Nursing Home Intervention

Falls are one of the major patient safety problems that every facility encounter on a day to day basis. An aging patient population, combined with multiple diagnosis and medications are prime contributing factors for patient fall. Other contributing factors are shortage of nursing and auxiliary staff, ineffective work environment and shortage of appropriate equipment. According to the Joint Commission around 30-50 percent of the falls happening in the hospitals have resulted in injury to the patients. Since Joint Commission started keeping records of fall from 1995 to 2012, it has been reported that there were 659 fall related death or permanent disability, which were voluntarily reported as a

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.

Most hospitalized patients of 65 years and above have been established to be more vulnerable to falling within their homes or in a facility. These falls have been attributed to various causative agents that need to be assessed and managed in an attempt to completely avert falls (Wilbert, 2010). Prevention of falls should be mandatory since they cause more danger to patients, including breakage of the main bones and even death. As a result, the patient may develop a more serious condition such as decrease functional immobility in addition to that which caused hospitalization. Most of these falls have been found to be caused by therapeutic impacts and ignored diagnostic information (Naqvi, Lee & Fields, 2009). For instance, a great number of elderly people who are hospitalized are diagnosed with dementia at the time of admission; hence, such information needs to be taken into consideration during the care of such a patient. Dementia is likely to cause disorientation and confusion which may result in recurrent falls. Therefore, falls may be described as the abrupt and unintended loss of uprightness that leads to body displacement towards the ground falls (Wilbert, 2010). The purpose of this paper is to develop a falls prevention, management program that will reduce the number of falls occurring within an organization.

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 sample group involved 280 old people who were 79-90 years old and have a history of falling especially in the last 6 months. The intervention recommended was assigned one of the four controlled groups which applied different balance and strength exercise.

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.

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

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

The efficacy of these interventions must constantly remain under scrutiny by maintaining surveillance of statistical evaluations. In addition, as a profession nursing must take into account practices that are working and those that are not based on evidence based practices and continue learning from past mistakes. It is also important not to overlook or take for granted even the slightest possible interventions for fall prevention. For example, although the CDC has ambiguously concluded that exercise programs can improve physical functioning but does not appear to reduce falls in nursing home patients, there is ongoing research that may conclude differently. The changes to current nursing practice are two-fold: 1) be open to change, 2) accept the challenge to analyze the data, learn from successes and failures, and seek to do away with unsustainable ineffective practices to reduce patient

Falls are the leading cause of unintentional injuries in the elderly patients living in the long-term care setting. The aim of this project was to identify risk factors associated with increase falls among the elderly in order to prevent and monitor safety related events relating to falls. There are numerous risk factors associated with falls among the elderly, as the direct care nurse, working in the long-term care setting, we need to identify any possible factors that can contribute to falls, in order to prevent injury. Through evidence-based research and education we can help decrease the incidents of falls in our elderly community.

A fall can make wide spread consequences on the health service or can be affected seriously by the increased health care utilization. Among the fallers approximately 30% of falls result in physical injury leading to extensive hospitalization with significant hospital expenses (Tzeng & Yin 2010). Preventive care phases can support health services to regulate the spare expenditure to a greater extend. A fall in hospital consequently affects the nursing staff, which lead to impaired job satisfaction, additional work load and startling time consume. As the front line of care, nurses can prevent falls and reduce fall injury rates in acute care unit with available resources (Dykes et al. 2013). This literature review aims to assess the efficiency of planned interventions to reduce the incidence of falls in acute medical units. The discussions of the main findings of the review as well as the recommendations for further research are revealed to conclude this study.

Hospital falls are extremely common. In a study that was conducted to describe the epidemiological nature of hospital falls, they found that that about 183 of 1,300 patients fell during the period of study. Hospital falls are more common in the elderly where the average age of the patients who had fallen was found to be 63.4%. Many of the falls were unassisted (79%) and they had occurred while the patients were in their own rooms (85%). Generally, the number of falls in hospitals ranges from 2.3-7 falls per 1,000 patient-days and it was found that 30% of the falls that happen in hospitals result in injury with 4-6% leading to serious injuries ADDIN EN.CITE Hitcho20041043(Hitcho et al., 2004)1043104317Eileen B HitchoMelissa J KraussStanley BirgeWilliam Claiborne DunaganIrene FischerShirley JohnsonPatricia A NastEileen CostantinouVictoria J FraserCharacteristics and Circumstances of Falls in a Hospital Setting: A Prospective AnalysisJournal of General Internal MedicineJournal of General Internal Medicine732-7391972004( HYPERLINK l "_ENREF_2" o "Hitcho, 2004 #1043" Hitcho et al., 2004). Some of the serious injuries include subdural hematomas, fractures, excessive bleeding and in some extreme cases, death ADDIN EN.CITE Belechri20021044(Belechri, Petridou, & Trichopoulos, 2002)1044104417Belechri, M.Petridou, E.Trichopoulos, D.Bunk versus Conventional Beds: A Comparative Assessment of Fall Injury RiskJournal of Epidemiology and

“My PICOT statement was: “In elderly hospitalized patients 60 years of age and above, do specific fall prevention interventions, as compared to standard care, reduce the amount of falls in an inpatient setting, during their hospitalization?” For this paper I will be reviewing a quantitative research article based around my PICOT on fall risk within the hospital setting. Patient falls within the hospital setting are a nursing-sensitive quality indicator based around the delivery and care of inpatient services. As identified by the American Nurses Association, “fall rates are perceived to be the indicator that could be most improved through safety strategies and interventions” (ANA, 2002, p.179). In order to create safety strategies to improve fall risk it is important to identify which preventative measures work best within the hospital. This paper will be reflecting on the peer-reviewed Quantitative journal article found on the GCU database titled, Effectiveness of multifaceted and tailored strategies to implement a fall-prevention guideline into acute care nursing practice: a before-and after, mixed-method study using a participatory action research approach. Within this research article it states the severity of inpatient falls, specifically in the elderly, stating, “Falls are a common problem in hospitals, particularly in patients aged 65 and older. Around 30% of all persons aged 65 or older suffer a fall each

“Fall may be defined as an unexpected event in which the person comes to rest on the ground, floor, or lower level” (Struksness, Lindström, Lord, Slaasletten, Johansson, et al., 2011). In older populations, falls are quite common, but with a mental illness such as dementia, the problem is worsened. This cross-sectional study showed that the most common causes of falls reported by nursing staff were individual factors like physical impairment and mental impairment.