Patient Safety : An Important Aspect Of Hospital Care

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,

The Center for Disease Control (CDC) reported that more than one third of adults 65 and older fall each year. Half of the elderly people, who fall, do so repeatedly. Aside from the health problems related to falls, nearly $20 billion of direct medical costs are associated with fatal and non-fatal falls (Larson & Bergmann, 2008).

Many of these inpatient falls can be prevented when following the proper fall prevention measures. Not only does patient safety make preventing falls a priority but the financial impact these falls have on an institution make it a priority as well.

As the United States population is advancing in age, the amount of patient falls and medical costs are estimated to increase. Approximately 700,000 patients fall per year in the hospital, which one-third of those falls could have been prevented (AHRQ, 2012). Prolonged hospital stays related to fall injuries is very costly. In 2013, a total of $34 billion dollars was paid due to falls by patients and insurance companies (CDC, 2015). Examples of injuries that can occur as a result of falls are fractures, lacerations, or internal bleeding (AHRQ, 2012). Studies also show

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.

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,

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

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.

According to the Joint Commission Resources-JCR (2005), there is no universally accepted definition of a fall. Thus several definitions have been floated over time in an attempt to define the same. One such definition of a fall is "an untoward event that results in the patient or resident coming to rest unintentionally on the ground or another lower surface" (Joint Commission Resources, 2005). Falls are regarded common causes of injury at every age. However, it is important to note that for seniors, falls can have serious consequences. This is more so the case given that a fall can bring about pain, trauma, or even death. With that in mind, the primary purpose of this program remains the reduction of falls and hence the aversion of related injuries amongst the concerned patients. Of key importance remains the identification of patients who appear to be at high risk of falling. This way, appropriate strategies can be developed to reduce the injuries related to inpatient falls.

As of 2008, the Center for Medicare and Medicaid Services (CMS) identified falls as a Hospital Acquired Condition (HAC). HAC is a complication or comorbidity that occurs as a consequence of hospitalization and is high volume and/or high cost, and be reasonably prevented using evidence-based guidelines (Radey & LaBresh, 2012). The Center for Medicare and Medicaid Services will no longer cover the cost of care as a consequence of an inpatient fall based on the presumption that falls are preventable by the organization (CMS,

The Joint Commission Center for Transforming Healthcare has identified 11 targeted initiatives. One of the initiatives focuses on patient falls. In fact, it is reported that “30 to 35 percent of patients who fall will sustain an injury” (Sentinel Event, 2015). Therefore, it is imperative for healthcare organizations to

As previously stated, falls account significantly for injuries witnessed in hospitalized patients. Falls are attributable to risks which can either be intrinsic or extrinsic. Intrinsic factors predisposing patient to falls relates to their physical state or their overall level of wellbeing (Miake-Lye et al., 2013). For instance, issues such as their age, gender, balance, ailments such as arthritis affecting their level of incapability, etc. Extrinsic factors relate to the patient's environment such as the lighting levels, the slipperiness of hospital floors and other contributory factors (Miake-Lye et al., 2013). The bottom line, however, is that most of these risk factors can be assessed, and appropriate measures taken to prevent most of these

The difference between getting back up and brushing yourself off and a trip to the hospital is all in how you break your fall. Falling the wrong way can cause life altering injuries such as hip fractures and traumatic brain injuries. Seniors can reduce their risk of falling as well as its consequences in a number of ways which are discussed below: