Every year, some 11,000 patients fall during their hospitalizations and die, according to The Joint Commission Center for Transforming Healthcare. The problem is hardly a new one, but it has received renewed attention in recent times.
Several years ago, the Centers for Medicare & Medicaid Services (CMS) declared falls among a handful of other conditions that are preventable and should never occur in hospitals. To give its ruling some teeth, it ceased paying hospitals for care associated with inpatient falls and resulting trauma.
Yet falls still happen.
Part of the challenge to nurses and other acute care staff is what the Agency for Healthcare Research and Quality (AHRQ) recognizes as “a complex and potentially conflicting set of goals when treating patients.”
Nurses are charged with providing care and treating the problem that caused the patient’s hospitalization. They are also expected to help restore or preserve the patient’s physical and mental function. Finally, nurses must keep the patient safe while carrying out those responsibilities.
As if that dance weren’t difficult enough, other complications are present that can increase a patient’s risk of falling. First is the patient’s health status. Weakness, dizziness, foot problems, blurred vision, fatigue and cognitive function are just a handful of factors that can make a patient prone to fall.
Second, environmental hazards. Cluttered hospital rooms, dangling cords from call lights and medical devices, dim lighting, slick floors and improper footwear contribute to the danger.
Third are, let’s be honest, caregiver slips. Unsafe transfers, inaccurate fall risk assessments, and uncommunicated fall-risk statuses can leave patients wide open for fall-related injuries.
Take any of the above—worse yet, combine them—and you get up to an estimated one million inpatient falls in the United States annually. Close to a third, according to the Agency for Healthcare Research and Quality, are preventable.
With steep patient consequences and costs associated with falls (falls with injury, on average, add an average 6.3 days and $14,056 to hospital stays), hospitals across the country are stepping up their fall prevention efforts.
A nurse-led fall prevention class was offered 28 times during July and August alone at the Cleveland Clinic Health System. The effort began as a unit-based session after a patient fell and sustained a fracture in the med-surge/telemetry unit at Medina Hospital, Medina, OH, in early 2014. The class encourages caregivers to use assistive devices, assessment skills and, when necessary, teamwork when preparing a patient for transfer.
“The class is an eye opener for nurses,” said co-creater Karen Theodore, BSN, RN. “It makes them question whether they are taking into account everything that contributes to a fall, and it stresses the importance of educating patients and families on fall risks.”
The Agency for Healthcare Research and Quality offers a toolkit for hospitals looking to better their fall prevention. And in 2015, the Joint Commission Center for Transforming Healthcare will release its Targeted solutions tool for preventing falls with injury. The kit is based on work the center did helping seven hospitals (ranging from a community hospital with 178 beds to an academic medical center with 1,700 beds) to reduce overall patient falls by 35% and injury-causing falls by 62%. Caregiver awareness, patient education and a validated fall risk assessment tool were central to that effort’s success.
“These numbers mean if the center’s approach is translated to a typical 200-bed hospital, the number of patients injured in a fall could be reduced from 117 to 45 and save approximately $1 million annually through fall prevention efforts,” writes Erin DuPree, MD, the center’s chief medical officer and vice president.
In dollars, injuries and even lives saved, hospitals are finding fall prevention programs to be well worth the effort.
What is your hospital doing to reduce the occurrence of patient falls? Tell us in the comments section below!