Improving Patient Safety through Fall Prevention in Hospitals

By Lauretta Ihonor



Recent data indicates that close to 25,000 fatal falls and 3.2 million medically-treated injuries from non-fatal falls occurred in hospitals across the U.S. in 2012. These figures make one thing clear: falls are highly prevalent in hospitals. This is a serious concern because according to the Center for Disease Control and Prevention, falls are the leading cause of injury-related death in adults over the age of 65.

But the problem doesn’t end there.


Inpatient falls are also expensive. They can prolong hospital stays—increasing inpatient care costs and creating an additional expense if patients have to be discharged to rehabilitation centers instead of their own homes. Additionally, there is an unquantifiable amount of money paid towards legal settlements each year. And, because the U.S. population is aging, the CDC predicts that both the number of falls and the cost of treating resulting injuries are likely to rise with each passing year.


So, what can be done to remedy the problem? To answer that, the causes of inpatient falls must first be identified.


The Key Causes of Patient Falls in Hospitals


A 2016 report on preventing patient falls in hospitals, produced by the American Hospital Association's Health Research and Educational Trust, revealed six key contributors to patient falls. These were:


  1. Fall risk assessment issues: Existing risk assessment tools don’t always accurately predict patient fall risk, and there is a lack of standardization in risk ratings given by different caregivers.

  2. Handoff communication issues: Communication of patient risk for falls is often incomplete or inconsistent between caregivers.

  3. Toileting issues: Some medications increase the risk of falls while using the toilet, and patients do not always seek help for toilet-related falls.

  4. Call light issues: Nurse response to call lights is not always consistent or timely, which in turn can deter patients from using them to attract the urgent attention they need.

  5. Educational and organizational culture issues: Standardization of practice and application of interventions are lacking in some hospitals. For example, fall prevention education for patient and family is inconsistently used or not used at all. Further, patient awareness and acknowledgment of the risk for falls is frequently lacking.

  6. Medication issues: Patients are often on medications that increase the risk of falls, such as diuretics, laxatives, narcotics, antipsychotics or anti-hypertensives.


The Secrets to Fall Prevention in Hospitals


With the key causes of falls clearly identified, it stands to reason that addressing these causes is likely to significantly reduce the risk of patient falls in hospitals. Indeed, that’s what the AHA report found when five hospitals that took part in the project tackled these six fall causes. On average, overall fall rates dropped by 35 percent and falls with injuries decreased by 62 percent.


So what strategies can prove effective?


Many. Here are just a few:


  • Adopting the practice of purposeful nurse rounding, in which nurses conduct routine checks on patients every hour or every other hour, can ensure that patient needs are proactively met. Robust research has shown that the adoption of this strategy alone effectively decreases patient fall rates and call light use.

  • Inconsistencies in assessing a patient’s risk of falling can be remedied by developing a single document that is reviewed by patients, staff and family members before a patient’s fall risk is determined.

  • Because risk assessment is futile unless risk minimization strategies are promptly implemented, it’s vital to follow all risk assessments with the creation of a care plan that outlines relevant interventions for addressing the risk factors identified for the patient.

  • Regarding toilet-related falls, the AHA report identified that older men did not readily use the call light if they fell while toileting because they didn’t want to be helped by a young female nurse. One participating hospital tackled this problem by making male nurses more readily available for assisting male patients in toilets.

Such strategies for creating a fall-aware culture are low in cost, requiring only staff education and consistent practice, rather than a significant cash injection.


Prioritizing Patient Safety


It’s often believed that falls are an inescapable side effect of getting older and receiving mobility-impairing treatment; however, this does not have to be the case. The examples highlighted here show that identifying the key causes of falls in hospitals and setting up simple strategies to correct any shortcomings or oversights can effectively reduce fall risks among patients. With falls negatively impacting patient health, experience and safety, as well as staff morale and both patient and hospital costs, a review of falls protocols and risk factors is a worthwhile exercise for any hospital.



Lauretta Ihonor is a medical doctor and a freelance health journalist/writer. She is based in London, UK and specializes in writing about medical technology and general medicine. She has worked for CNN International, BBC and Sky News.



References

Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults - United States. J Safety Res 2016; 58: 99–103.

Centers for Disease Control and Prevention. Costs of falls among older adults. 2013 http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallcost.html (Accessed 15 Sept 2018)

American Hospital Association's (AHA) Health Research & Educational Trust. Preventing Patient Falls: A Systematic Approach from the Joint Commission Center for Transforming Healthcare Project. 2016 Oct. http://www.hpoe.org/Reports-HPOE/2016/preventing-patient-falls.pdf (Accessed 15 Sept 2018)

Mitchell MD, Lavenberg JG, Trotta R. Hourly Rounding to Improve Nursing Responsiveness: A Systematic Review. J Nurs Adm. 2014 Sep; 44(9): 462–472.

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