Prevention of Patient Falls

Marquis, B.L., & Huston, C.J. (2012). Leadership roles and management in functions in nursing: Theory and application. (7th ed.) [Digital Edition].

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.

This work has significance because staff and patient education can help prevent falls. Specific interventions decrease falls. Nurses have a responsibility to their patients and their facility to be competent and confident in their abilities to do all that they can to prevent falls. Facilities have the responsibility to provide the tools and the training that is required to carry out fall prevention

Kalisch, Beatrice J. PhD, RN, FAAN; Tschannen, Dana PhD, RN; Lee, Kyung Hee MPH, RN (2012). Missed Nursing Care, Staffing, and Patient Falls. Journal of Nursing Care Quality: January/March 2012 - Volume 27 - Issue 1 - p 6–12 doi: 10.1097/NCQ.0b013e318225aa23.

Capan, K., & Lynch, B. (2007). Reports from the field: patient safety. a hospital fall assessment and intervention project. Journal of Clinical Outcomes Management: JCOM, 14(3), 155-160.

In the healthcare system, Core Measure sets are used to measure quality care. It consists of pneumonia, heart attack, immunizations, emergency department, sepsis, for infection prevention, and others. Evidence-based treatments are used to prevent occurrences using structures, processes, and outcomes. In nursing, they have adopted a similar method of performance measures, known as nursing-sensitive indicators. It includes falls, and this indicator is implemented in each unit of the hospital and managed by the manager and educator along with others like CAUTI and CALBSI. According to the American Hospital Association article (2015) “Falls with Injury,” Patient falls-an unplanned descent to the floor with or without injury to the patient affects between 700,000 and 1,000,000 patients each year.”

- Nurses will communicate with the patient’s physician about administering alternative medicine to prevent fall

According to the reports published by the Centers for Disease Control and Prevention Injury Centre (2007), falls are the third most common cause of unintentional injury death across all age groups and the first leading cause among people 65 years and older. A hospital can be a dangerous and erratic place for inpatients because of its unfamiliar

3) advocates autonomy and independence of the residents. According to the guideline states that medication review is an evidence-based intervention and this review should be performed regularly (ACSQHC 2009, p. 72). A meta-analysis was conducted in aged care facilities and the relationship polypharmacy and falls, and fall injuries were found out. Residents taking cardiovascular medications, including diuretics, antiarrhythmics, digoxin, have higher fall risks. But, by reviewing their medication, the risks of fall were reduced up to 66% (Baranzini et al. 2009, p. 228). A randomise controlled trial was conducted targeting residents in aged care facilities, and a comparison between medication-reviewed population and non-reviewed population performed. The effectiveness of medication review was statistically confirmed that reviewed population showed 38% lower number of falls than the non-reviewed population (Zermansky et al. 2006, p. 589). Therefore, in aged care facilities, falls are obviously a big problem and often harm the residents. Medication is a major factor for falls because the vast majority of residents are taking multiple medications. However, reviewing their medications, fall risks are significantly reduced. As a nurse, careful observation for the residents and frequent collaboration with pharmacists or doctors should be performed to ensure the residents

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

The evidence indicated that age, narcotic/sedative use, and overnight shift significantly and independently predicted the likelihood of a fall during the hospitalization (Cox et al., 2015). Moreover, cardiovascular comorbidities, neuro/musculoskeletal disease, evening shift, implementation of fall prevention strategies, and a higher RN-to-unlicensed assistive personnel (UAP) staffing ratio (RN/UAP) were significantly and independently associated with a decreased likelihood of a fall during the hospitalization. Additionally, the initiation of fall prevention strategies following a prescribed fall prevention protocol was found to decrease the likelihood of fall occurrence (Cox et al., 2015). From the evidence of the study, results can indicate that evidence-based fall prevention intervention can be effective modalities that can decrease fall occurrence for inpatients and the presence of RNs is indispensable to fall prevention setting (Cox et al., 2015).

If patient safety is the most important issue in Health Care facilities then how come hospital inpatient falls continue to be the most reported of all accidental falls (Tzeng & Yin, 2009)? Throughout the years, hospitals continue to make changes to decrease the risk of accidents and increase the quality of patient safety. With research studies and improvements made, patient falls still hold the largest portion of reported incidents in hospitals (Tzeng, & Yin, 2008). According to Tzeng & Yin (2008), “fall prevention programs apparently do not effectively reduce inpatient fall rates because of human factors and ergonomics in a hospital environment (p.179, para. 2). The two studies reviewed in this paper were performed with the hopes of

Falls is the leading cause of injuries among older adult; however, falls should not be an inevitable result of aging. Falls affect not only on an older individual’s independence and well-being but also personal and the nation financial. It is important that older adults are aware of how to prevent themselves from falling. Health care providers play a crucial role in falls prevention. Providers should perform gait and balance screening older adults 65 years and older for falls risk at least once a years and should pay more particular attention to individuals who have history of falling. Additionally, older adults have a higher tendency of taking multiple medications, providers should review their older patients’ medication regimen periodically because some medication can increase risk for falls. Exercise is found to have a positive impact on preventing falls. Providers should encourage older patients to start exercise program to increase strength and improve body balance.

Falling is inevitable at some point in life, and although most of the time falls are not serious, some can be life-threatening. Falls are a danger to both physical and psychological well-being because they may diminish a person’s ability to maintain an active and independent lifestyle.1 There are many factors that place individuals at risk for falls such as age, muscle weakness, difficulty with balance or walking, psychological diagnosis, and several medical conditions.1,2 Approximately one-third of people over the age of 65 fall at least once a year.3 Individuals that are status post stroke are at an increased risk of falls, making falls assessment and prevention a common priority for clinicians treating this population.1,2 Therefore, to direct the experimental methods and build on a basis of previous literature on this topic, the search began using OneSearch, CINAHL, PubMed, and