Other fall preventative techniques include the “Night Watch” (NOC WATCH). The NOC WATCH device consists of a credit-card size device contained within an adhesive "patch" and worn on the thigh continuously for many days. The patch is small, wireless, disposable, waterproof, shockproof, and unobtrusive. When a patient's leg becomes weight-bearing (such as when a patient gets out of bed or stands up unassisted), the receiver emits an audible signal which both alerts the patient to sit down and also summons a caregiver. Results from a clinical study conducted to measure the effectiveness and operational characteristics of this device intended to reduce the incidence of falls in elderly patients at high risk of falling, NOC.watch device appears to have a large impact on reducing fall risk in nursing home patients, further evaluation in the acute care setting in needed. However, due to the lack of an equivalent control group, these results should be confirmed with a larger, randomized, controlled study to better estimate the true magnitude of the effect of the NOC.watch device on fall rates. Kelly Phillips, Cain, Polissar (2002).

High technology is also used as a “fall prevention” strategy and it is not cheap. Patients are remotely video surveillance for falls. With this, from a remote station, the tech observes a patient attempting to get out of bed they will call the nurse, or nurse’s station and report it. Communication from the monitor room to the nurse needs to be quick, like all other alarm responses, however, not quick enough to prevent most falls.  By the time the nurse gets the message and stops what he/she is doing, chances are, calling for lift help is the response. There is no better intervention to reduce falls than observation, unfortunately the high cost associated with the use of sitters verse modern technology has been under scrutiny all over the U.S especially during the current economic crises. Research has been mixed about the effectiveness of other approaches, such as increased vigilance, use of patient sitters, frequent assistance for toileting and other functions, and bed exit monitors. However, Nursing Economics (2007) reported use of a patient vigilance system is cost-saving as compared with increased use of patient sitters, even if patient fall rates drop with increased sitter use.

Contributing factors why patients end up on the floor are intrinsic, such as physiological illness, lower extremity weakness, poor grip strength, balance disorders, visual defects, cognitive impairment, and polypharmacy, as well as extrinsic, such as lighting, faulty assistive devices, and wet or cluttered floor surfaces. Reasons that contribute to falls are essential and every nurse and caregiver ought to know them. More importantly, what does the hospital have in place that limits falls and what is done post fall go hand in hand?

Studies on “Interventions for Preventing Falls in Acute- and Chronic-Care Hospitals” found no conclusive evidence that hospital “fall prevention programs” reduce the number of falls or fallers, although more studies are needed to confirm the tendency observed in the analysis of individual studies that targeting a patient's most important risk factors for falls actively helps in reducing the number of falls. These interventions seem to be useful only on long-stay care units. Coussement, DePaepe, Schwendimann, Denhaerynck,  Dejaeger and Milisen, (2008).

There may not be a successful 100% fall free program; however, there are many fall prevention/injury program ideas that are worth investing.  One of Joint Commission goals focuses on reducing the risk of patient harm resulting from falls in health care settings. Reviewing your falls with injuries against current prevention programs that include injury protection is critical for eliminating injuries.  
 
 
LEGAL NURSE CONSULTANT PERSPECTIVE

Litigation for hospital falls is growing in frequency and settlement size. As a legal nurse consultant (LNC) I analyze records, evaluate the case, and render an informed opinion After reviewing 6 cases of fall related injuries in LTC and Acute Care facilities in 2008, 100% of the patients reviewed were on documented fall precautions and 100% had a fall risk assessment. However, 0 had a documented prevention noted. From the documentation, there was nothing that addressed if there was a bed alarm on, rounding, placement of patient closer to a nurses station or use of a sitter.  The lights are on but no one is home.

In the case of  Cifelli v. St. Vincent’s, 2008 WL 4093163 (Sup. Ct. Richmond Co., New York, July 17, 2008). Titled Psych: No Fall-Risk Assessment Done,

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