Patient Falls: A Case Study

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

As a nurse we want to ensure that our patients receive a high quality of care. Patients should feel safe and satisfied while hospitalized. Many hospitals are continually looking for answers and implementation to significantly reduce the inpatient fall incidents. According to Bechdel et al (2014), the top priority of health care organizations nationwide is to reduce and eliminate falls within the clinical care settings. One of the serious problems in acute care hospital is the patient’s fall. The unfamiliar environment, acute and co-morbid illnesses, prolonged bedrest, polypharmacy, and the placement of tubes and catheters are common challenges that place patients at risk of falling. Most of the falls that I have encountered while working involves

Problem: Patient falls have long been a common and serious problem in hospitals across the nation, causing

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.

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,

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

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.

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, and difficulty with activities of daily living all of which are factors linked to falling. Contributing causes of nursing home falls include walking or gait issues, environmental hazards such as wet

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.

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

This outcome reduces potential injury of fall in a primary care setting and a hospitalization, prevents additional financial strain on patients and their families by protecting the patients’ healing process and reducing unwarranted hospitalization and the length of staying in the hospital. The outcome can also benefit staff and the health care facility by preventing unnecessary staff burnout and injury, and reducing cost spending in providing unwarranted care that reduces profit and increase

Intervening falls can reduce the financial burdens attributed to patient falls in hospitals and other healthcare settings are among the most serious risk management issues facing the healthcare industry.

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.

he incidence of falls has a large impact in healthcare today, including legal, ethical, economical and safety implications, for patients, healthcare organizations and the community. Adhering to standards of care, and preventing falls assist the nurse, organization and patient in avoiding legal implications from falls. Protecting the patient's’ well-being, providing autonomy, and freedom are ethical obligations the nurse must consider when taking care of patients. Financial implications for falls can be devastating to the patient, as well as the organization and community. The safety of the patient is our number one goal in healthcare, and reducing fall incidence will not only improve patient safety, but it will improve healthcare as a whole.