Fall Risk Management Strategies in Healthcare Facilities

Introduction and Overview of the Problem

It has become necessary to address the issue of patient falls at the healthcare facility by which the author is employed (Facility A). Recently, there has been a pattern of accidents all relating to patients falling. The facility is concerned not only about injuries to patients, but also about associated liability issues. For this reason, the facility has taken steps to assess the risks pertaining to falling and to address those issues.

The following discussion covers those steps and the ways in which the facility intends to remedy the situation. Additionally, a review of existing literature will be conducted to identify methods used by other healthcare facilities to address the common risk of patient falls. Finally, the steps being taken by Facility A will be compared with the evidence-based methods of risk management discussed in the literature review.

Internal Review Process at Facility A

Initially, the administration at Facility A formed a team to review all reports regarding every falling incident over the previous two years. The objective of this review was to determine whether there were commonalities associated with the falling incidents. The team reviewed each file and determined that commonalities did exist; however, the review also revealed that additional fact-finding methods were necessary. This was due to the lack of information in the reports and the disorganized manner in which they had been completed. The contents of the reports varied significantly depending on who completed the write-up after each accident.

As a result, it was determined that every employee who had initially filed a report on a particular incident would be re-interviewed to gather any additional information available. The objective of the fact-finding team was to chart each accident, track the location in which it occurred, and examine the circumstances and environment surrounding the fall.

Patient Risk Identification and Environmental Assessment

By identifying commonalities, the team was able to compile a list that would allow the facility to identify the types of patients at higher risk of falling and take appropriate measures to reduce or eliminate that risk. The review also enabled Facility A to identify high-risk physical environments. After reviewing the files and interviewing witnesses and those who took the initial reports, the team structured a chart indicating the physical environment in which each accident occurred, the injuries sustained, and the physical condition of each patient prior to the fall. The factors were then separated by physical environment, the patient's original physical condition, and the patient's condition after the fall. This information provided insight into the most dangerous areas of the facility, identified which patients were at high risk, and — based on degree of injury — offered a priority list of areas to address first.

Environmental issues were considered among the most straightforward to address. For example, if a disproportionate number of falls occurred in a specific corridor, that corridor would be assessed to determine the contributing factor. If the factor was easily identifiable — such as an unmarked step — the problem would be corrected accordingly. The functions performed in each area were also examined to determine whether the area's purpose made it a higher-risk environment. Bathrooms, for instance, were assessed and found to be high-risk not because of their physical layout alone, but because of the activities performed within them, such as bathing and using the toilet. Since installing a grab bar in the shower was not sufficient on its own (one was already present), the safety focus shifted to the level of assistance provided to patients in the bathroom.

Facility A also developed an admission risk screening tool for each incoming patient. The checklist addressed various factors found to be common characteristics among previous fall victims, including the patient's age, current medications, level of lucidity, ambulatory ability, and history of falls. By identifying high-risk patients, Facility A could assign additional assistants as warranted and devise safer methods for moving patients. Each patient's medical file was clearly marked with their fall risk level so that all staff members who might interact with the patient could take appropriate precautions.

Literature Review on Fall Risk Management

Along with these physical measures, it became apparent during the review that accident reporting was itself an issue. The team had initially planned to limit its investigation to written reports, but after encountering incomplete records, it became necessary to interview witnesses directly. In the interest of better record-keeping and improved safety initiatives, the team developed a standardized accident reporting form for falling incidents. This form must now be completed by any employee or witness to an accident. Better records are expected to make areas of concern apparent more quickly, enabling more timely responses.

A review of the risk management literature proved highly informative. The Health and Safety Executive (HSE) (2011) outlines five steps to risk assessment: first, identify the hazards; second, identify who might be harmed and how; third, evaluate the risks and decide on precautions; fourth, record findings and implement them; and fifth, review the assessment and update it as necessary (HSE, 2011).

Pearson and Coburn (2011) assert that both intrinsic and extrinsic factors must be considered when reviewing fall risks. Intrinsic factors identified by Pearson and Coburn include chronic illness, confusion, the use of five or more medications, urinary incontinence, age-related physiological changes, history of falls, fear of falling, and length of stay in a medical facility (2011). Extrinsic factors include elements related to the physical environment, such as the absence or inadequacy of grab bars, poor floor surface conditions, and improper use of assistive devices (Pearson and Coburn, 2011). Pearson and Coburn also stress that education and communication across all levels of staff are critically important in fall prevention, including the use of detailed and consistent methods for reporting fall accidents (2011).

A third source, Akyol (2007), agrees that fall risk factors are both intrinsic and extrinsic. Like Pearson and Coburn, Akyol strongly recommends the use of rigorous fact-finding questionnaires completed for each patient to assess individual fall risk (2007). Akyol also emphasizes the need for thorough environmental reviews to identify and correct physical hazards (2007). Consistent with the other sources, Akyol stresses that communication and patient safety education among healthcare professionals is essential to eliminating or reducing falling accidents (2007).