Hospital falls: how to prevent the injuries

Introduction 

According to the World Health Organization (WHO), hospital falls are a major public health concern that could lead to unintentional injuries and death in hospitalized patients. In demonstrating the impact that hospital falls have on individuals, Slade et al., (2017) say, "The estimated number of falls deaths is approximately 424 000 globally with falls responsible for 17 million disability-adjusted life years." It is also important to note that the in-hospital falls come with a plethora of legal, clinical, and regulatory problems. For instance, the Center for Medicare and Medicaid services does not reimburse hospitals for falls that occur with trauma. As the population in the United States continues to age, fall prevention has developed into one of the most important topics that need to be addressed. However, due to various complexities in the acute care setting, prevention of the falls is not an easy task. Falls prevention programs require the combined effort of healthcare workers, patients, evidence-based strategies, and the use of modern technology. 

The Problem of Hospital Falls 

Falls are a significant public health problem not only in the United States but also in the rest of the world. One of the factors that increase the risk of falls is hospitalization. The patient falls, together with the injuries that result are a burden to the patients, health workers, and the entire healthcare system. Older adults aged 65 years and above face the highest risk of experiencing the falls. In illustrating the statistics, Slade et al., (2017) say, "Over one in three adults fall annually, and falls are the main cause of hip fractures and hospitalization." Additionally, falls are generally associated with more extended hospital stays and poor outcomes for the patients. Other problems associated with falls other than hip fractures include bruises and head injuries. Additional risk factors for hospitalized patients include a history of previous falls, cognitive impairment, psychotropic medications, gait instability, and urinary inconsistence, among others. Falls can also be contributed by the nature of the hospital building, including aspects such as slippery flaws, numerous staircases, and uncomfortable beds. 

Vonnes & Wolf discuss the problem of hospital falls in the oncology section. The authors say, “Oncology patient is at an increased risk for injury from a fall due to coagulopathy, thrombocytopenia and advanced age” (Vonnes & Woolf, 2017). It is therefore essential to assert that falls pose a significant challenge, especially in the acute care system. More fundamentally, it contributes to morbidity and mortality. Despite hospital falls being a significant problem, little research has been done on it, thereby inhibiting the probability of acquiring remedies. Studies have also shown that many nurses and the health professional fraternity, in general, lacks the much-needed knowledge in identifying, managing, and preventing the incidences of falls, especially in the acute care setting. All these factors explain the recent increase in hospital falls in the care facilities. Despite the rising numbers, most cases go unreported, thereby setting the center-stage for more problems. Once an individual experiences a fall, they become susceptible to many other episodes which increase the risk of severe injuries and death. 

Preventing Hospital Falls 

In acknowledging the difficulty associated with preventing hospital falls in the care setting, Hempel et al., (2013) say, “Preventing falls in U.S. acute care hospitals poses particular challenges, given that patients are acutely ill and average only 4.9 days in the hospital.” The challenge is even greater in the acute care setting due to the high level of compressed acuity. The prevention programs that have been utilized are largely complex and involved a wide array of components that rely on leadership and cooperation. It is also crucial to note that the programs require constant monitoring strategies to guarantee that the hospital staff members stick to the implemented care protocols. Several strategies have been used in an attempt to stop the hospital falls, which have a significant impact on the healthcare conditions of patients in the care setting. Dykes et al., (2010) suggests a method known as the fall prevention tool kit (FPTK) that employs the use of the health information technology (HIT). 

Through the FPTK, it is possible to integrate workflow patterns and communications into the HIT application. A nurse will then complete a fall risk assessment scaling to assess some of the specific factors that increase a patient's risk of experiencing a fall. The research found out that the tool played a crucial role in stopping the falls. The second aspect that can reduce hospital falls is a policy known as the Fall Risk and Prevention Agreement. Upon admission, patients are required to be oriented into this program. The basis of this model stems from the incorporation of patients and families into the prevention strategy. Based on the research conducted by Vonnes & Wolf, (2017), "Falls and fall injuries on the medical oncology unit had an overall reduction of 37% and 58.6%, respectively.” Therefore, this system encourages a collaborative effort between the nurse, patient, and the family members in preventing falls by identifying bedside challenges and risks that could increase the falls. 

