What Is Patient Falls Are More Impacted By Inappropriate Staffing, Or Missed Nursing Care?

A study was done at a 1,300 bed urban facility over a 13-week period. The purpose of the study was to describe the causes of inpatient falls in hospitals (Hitcho, et al., 2004). All falls were reported except falls in the psychiatry service and during physical therapy sessions. During the 13-week period, a total of 183 patients at an average age of 63.4 years old fell. Of the total number of falls 79% were unassisted, 85% happened in the patient room, 59% occurred during the evening or overnight shift, 19% were while walking, and 50% were elimination related (p. 732). In this study it was identified that many patients did not use their call bell before getting up because they did not believe they needed assistance. It was stated that, “perhaps patients need to be better educated on the effects that a new environment, decreased activity, medications, tests, and treatments can have on patients’ energy and ability to ambulate safely” (p. 737). The findings of this study showed that falls not only happen in the elderly, but in the younger population as well. Patients that fall in hospitals are often unaided and are due to elimination needs. To prevent falls and decrease injury rates, more studies need to be done.

Patient falls in hospitals continue to be a major and costly problem. The definition of a patient fall is an unplanned descent to the floor, assisted or unassisted, with or without injury to the patient. The authors of this article wanted to investigate the effect “missed nursing care” has on patient fall rates and patient outcomes. The authors also looked at hospital staffing as it relates to patient falls and nursing staff having enough time to carry out all nursing responsibilities.

Patients are medicated, in an unknown environment, attached to lines, drains, and physiologically impaired in some manner. They are at a very high risk for falling. The American Hospital Association explains how participating hospitals have reduced falls by 27% by using the bundles and toolkits from Hospital Engagement Network (AHA HEN), this process requires the interdisciplinary team involvement. Each has their own role, nursing plays a critical role in fall prevention, they are with the patient for 12hours in a hospital setting and have direct care with assessing, creating a care plan, implementation of interventions, and evaluation. They can report any concerns or data to the

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

In addition, high risk participants received education relating to falls which involved nurses instructing participants not to get out of bed without assistance, to press the call-bell for assistance and how to use the call-bell. As part of this study protocol, participants in the intervention group received usual care which include: fall risk assessment, placing the call-bell, TV remote control, eyeglasses, dentures, and hearing aids within the patient’s reach. Other interventions that have been used were bed and chair alarms, bed was in the lowest position at all time except when care was being provided and bed brakes were locked at all times. The patient’s elimination needs were scheduled every two hours, bedside commode was provided for frequent elimination needs, the patient was not left unattended while on bedside commode or in the bathroom. For a safe bathroom environment toilets was raised, toilet seats were secure, and handrails was strong enough to support patients, and patient was also instructed to pull the call light if feeling dizzy or in need of any assistance . Furthermore, the room temperature was

An hourly rounding is an excellent precaution strategy to make sure that patients’ alarms, call lights, and personal belongings are within reach. One benefit of hourly rounding is that it is pro-active. It reduces patients’ need to get up, thus reduced falls. In Kamehameha Nursing Home, hourly round is required, but because nurses are most of the time busy, they often forget to implement it. This needs to be addressed in order to reduce the number of falls in the facility (Agency for Healthcare Research and Quality, 2013). If Universal Precautions is effectively implemented, Kamehameha Nursing Facility’s fall incident will decrease.

Falls among elderly individuals have continued to be a major challenge for health care providers. Individuals hospitalized for falls incur a higher health cost compared to other hospitalized patients. Despite efforts to reduce the number of falls through the use of some strategies, fall rates continue to be high in hospitals. According to Massachusetts Department of Public Health, and a recent summary performed by the Bureau of Health Care Safety and Quality (2011), Massachusetts acute care hospitals reported 57% of serious reportable events as environmental; 98% of those serious events were attributed to patient falls (Nientimp & Peterson, 2012). There is limited research that supports the idea that hourly rounding performed by nurses has an impact on reducing patient falls (Lascom, 2015).

Statistical analysis showed that there is a high correlation between patient falls and the factors of nurse staffing that were addressed in this study. This shows that nurse staffing is significant in preventing patient falls and safety concerns in the hospital. The findings in data collected reinforce previous findings that greater staffing leads to fewer patient falls in the hospital. There were several correlations between the data collected and patient falls.

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.

The practice project I have chosen to complete for my Capstone is preventing falls on a medical-surgical unit. “Even with fall reduction programs in place, falls continue to be a significant problem for hospitalized patients. Falls are a perennial top adverse event in inpatient settings, occurring more frequently than catheter-associated urinary tract infections” (Nolan 2016, Medscape Nurse, p.1). My unit has experienced an increase in the number of falls over this past year, which has resulted in an extended hospital stays. I will conduct chart audits over the past six month to determine which population has experienced the most falls. Also, at what times did the majority of falls occur. “Patient falls are widely regarded to be nurse-sensitive

The population for the research was two postoperative orthopedic units with 29 beds each (Tucker et al., 2012). Nursing staff provided care for the patient with total joint replacement, adult reconstructive surgery, and orthopedic oncology (Tucker et al., 2012). Patient care was directed, planned, delivered, and evaluated by registered nurses only. Data collection was through nurse’s documentation. The SNRI interventions included offering toileting assistance, assessing and addressing patient comfort and position, placing call light Kleenex, water, remote, and garbage can within patient reach. Prior leaving, they would ask the patient if they needed any help, inform the patient that nursing staff will be back, and emphasized the willingness of the staff to respond rather than the patient try to ambulate unassisted (Tucker et al., 2012). To determine the effectiveness of SNRIs there were variables that were examined patient fall rates, patient fall risk, and nursing SNRIs fidelity. The research was approved by the Institutional Review Board for the protection of human subjects. Nurses were allowed to review medical record for fall-related data, participate in the SNRI implementation, and attend focus groups with the study nurses (Tucker et al., 2012).

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.

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

Intervening with education sessions for the patient on why they are at risk for falling and placing a different colored arm band to alert staff for their high risk for falls can help reduce them as well (Nazarko, 2012). Assigning a nurse aide specifically for “falls duty” can help with assisting patients to the bathroom and up to a chair. This is not as cost effective as education and an armband, but overall may reduce the risk. Delegating this role to an aide on both shifts may help decrease the incidence of falls (Ang et al.,

In the acute care setting, nurses are responsible for the care of multiple patients with varying levels of acuity and individual needs. Because of this, the nurse’s time and attention is prioritized to complete the necessary requirements with little time left for care that does not directly affect the nurse’s responsibilities to avoid legal negligence. Research shows that 45% of people who have had a direct hospital experience believe that their safety or the safety of their family member was impaired because of the decreased availability of the nurses (National Consumers League, 2004). In the same study, 35% of patients or family members felt that care was not provided in a timely manner and 45% even believed that there was no prompt response to their calls for assistance (National Consumers League, 2004). In light of these statistics, the question is raised: Do nursing staffing hours influence missed nursing care in patients who are admitted to an acute care setting in hospital stays longer than three days?