Fall Prevention Showcase
November/December 2011
Fall Prevention Showcase
What Goes Down—Shouldn’t
Between 2 and 15% of hospital patients in the United States experience falls. Nearly a third result in injuries and sometimes even death. Preventing falls in the acute environment is a constant battle against gravity and human behavior.
As Jacqueline Close, RN, PhD(c), clinical nurse specialist in gerontology at Palomar Pomerado Health in Escondido, Calif., explains, “We find that there are two classes of patients most likely to incur falls: the middle-aged male who ‘doesn’t need help’ and the older patient. Our older patients have the same issues—they don’t want to ask for help when they really need to, or they have to use the restroom and can’t wait for someone to help them.”
Although we tend to think of age as a primary factor in hospital falls, substance abuse is a factor in some cases, too. “Patients who enter our emergency departments sometimes pose a fall risk for just this reason, and it’s very difficult to keep them safe,” comments Close. “Another population that is hard to keep safe is our patients that have suffered a stroke or a brain injury. They are unaware of their new deficits in balance, visuo-spatial abilities, and impulsivity.”
Close mentions one approach to fall prevention. “We have a program called the Walk-About Program that utilizes young college and high school volunteers in assisting our patients in walking around the hallways if they are able. These students are here as clinical career extenders to volunteer their time in 4-hour blocks to get hands-on patient care experiences to see if healthcare is something they may be interested in. They are taught by trained physical therapists how to safely ambulate a patient.”
A company that focuses on fall prevention from a research perspective, AHI of Indiana licenses an assessment tool known as the Hendrich II Falls Risk Model as part of a comprehensive approach to fall reduction in acute care settings. Jim Hendrich, president of AHI, agrees with Close that “the most common reason for patients falling in rooms is because patients are trying to meet elimination needs. A variety of tactics and strategies have been applied in healthcare by nursing and assisting personnel. You’re also seeing strategies, like hourly rounding, having more warm bodies in the room checking on patients to see if there are needs to be met. You’re seeing enhanced patient monitoring systems. But the important thing is trying to understand and approach the problem—we are doing a better job at identifying fall risk patients, but the reality of it is we’re not being as effective and efficient as we should be.”
Hendrich adds, “We do have hospitals that are approaching zero falls and we do have some hospitals that have been at zero for several months repetitively. What we found in talking to our clients in the field is that they identify the patient as being at risk or not at risk. If you only apply general strategies to fall-risk patients, you may find that your efforts work on some patients but not on others.” And that’s probably correct. Unless interventions that are matched against the identified risk factors for that specific patient are implemented to mitigate risk, a fall may still occur.
He continues, “We encourage caregivers to shift their thinking from placing patients into ‘groups’ of being at fall risk vs. not at risk and start looking at a patient-centered, patient-focused care plan approach. This means having a nurse who can identify the risk factor(s) for the individual patient at any point during the stay. Incorporate evidenced-based interventions that are matched against that risk factor to reduce or eliminate the possibility that a fall could occur. When you are able to assess in real time with an effective tool and proven strategies, you can begin to track changes in acuity in patient populations and that helps maximize nursing time without over-targeting for fall risk.”
As Hendrich admits, “There should be a comprehensive approach to fall prevention. Be proactive in identifying fall risk factors and changes in the condition of the patient that require re-assessment and provide additional information to patients and families to help eliminate fall events because every patient is different.”
Tom Inglesby is an author based in southern California who writes frequently about medical technologies and improvement strategies.