). The majority of falls are associated with patients ambulating from a bed, chair, or toilet without the proper assistance (Shorr, Chandler, Mion, Waters Liu Daniels, et al., 2012). There is a new regulation published by the Center for Medicaid Services. It states that injuries acquired through a fall in an organization will be held responsible for those medical costs (Hill & Fauerbach, 2014). In fact, in 2010, there was approximately $30B in hospital costs related to patient falls (Hill & Fauerbach, 2014). With the increasing number of patient falls in acute care settings and the change of healthcare coverage, does the use of bed alarms reduce the risk of falls of

Problem statement: According to Quality Improvement Organization Health Services Advisory Group, Alabama’s state average for falls without injury is 41.9% with the National average being slightly higher at 45%, falls with injury in Alabama is 3.2% with the National average being 3.4%. Research done by the Alzheimer’s Association (2016) has revealed that “People with dementia are at risk of falls because of their neurological impairments.” Another study completed by Esstmann discusses “The etiology of orthostatic hypotension should be investigated for older adults with known orthostatic

The World Health Organization (2012) define falls as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level” (WHO, 2012). They can happen to anyone but are more likely to happen to those over 65 years (Rubenstein L. 2016). Individuals who have already fallen are more likely to fall and sustain an injury than those who haven’t (Rubenstein L. 2016). Because falls are not a result of just one cause, they stem from a myriad of reasons further inhibiting the prevention of them (Rubenstein L. 2016). The more we understand about falls and its complexities (Rubenstein L. 2016); the emotional, physical, and financial consequences, as well as the many ways we can prevent them; the more we are able to enjoy a high quality of life in our later years.

prevention of the falls could save older adults from related injuries and deaths. Researchers have