Fall Prevention

Fall Prevention

Name

Institutional Affiliation

Author Note

Fall Prevention

Introduction

The global patient falls number in health organizations have been on the rise with an approximate rate of 46% per 1000 patient days. Most of these falls occur around the bedside area or in washrooms among patients with both physical or mental complications. Patient falls account for the most recurrent dangerous event occurring in health institutions that deal with acute care (Morris & O’Riordan, 2017). An estimate of 30% of these fall injures the patients.

People within a hospital often have a compromised health status, and falls can result in complications. These complications include internal bleeding, lacerations, and fractures. Falls, therefore, lead to increased utilization of healthcare facilities, which results in high costs. It negatively impacts patients outcomes when admitted to the hospital. It is estimated that falls can cause an additional 12.3 days to stay at a hospital, which increases the cost by almost 61%. (Gu et al., 2016)

Falls negatively impacts the organization in that the hospital is unable to provide quality healthcare services. Fall patients stay longer in the hospital, and therefore there is a strain on the facility’s resources. Falls are regarded as a nursing-sensitive indicator and are associated with quality healthcare services. Recording high fall rates build a bad reputation for an organization. Patients can also sue a hospital since it can be regarded as a form of negligence on the part of the organization. The hospital is expected to eliminate all hazards likely to expose patients to falls, and failure to do so can be considered negligence.

Several fall prevention interventions are currently used in addressing the issue. Among them is a ten-week initiative that incorporates a game with exercise and education about health. The game is meant to enhance aging adult’s participation since the game is exciting, well known, and done in groups. This program has proved to improve patients’ physical fitness, make patients more knowledgeable and more social in different settings. The purpose of this program is to enable aging adults to enhance their mobility and become more independent. It is also aimed at educating them on matters concerning fall prevention and health-promoting behaviors.

The article by Cassandra Vonnes and  Darcy Wolf is a research article highlighting the importance of patient and family involvement in fall prevention strategies. The article’s purpose is to establish whether involving patients in decision making during admission would help reduce patient falls more effectively. Patients were made aware of all the possible fall risks and allowed to take part in designing fall mitigation strategies. The article also discusses the importance of reassessment in case the patient’s health status changes and transfers. There was a 37%  reduction in falls and a 58.6% reduction in fall injuries(Vonnes & Wolf, 2017).

The article by Rob Morris and Shelagh O’Riordan is a research article that discusses fall prevention interventions. The report states that identifying a wide range of underlying risk factors and clearly defining strategies can reduce falls by up to 30%(Morris & O’Riordan, 2017). The article emphasizes the importance of involving different stakeholders when designing interventions. There is a need to incorporate staff who closely associate with patients since they are familiar with their individual needs(Morris & O’Riordan, 2017).

The article by the Expert Institute is a non-research article that evaluates patients’ falls in a hospital setting. The article acknowledges that patient falls is a growing concern that needs to addressed because it can result in fatal injuries. The paper states that every patient is exposed to the fall risk and therefore it is important to assess them during admission. Patients’ needs may, at some point, change, and so they should be regularly reassessed to individualize interventions(“Expert Perspective – Evaluating Patient Falls in a Hospital Setting,” 2020). The paper concludes by stating that fall prevention is achievable if interventions are correctly designed.

The article by Julie Honaker is a non-research article discussing the importance of fall mitigation strategies based on patient-centered outcomes. The article states the importance of designing interventions around a patient’s functional status since patients have different needs. The paper also reports that the patient’s family should be considered when designing interventions since they can provide valuable information about the patients. The document also states that fall prevention is important not only to the patients but also to those around them since they can cause psychological distress(Honaker, 2015).

In a bid to lower the number of patients injured through these incidents, the PICO question asks: What evidence-based strategies are effective in reducing inpatient hospital falls?

P- population under focus is patients in inpatient hospitals.

I-The intervention involves integrating diverse disciplines and the inclusion of relevant staff such as nurses and patients.

\C-There will be a comparison between past patient fall rates and current rates.

O-Expected outcomes are a reduction in the patient fall numbers in inpatient hospitals.

