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Hospital Falls: An Ongoing Problem
Inpatient hospital falls especially in elderly patients can impact not only the quality of care provided but can have a substantial financial burden to the organization (Hoffman, Neumann, Golgert, & Von Renteln-Kruse, 2015). Healthcare providers must be aggressive in adhering utilizing tools and resources prevent falls and ensure patient safety.
The Medical Telemetry unit has an average of four days stay for patients are admitted for multiple co-morbidities but all require cardiac monitoring (Hoffman et al., 2015). Examples include congestive heart failure (CHF), dialysis, irregular heart rhythms, altered mental status, and strokes to name a few. Many present with acute problems secondary to chronic conditions such as CHF exacerbation, altered mental status due to drugs, toxins, or infections. The population serves about 90% Caucasians and about 43% are age 60 and above (Office of Statewide Health and Planning Development [OSHPD], 2015). Staffing ratio is 1:4 and a multidisciplinary team approach is used in caring for patients.
Problem, Issue, Suggestion, Initiative, or Education Need
For every 1000 bed occupied, 3-20 falls will occur (Haines, Lee, O’Connell, McDermott, & Hoffmann, 2012). Many factors contribute to patient falls particularly chronic conditions and medications. For example, a patient on Lasix may try to jump out of bed to the bathroom, a dialysis patient is confused due to elevated toxin levels, and stroke patients on heparin drips are at higher risk for bleeds and falls if there are deficits from the stroke. A substantial contributing factor to this is that elderly patients a weak bone structure as a result of age hence their general weakness, often resulting to falling while in the hospital (Thomas & Mackintosh, 2016).
Many falls occur during shift change when nurses are pre-occupied with report. It is recommended that fall risk is assessed at the beginning of every shift and interventions are implemented immediately (call light at bedside, mobility aids within reach, beds locked and at lowest position, and alarms on as necessary). Nurses should perform handoff at the bedside to ensure that IV lines and meds are evaluated, patient is involved in their plan of care, and to ensure that patient is safe and both staff member should sign off. Education should be continuous to staff and to patients the importance of adhering to the plans discussed.
Impact on Work Environment, Quality of Care, and Patient Outcomes
The repercussions of patient falls not only affects patient outcomes, but the hospital work environment and quality of care provided. Looking at the effects of falls on patient outcomes, hospital falls have been an impeding factor to quick recovery of patients in hospitals. In this regard, patients who are victims of falls often end up being injured contributing to their health problems as well as their social and psychological well-being (Oliveira, Hammerschmidt, Schoeller, Girandi, & de Paula, 2016).
This prolongs their recovery time hence elongating their stay in the hospital. Shifting gears to quality of care, hospital falls are a subtracting factor to quality of care given to patients in hospitals. Hospital falls are a pointer of lack of safety for inpatients. This significantly affects the reputation of hospitals with high number of falls (Babine et al., 2016). The effects of hospital falls on work environment are centered on the compromise of patient safety during their stay in the hospital. A work environment is rendered unsafe for patients having in mind that there is a high potential for patients to fall (Tzeng, Hu, & Yin, 2016).
Implications to Nursing
Poorly implemented programs, failure to follow recommendations, and quality of delivery of fall risk programs can explain why falls continue to occur (Morello et al., 2017). Studies show that fall programs are effective if carried out as it should. A study of the 6-PACK falls program includes assessing patients daily using fall risk scales, placing a “Falls Alert” sign outside the door, and at least one of the 6-PACK recommended strategy: a) assisting patients to bathroom, b) bed at lowest level, c) mobility aids within reach, d) planned toileting, and e) using bed/chair alarms (Morello et al., 2017).
Conclusion
Preventive measures that are based on evidence-based practice are implemented to ensure the safety of patients during their stay. It is up to the organization as a whole to collaborate to ensure that programs are adhered to. Nurses musts be consistent with shift assessments and required interventions, handoff should be at the bedside, and management should provide resources and support to ensure that interventions are not missed due to overwhelming workload.
