Reducing Falls on the Surgical Step Down Unit
Introduction
The problem of falls in acute care hospitals is one that continues to persist in spite of the existing literature available on this topic (Zhao et al., 2018). Hester, Tsai, Rettiganti and Mitchell (2016) note that inpatient falls account for the largest number of reported incidents in hospitals. One reason for the problem is that hospitals fail to implement proper and effective preventive strategies based on best practices (Melin, 2018). The purpose of this paper is to provide guidance on reducing the number of falls on the surgical step down unit by implementing evidence based fall precautions, effective communication, and education of the patient/family. The research question guiding this research paper is: What are the preventive strategies that can be put in place to reduce falls in a surgical step down unit? To answer that question, a literature review was conducted and a discussion of the evidence is herein included to describe what those best practices are.
The goal of this paper is to reduce the number of falls on the surgical step down unit by implementing evidence based fall precautions, effective communication, and education between the patient/family.
Literature Review
Patient falls are a problem that can be overcome through the implementation of preventive strategies (Khalifa, 2019). By using preventive strategies as a policy approach to reducing falls, a hospital setting can give nurses the support and guidance they need to address this patient health issue. Khalifa (2019) showed as much by identifying the top five strategies that help to prevent falls. These strategies include patient and staff education about what leads to falls and how to prevent them; engaging in exercise with patients so that they are more flexible and able to maintain balance; diagnosing and treating medical conditions more effectively; enhancing the environment by removing obstacles that could lead to falls; using information technology to assist staff in providing care for patients so that they do not attempt to take steps without assistance and so that staff can better monitor patients. Of these strategies, exercise with patients is one that has been highlighted by several other researchers as well, including Lim, Cho, Kim, Kim and Yoon (2017) and Fu, Gao, Tung, Tsang and Kwan (2015). The studies by Lim et al. (2017) and Fu et al. (2015) support the findings by Khalifa (2019) calling for exercise as a preventive strategy. What makes the studies by Lim et al. (2017) and Fu et al. (2015) so helpful is that they focus on virtual training exercises and exergaming as a way of helping patients become more mobile, agile and stronger. Khalifa (2019) identifies the strategy of exercise as a necessary component of a prevention strategy, but it is the other two studies that provide excellent details on what type of exercise program can be pursued to help with patients.
However, in a surgical step down unit, it is unlikely that such an intervention as exergaming or virtual training will have much applicability. The key to reducing falls is to tailor prevention strategies to the specific needs of the setting (Wilson et al., 2016) One way to do that is to recognize the patients who are at a high risk for falls and to make sure that they are being cared for properly. They will need to be educated on what to do if they require assistance and the nurses will have to be very careful about accommodating their needs, according to Wilson et al. (2016). The study by Wilson et al. (2016) is helpful because it provides nurse perceptions and gives a qualitative understanding of what nurses think the problem is. Since they are on the front line in terms of caring for patients, their perspective is an essential one to consider, and that is why the study by Wilson et al. (2016) is useful in getting a grasp on this issue. Though Fu et al. (2015) and Lim et al. (2017) focus on good falls prevention strategies in situations where there is time to train people who are at risk, Wilson et al. (2016) actually look at what can be done in a hospital setting, based on what nurses’ experiences are for this type of problem. Thus, for a hospital, there are specific steps nurses can take to address the matter. The study by Wilson et al. (2016) helps...
References
Fu, A.S., Gao, K.L., Tung, A.K., Tsang, W.W. & Kwan, M.M. (2015). Effectiveness of exergaming training in reducing risk and incidence of falls in frail older adults with a history of falls. Archives of physical medicine and rehabilitation, 96(12), 2096-2102.
Growdon, M. E., Shorr, R. I., & Inouye, S. K. (2017). The tension between promoting mobility and preventing falls in the hospital. JAMA Internal Medicine, 177(6), 759-760.
Hester, A. L., Tsai, P. F., Rettiganti, M., & Mitchell, A. (2016). Predicting injurious falls in the hospital setting: Implications for practice. American Journal of Nursing, 116, 24-31.
Khalifa, M. (2019, July). Improving Patient Safety by Reducing Falls in Hospitals Among the Elderly: A Review of Successful Strategies. In ICIMTH (pp. 340-343).
King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of fall prevention on nurses and care of fall risk patients. The Gerontologist, 58(2), 331-340.
Lim, J., Cho, J.J., Kim, J., Kim, Y. & Yoon, B. (2017). Design of virtual reality training program for prevention of falling in the elderly: A pilot study on complex versus balance exercises. European Journal of Integrative Medicine, 15, 64-67.
Melin, C. M. (2018). Reducing falls in the inpatient hospital setting. International journal of evidence-based healthcare, 16(1), 25-31.
Titler, M. G., Conlon, P. C., Reynolds, M. A., Ripley, R., Tsodikov, A., Wilson, D. S., & Montie, M. (2016). The effect of translating research into practice intervention to promote use of evidence-based fall prevention interventions in hospitalized adults: A prospective pre-post implementation study in the U.S. Applied Nursing Research, 31, 52- 59. doi:10.1016/j.apnr.2015.12.004
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