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Evidence Matrix

Recommendation

Interventions such as education, fall risk wristbands, and hourly rounds have shown to produce positive results, but more can be done. Fall prevention is considered a multifaceted issue that needs integration of diverse disciplines and the inclusion of relevant staff such as nurses and patients. Studies show that it is vital to collaborate with the point of care staff when designing fall prevention interventions. Nurses are close to the patients and are the most crucial contributors to fall prevention. It is critical to train nurses and provide them with the necessary tools vital in fall prevention (Gu et al., 2016). Competent nurses are innovative and can suggest the best approaches applicable to preventing falls. Nurses are in a position to provide information unique to a specific patient and help in customizing an intervention to meet their needs. Capacitating nurses to design new approaches and evaluate falls in real-time develops a safety culture in an organization (Gu et al., 2016). Nurses in contact with patients are equally crucial as administrative nurses and can be of value to fall prevention.

In a study involving assessing the impact of mentoring fall mitigation guidelines, leaders emphasized the need to prioritize staff needs when planning and allocating resources (Ploeg et al., 2018). Point of care nurses and support staff should contribute to the strategies to enhance the program’s sustainability. Several educational methods executed both formally and informally are essential in maintaining a consistent fall risk assessment. Several point-of-care nurses complained of how their concerns, not being prioritized, frustrated, and discouraged (Ploeg et al., 2018). It is vital to enhance communication between different departments and staff since engaging a wide range of stakeholders makes the program more effective. Point of care staff can not only communicate about fall rates and numbers, but they can also provide vital information concerning a patient context, enabling the application of personalized care (Ploeg et al., 2018).

The program should be all-inclusive and should also put patients and families into consideration. In a bid to promote safety, patients and families should be encouraged to participate in the program to enhance effectiveness (Vonnes & Wolf, 2017). Engaging patients and families at the time of admission provide an opportunity to communicate the importance of collaborative efforts in addressing falls. Involving patients and families in strategizing the most suitable approach can substantially reduce falls among patients moderately exposed to fall risks (Vonnes & Wolf, 2017).

Customizing an intervention in line with the patient’s context is a significant factor that makes a program successful. A study revealed that fall risks addressed from a patient-centered perspective depending on the individual’s needs and preferences, enhance personal adaptations (Johansson et al., 2018). In this study, participants went through a nine-month program, and no problems related to adherence came up with this approach. This pilot study showed that designing an intervention around a patient’s needs and preferred methods makes the patient feel part of the program and thus they become more interested in making the process more efficient (Johansson et al., 2018)

It is crucial to identify areas where flexibility can apply to enable the nurses to customize interventions in line with patients’ needs since different patients may have different needs. In the past, bed exit alarms had not achieved any positive results in fall prevention. It was only after considering the patient’s preferences that the bed exit alarm intervention became successful. The nurses only applied the strategy to patients who would benefit from the intervention. Nurses only picked those patients at a high risk of falls and incapable or not willing to use the call bell (Cuttler et al., 2017). Putting all aspects into consideration can make the intervention more fruitful since there will be reduced inconveniences for everyone involved.

In a Midwest hospital that mainly deals with heart-related problems, the education intervention in coping with falls was successful. The cost of falls reduced by more than fifty percent (Cangany et al., 2015). The primary factor that contributed to these positive results was the high level of inclusivity. Everyone important to the intervention was called aboard. The staff’s training was executed efficiently, and the team was fully equipped to carry out their roles competently. Patients and families agreed on how training should occur, and the implementation was able to accommodate patients’ preferences and needs. Providing every collaborator’s interests enhances an intervention.

All successful intervention approaches have the element of bottom-up implementation and empowering the staff to try out ideas and continuously improve them until they produce positive results (Morris & O’Riordan, 2017). Encouraging an all-inclusive intervention in the clinical setting makes people feel attached to the initiatives, and there is increased responsiveness and opportunity to gauge the effectiveness. All these factors facilitate the consistent improvement of interventions.

