Target Key Risk Factors to Reduce Falls -- by Robin Walters, RN, BSN

Patient falls top the list of the most frequently reported adverse events for hospitalized adults. Even with possible under-reporting, rates of inpatient falls range from 1.7 to 25 per 1,000 patient days, depending upon the area of the hospital in which patients receive care . This translates to falls occurring among 1.9% to 3% of all acute care hospitalizations, totaling as many as one million falls per year.

 

Serious injuries occur in 2% to 8% of acute care falls, resulting in about 90,000 serious injuries and 11,000 deaths each year in the U.S. And according to the CDC Web site, up to 75% of nursing home residents fall each year. Among these, serious injuries occur 10% to 20% of the time, leading to approximately 1,800 deaths annually.

Hospitals that participate in national reporting databases such as the American Nurses Association, National Database of Nursing Quality Indicators(ANA-NDNQI) can compare their rates of falls and injuries to similarly-sized hospitals with comparable types of patients.

 

Patients in rehabilitation, behavioral health, and oncology settings are at higher risk for falls.  Pediatric patients are at much lower risk, possibly because parents tend to stay with children, providing increased supervision. The five main risk factors for falls among all types of patients are: side effects from medication, gait problems, increased toileting needs, a history of falls, and—perhaps most significantly—confusion. Extrinsic risk factors include: inadequate lighting, objects in patient rooms that are colored so similarly to the room itself that they are hard to distinguish, and poorly-placed handrails

.            

When hospitalized patients fall and are injured, hospital charges rise by about 60%.  The impact on a hospital’s bottom line is likely to grow now that Medicare, as well as many private insurers, will no longer reimburse for diagnoses resulting from injuries caused by falls during the hospital stay.

 

Of all the hospital acquired conditions on the “no-pay” list, falls can be the most difficult to prevent. Instruments to assess patient risk for falls and injuries have been unreliable, and a review of the literature raises questions about the effectiveness of today’s fall prevention programs.

 

The evidence does support focusing on each patient’s most important risk factors for falls and using a combination approach to prevention, including the following practices:

• Review and monitor medication side effects

• Treat contributing conditions such as anemia, syncope and impaired vision

• Check confused patients for toileting needs every two hours

• Educate staff about risk factors for and prevention of falls

• Use bed/movement alarms

• Make environmental changes (e.g., better room design)

• Conduct post-fall assessments

Robin Walters, R.N., B.S.N., has been privileged to provide care in hospitals, clinics, schools and physician offices, at sites ranging from large urban to remote rural. Be sure to also read Robin's other contributions on bloodstream infections, hand washing compliance, and culture of safety.