Hospital patient falls: prevention strategies and policy solutions

Patient Falls

Preventing Patient Falls

The primary goal of every hospital and care facility is the health and safety of their patients. While some problems, such as illness cannot be avoided, compounding illness with injuries can and should be avoided. Risks such as slipping, tripping, and falling while in the hospital are an increasing problem for hospitals. The purpose of this paper is to identify a preventable patient injury and suggest a corrective policy for the hospital to reduce the amount of incidence.

Identification of Problem

Patient falls are a growing problem in hospitals. In fact, according to the Centers for Disease Control and Prevention, "In 2004, 14,900 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized." (National Center for Injury Prevention and Control, 2007). These falls are not only common, but very expensive. According to the Wall Street Journal, the costs of treating the resulting injuries for a hospital-related fall is equal to $1.08 billion annually, or approximately $15,000 to $30,000 per fall. And roughly 244,500 nursing home residents suffer a serious fall injury annually, with costs estimated at $4.9 billion in 2005 (Landro, 2005). Addittionaly, this problem extends to all ages of patients. According to a 2003 study, half of all patients that fell were less than 65 years old (Hitcho, 2004). These falls are not only expensive to hospitals, but cause excessive suffering to the patient and families.

Timeline

Before anything can be done to properly solve this problem, the extent of the problem must be determined and a solution sought. The first step to improving this problem will be a study of documented patient falls for the past three years. This study will give the hospital a basis to assess improvements. The information should be charted by month for the past three years and then forecasting done to determine the predicted amount of falls for the next three years if nothing were to change.

Next, a method for determining the patient's fall risk must be used on all patients admitted to the hospital. A sample of the Morse Fall Scale is available on the U.S. Department of Veteran's Affairs website. See appendix for this chart. The chart assesses basic symptoms and characteristics of the patient's visit and determines how high of the risk that particular patient is for falling. The risk factor goes from 0 to 100 with a score of 0-24 being no risk, 25-50 being low risk, and any score greater than 51 being high risk for a fall. A form should be created from this information and added to the standard evaluation completed by the nursing staff. The patient's fall risk should then be indicated in a clear way. For instance, a specific color code on the patient's admission bracelet for those at a low or high risk for a fall. This ensures that all nurses will be immediately informed about that particular patient's condition and whether or not they pose a fall risk.

The third step is to set fall metric expectations for the nurses to uphold during their shift. The metrics should begin at 10% lower than the current fall rate and slowly reduce the amount to a pragmatic number of falls. Each nurse will be tracked during their shift and any falls will be recorded for that particular month against that nurse's metrics. Rewards and consequences should be attached to patient falls. For instance, a nurse who goes an entire three months without any falls should be entitled to a pay raise, promotion, or bonus. Whereas a nurse who has too many falls should receive additional safety training and then disciplinary action.

This method of intervention has been proven by many researchers including Janise Morse, PhD, RN, CCRN, who published an entire book on the subject suggesting these very steps as being highly beneficial in establishing a fall prevention program. According to her book, "Preventing patient falls requires a planned and coordinated effort in an institution, this means involving all staff, from the highest level of administration to housekeeping. It includes all the health professionals, but especially nursing, medicine, pharmacy, and physiotherapy." (Morse, 2009). In other words, there must be a means of ensuring that every department that comes into contact with that patient is aware of the fall risk and able to take the necessary steps to ensure that a fall does not happen. The best means is a clear fall risk indicator on the patient's bracelet.

Falls will inevitably happen in a hospital. There are simply times when a patient who has not otherwise shown any risk factors simply feels faint or a knee gives out. The key is to be alert to those patients who are obvious fall factors and make certain that these "accident waiting to happen" patients are carefully guarded and all care is taken to prevent injuries.