Studies show that adequate organizational support is a crucial factor and can enhance fall prevention interventions. The organization should be accountable and should have fall risk assessment compliance audits This support should be across all different disciplines and departments. The organization should place a system that maintains consistent learning and evaluation to identify areas that need improvement (Degelau et al., 2017). They should track the progress of the intervention to determine the level of effectiveness. Optimal intervention effectiveness is achievable only if there are proper fall risk assessment, standard, and multifactorial education of nurses, patients, and their families. The interdisciplinary aspect of fall prevention is critical and should be considered during the program’s initial stages. For example, key collaborators should include clinicians, nurses, physicians, and pharmacists. Patients can be involved more through strategies such as teach-back teaching methods.

Stakeholders

Staff is among the most critical stakeholders in implementing fall prevention strategies. As a team leader, I will ensure I clearly define the roles of these staff. I will consider both their strengths and skills when assigning tasks to ensure optimal implementation. For example, I would look out for charismatic staff and encourage them to mobilize their colleges and maintain the initiative’s momentum. It is important to note how individual roles interact to consolidate all collaborators’ contributions to a functional unit. I will ensure that every one of them has a spelled out responsibility to ensure accountability. For example, I will assign registered nurses to supervise accurate assessments and record fall risk assessment. He/she will also be in charge of filing and assessing new falls to determine the most suitable approach for the patient.

For the licensed practical nurses, I will involve them in every decision because they have a better understanding of individual patient’s needs and preferences. Their take on the intervention should be taken seriously because they are in charge of the most practical bit of fall prevention strategies. The licensed practical nurse will be in charge of accurately conducting fall risk factors assessment at the admission stage and during the patient’s stay at the hospital. He/she will be part of the decision-making team to determine potential fall prevention measures for specific patients. The licensed practical nurse will also be responsible for documenting care pans in connection to an identified risk. There will be, for instance, an assessment of the psychological status or the level of mobility. The nurse will also be responsible for performing treatment procedures through careful patient observations to identify any concern that may require special attention. The nurse is also familiar with clinical realities and will know how best to develop patient assistance measures and toilet schedules. The nurse will also ensure the patient environment is conducive and does not increase fall risks in any way by, for example, decluttering the patient’s surroundings. These nurses will also work together with other staff to ensure reports on new falls are dealt with accordingly on time.

Other vital stakeholders in fall prevention are patients and families. I will involve them by first communicating with them all the essential information concerning the fall prevention program. I will inform them about fall risks at the admission stage, changes in risks, and their status at the end of the program. I will explain every aspect of fall prevention strategies and teach them how to recognize and understand visual identifiers. I will also clarify the issue of realistic expectations for the program outcomes. I will educate the patients and families on how they can positively contribute to the fall prevention initiative. The program is multifactorial, and all elements need to be factored in to enhance the learning process. I will use the teach-back technique, which facilitates patient participation during learning and enables them to understand concepts. Research shows that adequately educating patients can contribute to the overall success of a program. Information concerning falls, risk factors, assessment, and mitigation measures can be in written form.

I will also collaborate with an occupational therapist since it is imperative to examine patients and determine their mobility levels and functions to monitor their progress. These collaborators are also responsible for educating patients and families on safety issues being transferred from one location to another. Occupational therapists will also help determine the need for devices used in assisting patents in exercising and rehabilitating during the program.

Barriers

One barrier likely to be encountered during the implementation process is resistance and reluctance from a faction of staff and clinicians, even when involved in the program. One of the reasons that may contribute to this problem is that the staff not fully understanding the program’s essence. Some employees may be rigid and may prefer sticking to previous approaches. Some employees are reluctant to adopt new strategies because they are afraid of failing. Some of the staff may also be overwhelmed by other programs within the organization and so they may be unwilling to be involved with other programs. Lack of incentives may also translate to reduced motivation. Unsuccessful previous intervention programs may also make some of the staff skeptical about taking up change. Finally, workplace politics may also cause resistance since individuals politically opposed to the plan may resist proving a message.

