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Videos, Bells and Whistles; Fall Risk or Injury Prevention?

A review of your fall related assessment tools and alarms that may alarm you and keep you in or out of court. 

by Michelle Myers Glower RN MSN LNC

 
Every healthcare system should be safe, effective, patient-centered, timely, efficient, and equitable. Quality of care review is done in Hospitals and Health Care facilities across the nation, at least it should be. Accredited facilities are required to have systems in place they can measure to determine whether the quality of services provided meet professionally recognized standards of care, including whether appropriate healthcare services were not provided or were provided in appropriate settings. (The Institute for Healthcare Improvement {IHI}, 2008) report patient falls are among the most common occurrences reported in hospitals and are a leading cause of death in people ages 65 or older. Patient death or serious disability associated with a fall while being cared for in a healthcare facility is considered a “Never Event” and a costly risk. The term “Never Event” is not friendly.  Never events consist of 28 occurrences on a list of inexcusable outcomes in a healthcare setting. They are defined as "adverse events that are serious, largely preventable, and of concern to both the public and healthcare providers for the purpose of public accountability. The list was compiled by the National Quality Forum is available and free to copy at http://en.wikipedia.org/wiki/Never_events

Of those who fall, as many as half may suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death. About 50 percent of older adults hospitalized for hip fracture never regain their previous level of function.

The US population is aging, the problem of hip fractures will likely increase substantially over the next four decades. There is a considerable body of literature on falls assessments, identification of fall risk and fall prevention programs; little evidence exists for the absolute impact of any given intervention. Yet, health care professionals believe they can prevent falls in hospitals and undertake well thought out improvement programs, with falls still being reported, with and without injuries. The intent should be applauded, but the fact remains, falls happen.

Hip fractures are the most frequent type of fall-related fractures. The cost of hospitalization for hip fracture averaged about $18,000 and accounts for 44% of direct medical costs for hip fractures. About one out of five hip fracture patients dies within a year of their injury. Leibson, Toteson, Gabriel, Ransom and Melton. (2002). Preventing a hip fracture in the elderly can be cushioned through the use of hips protectors, carpeted or padded flooring and or a mattress on the floor. Depending on whose study you read, the use of hips protectors to reduce or prevent hip fractures is widely debated.

Tzeng HM, Yin CY (2007) report heights of occupied beds as a possible risk factor for falls concluded the average height of patient beds on fall precaution was significantly higher than of those not on fall precaution. In a recent purchase of new hospital beds, we later found a significant difference in the bed heights from previous versions, assumptions were made that upgrading our hospital beds all had the previous height.

Another observation noted, if you have a higher patient/nurse ratio on weekends than on weekdays, this may result in nurses being less conscientious about keeping beds in the low position after treatments. In an effort to prevent high-fall-risk patients from falling, nurses may have consciously or unconsciously kept their beds in higher positions. Tzeng & Yin (2008).

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