Preventing Falls in a Hospital Setting

A Hospital Based Practice Paradigm to Improve Patient Outcomes
Advanced practice nurses are well situated to assume leadership roles in improving patient outcomes through the development and implementation of evidence-based interventions that affect large patient populations (Curley & Vitale, 2011). All types of evidence-based interventions, however, are not necessarily appropriate or optimally effective in all circumstances, making the need for ongoing research an essential part of the process (Mateo & Foreman, 2013). Nevertheless, some interventions already have proven efficacy in a wide range of hospital settings, and it just makes good sense to draw on these in formulating new practice paradigms. The purpose of this paper is to describe a fall-prevention hospital based practice paradigm that can improve patient outcomes in virtually all inpatient settings.
Review and Discussion
With a growing percentage of the American population entering their elder years today, it is reasonable to suggest that a greater share of already scarce health care resources will need to be used for age-related illnesses and infirmities in the future. In many cases, inpatient care and aggressive treatment will be needed to help these senior citizens regain their health. One of the major risks associated with inpatient stays is falls, and this problem is especially pronounced in acute care settings where infirm elderly patients may be heavily medicated and disoriented with respect to time, person and place (Hill & Vu, 2009).
The scope of the problem, though, extends to patients of all ages and medical conditions. In fact, the Agency for Healthcare Research and Quality (2018) reports that, “Between 700,000 and 1 million patients fall in hospitals each year” (Butcher, 2017). Although most of the patients who fall in hospitals are not injured seriously in the process, the potential for harm is still significant and patients can even die from falls. An extreme case in point occurred at a Department of Veterans Affairs Medical Center in Oklahoma City. The policy in place at the time required patients to fall three times before receiving a fall warning. In one case, an elderly veteran patient who had already fallen once fell yet again, breaking open his colostomy bag which infected his surgical sites and resulted in his death within 2 days (pers. knowl.). Furthermore, beyond the human costs that are involved, the economic costs that are associated with injury-causing falls in hospitals are significant, with the Joint Commission estimating the costs at more than $14,000 per patients with an additional 6.27 inpatient days of stay (Farenz, 2014).
While additional research is currently underway to identify ways to prevent falls in hospitals (Farene, 2014), advanced practice nurses in risk management and quality assurance can help reduce the frequency of falls at present by assessing patients for fall risk prior to their actually suffering from a fall and ensuring this information is entered into their charts. In addition, small red warning flags indicating a fall risk should be placed on patients’ beds to ensure that all staff members remain vigilant during their inpatient stay. Likewise, fall frequency and severity data can be tracked from patient incident reporting records by shift and ward to identify high priority areas that require targeting for additional preventive measures.
Conclusion
Although patient falls are not completely preventable, the research showed that advanced practice nurses can help reduce the frequency of falls in hospitals by implementing assessment protocols and warning mechanisms that alert staff members to the high risk of these patients falling. The research also showed that the costs of failing to implement timely and effective fall prevention protocols are significant, and it is reasonable to conclude that these costs will increase in the future unless and until appropriate measure are taken today.
References
Butcher, L. (2017, June 1). The no-fall zone. Hospital & Health Networks. Retrieved from https://www.hhnmag.com/articles/6404-Hospitals-work-to-prevent-patient-falls.
Curley, A. L., & Vitale, P. A. (2011). Population-based nursing: Concepts and competencies for advanced practice. New York: Springer Publishing Company.
Farene, J. (2014, August). Joint Commission targets solutions for fall prevention. Health Facilities Management, 27(8), 5.
Hill, K. D. & Vu, M. (2009, August). Falls in the acute hospital setting - Impact on resource utilization. Australian Health Review, 31(3), 471-475.
Mateo, M. A., & Foreman, M. D. (2013). Research for advanced practice nurses: From evidence to practice. (2nd edition). New York: Springer Publishing Company.