Another possible obstacle to the fall intervention program is related to the care provider’s inadequate knowledge. Nurses may fail to effectively implement the interventions due to a lack of strong professional background. Some nurses have only gone through technical institutes and may not even have a degree in nursing. Some nurses have also not been exposed to evidence-based strategies implementation and may lack adequate skills to contribute to the success of the program.

Overcoming Barriers

If resistance towards the implementation is among a specific group within the organization, then the best strategy in addressing this problem will be not to involve these groups in the initial stages of the program. It would be best to initially only work with individuals from units that strongly support the initiative and have a likelihood of positively contributing to the success of the program. If the program starts becoming successful, then it becomes easy to convince those who had, in the beginning, doubted the practicability of the intervention. Those skeptical about the program may start supporting the program based on tangible results.

For the barrier concerning lack of education and knowledge among nurses, one possible strategy capable of addressing this issue can be taking these nurses through sessions and educating them on critical areas. This strategy can enhance and support the implementation process. These sessions will include discussions about the essence of fall risk assessment, the importance of preventing falls, necessary skills in risk assessment and risk identification, and so on. These nurses will also sit for tests before and after the sessions to determine whether they have become more knowledgeable.

Outcome Indicators

One indicator that can be used to measure the outcomes in this program is the number of falls or fall-related injuries. These indicators are easy to measure, and they can be valuable in the fall prevention program assessment. Rates improvement is a reflection of an efficient fall prevention intervention. If the rates worsen, improvements in the identified areas of concern are essential. Therefore, this data is vital in identifying areas of improvement and tracking the program’s progress. When it comes to fall rates, I will use the falling number and occupied bed days in a given timeframe. When assessing injuries related to falls, the crucial information includes the injured individual’s identity, time of the occurrence, and the injury degree.

References

Cangany, M., Back, D., Hamilton-Kelly, T., Altman, M., & Lacey, S. (2015). Bedside nurses leading the way for falls prevention: An evidence-based approach. Critical Care Nurse, 35(2), 82-84. https://doi.org/10.4037/ccn2015414

Cuttler, S., Barr-Walker, J., & Cuttler, L. (2017tt). Reducing medical-surgical inpatient falls and injuries with videos, icons, and alarms. BMJ Open Quality, 6(2), e000119. https://doi.org/10.1136/bmjoq-2017-000119

Expert Perspective – Evaluating Patient Falls in a Hospital Setting. Expert Institute. (2020). Retrieved 17 August 2020, from https://www.expertinstitute.com/resources/insights/evaluating-patient-falls-with-injury-in-a-hospital-setting/.

Gu, Y., Balcaen, K., Ni, Y., Ampe, J., & Goffin, J. (2016). Review on prevention of falls in hospital settings. Chinese Nursing Research, 3(1), 7-10. https://doi.org/10.1016/j.cnre.2015.11.002

Honaker, J. (2015). Fall Prevention: Patient-Centered Outcomes. Asha.org. Retrieved 17 August 2020, from https://www.asha.org/Articles/Fall-Prevention–Patient-Centered-Outcomes/.

Johansson, E., Jonsson, H., Dahlberg, R., & Patomella, A. (2018). The efficacy of a multifactorial falls-prevention program, implemented in primary health care. British Journal of Occupational Therapy, 81(8), 474-481. https://doi.org/10.1177/0308022618756303

Morris, R., & O’Riordan, S. (2017). Prevention of falls in the hospital. Clinical Medicine, 17(4), 360-362. https://doi.org/10.7861/clinmedicine.17-4-360.

Ploeg, J., Ireland, S., Cziraki, K., Northwood, M., Zecevic, A., & Davies, B. et al. (2018). A sustainability-oriented and mentored approach to implementing a fall prevention guideline in acute care over 2 years. SAGE Open Nursing, 4, 237796081877543. https://doi.org/10.1177/2377960818775433

Vonnes, C., & Wolf, D. (2017). Fall risk and prevention agreement: Engaging patients and families with a partnership for patient safety. BMJ Open Quality, 6(2), e000038. https://doi.org/10.1136/bmjoq-2017-000038