More focus should be placed on identifying the high-risk patient. It is common knowledge that some of the high-risk patients include the elderly ones, especially those with additional conditions such as mental problems. Therefore, one of the strategies commonly utilized in health care settings today revolves around the easy identification of these patients. For instance, high-risk patients can be given red socks or an armband to enable their easy isolation. Visual cues can be placed at their door to alert the providers in case of a risk. Patient falls are also possible when patients are sleeping. Their bed can, therefore, be fitted with alarms that ring in case of an inappropriate landing of the patient. Easy identification of the at-risk patients enables both the clinicians and the staff to respond appropriately and take correct protocols, which will reduce the risk of falling (Phelan et al., 2016). Other than the family members, it is also crucial to increase safety companions to the patients experiencing the highest risk of falling. 

It is vital for hospitals, especially the ones with a huge older adult population to avail the safety companions. This is particularly crucial for the disoriented patients and the ones that face difficulties in following directions. The role of the safety companions will encompass continuous observations and aiding patients where appropriately to prevent unnecessary movements that could contribute to the falls. Other hospitals have engaged in programs aimed at keeping the patient busy. Patients are given different activities to do to ensure that they are occupied enough, which limit their likelihood of getting out of the bed. Phelan et al. (2016) asserted that the staff member could also educate and work with the family members in a bid to prevent the falls. The author further emphasizes the essence of doing safety rounds. For the high-risk patients, the safety rounds should be twice or thrice a day to ensure that maximum care is accorded to them. During the rounds, the role of the nurse would be to assess the precautions and prevent the likelihood of the occurrence of the falls. It is also important for the nurse to check where the at-risk patients are putting on their identifiers. 

Lastly, changes should be implemented to improve the general landscape of the hospital. It should be noted that the hospital has a plethora of risk factors to do with the general architect of the building. Risk factors of this nature include poor lighting, slippery floors, and staircases, among others. It is therefore incumbent upon the hospital to make necessary changes. Appropriate lighting, especially in the wards and the washrooms, should be mandatory. Secondly, ramps should be constructed as an alternative for the staircase, which is more comfortable and safer to climb. All floors should be fitted with materials that increase the grip while walking (Dykes et al., 2010). However, this is an area where many hospitals have failed to place keen consideration. For instance, tiles can become extremely slippery, especially when wet. As such, this could lead to abrupt slips and falls that could lead to fractures and bone breakage. 

Conclusion 

In conclusion, due to various complexities in the acute care setting, prevention of the falls is not an easy task. Falls prevention programs require the combined effort of healthcare workers, patients, evidence-based strategies, and the use of modern technology. Hospital falls are detrimental to the well-being of the patient, the healthcare workers, and the entire healthcare system. For the patient, it could worsen their already compromised condition causing paralysis or death depending on the severity. Some of the preventive strategies discussed include the use of the fall prevention tool kit (FPTK), identification of high-risk patients using red socks, using companions, establishing a collaborative force between patients, healthcare, and families, and lastly, improving the general hospital environment. Nurses and other caregivers must receive the necessary training on how well to manage and prevent falls for better future outcomes. 

References 

Dykes, P. C., Carroll, D. L., Hurley, A., Lipsitz, S., Benoit, A., Chang, F. ... & Middleton, B. (2010). Fall prevention in acute care hospitals: a randomized trial. Jama, 304(17), 1912-1918. 

Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B. ... & Ganz, D. A. (2013). Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), 483-494. 

Phelan, E. A., Aerts, S., Dowler, D., Eckstrom, E., & Casey, C. M. (2016). Adoption of evidence-based fall prevention practices in primary care for older adults with a history of falls. Frontiers in public health, 4, 190. 

Slade, S. C., Carey, D. L., Hill, A. M., & Morris, M. E. (2017). Effects of falls prevention interventions on falls outcomes for hospitalized adults: protocol for a systematic review with meta-analysis. BMJ Open, 7(11), e017864. 

Vonnes, C., & Wolf, D., (2017). Fall risk and prevention agreement: engaging patients and families with a partnership for patient safety. BMJ Open Qual, 6(2), e000038.