Preventing Falls in Hospital Patients

Falls are a common and serious problem for patients in hospitals. They can cause injuries, complications, longer stays, and lower quality of life. According to research, about 3 to 11 falls occur per 1000 bed days in hospitals worldwide, and about 25% of them result in injuries such as fractures, bruises, or lacerations [1]. However, research also shows that close to one-third of falls can be prevented by addressing the underlying risk factors and improving the physical environment [1].

In this blog post, we will discuss some of the best practices for preventing falls in hospital patients, based on the latest evidence and guidelines. We will also provide some examples of how hospitals can implement these practices in their settings.

Universal Fall Precautions

Universal fall precautions are basic measures that apply to all patients, regardless of their risk level. They include:

– Providing a safe and clutter-free environment, such as removing obstacles, securing cords, ensuring adequate lighting, and using non-slip mats.
– Educating patients and their families about the risk of falls and how to prevent them, such as using the call bell, wearing appropriate footwear, and following the staff’s instructions.
– Encouraging patients to stay active and mobile within their limits, such as providing assistive devices, offering exercise programs, and facilitating transfers.
– Ensuring patients have access to their personal belongings and necessities, such as glasses, hearing aids, medications, water, and toiletries.
– Checking on patients regularly and responding to their needs promptly, especially during high-risk times such as night shifts, shift changes, and meal times.

Standardized Assessment of Risk Factors

Standardized assessment of risk factors is a process of identifying patients who are at higher risk of falling based on various criteria. These criteria may include:

– Age, gender, diagnosis, medical history, medications, and co-morbidities.
– Cognitive status, mental health, mood, behavior, and delirium.
– Mobility status, balance, strength, gait, and functional ability.
– Sensory status, vision, hearing, proprioception, and pain.
– Continence status, bladder and bowel function, frequency, urgency, and nocturia.

There are various tools that can be used to assess these risk factors, such as the Morse Fall Scale (MFS), the Hendrich II Fall Risk Model (HFRM), or the Johns Hopkins Fall Risk Assessment Tool (JHFRAT) [2]. These tools assign scores or categories to patients based on their risk factors and provide recommendations for interventions.

Fall Prevention Care Planning

Fall prevention care planning is a process of developing individualized strategies to address the specific risk factors identified by the assessment. These strategies may include:

– Modifying the environment to suit the patient’s needs and preferences, such as adjusting the bed height, providing rails or alarms, or relocating the patient to a more visible or accessible location.
– Providing tailored education to the patient and their family about the causes and consequences of falls and how to avoid them,
such as using safety tips or videos.
– Implementing interventions to improve the patient’s physical condition and function,
such as prescribing medications or supplements,
referring to physiotherapy or occupational therapy,
or applying braces or splints.
– Managing the patient’s psychological state and behavior,
such as treating depression or anxiety,
monitoring for delirium or confusion,
or using distraction or relaxation techniques.
– Coordinating with other health care professionals and services,
such as consulting with pharmacists or dietitians,
arranging for home care or community support,
or planning for discharge or follow-up.

Post-Fall Assessment and Management

Post-fall assessment and management is a process of evaluating and treating patients who have experienced a fall in the hospital. It includes:

– Providing immediate care to the patient after a fall,
such as checking for injuries,
administering first aid,
and notifying the physician.
– Conducting a root cause analysis to determine the factors that contributed to the fall,
such as reviewing the patient’s chart,
interviewing the patient and witnesses,
and inspecting the scene.
– Implementing corrective actions to prevent recurrence of falls,
such as revising the care plan,
modifying the environment,
or educating the staff.
– Documenting and reporting the fall incident according to the hospital’s policy,
such as completing an incident report form,
entering data into a database,
or conducting a quality improvement review.

Conclusion

Falls are a major concern for hospital patients and staff. They can have negative impacts on health outcomes,
quality of care,
and health care costs. However,
many falls can be prevented by applying evidence-based practices that target the multiple factors that influence falls. These practices include universal fall precautions,
standardized assessment of risk factors,
fall prevention care planning,
and post-fall assessment and management. By implementing these practices in a systematic and coordinated way,
hospitals can reduce the incidence and severity of falls and improve patient safety and satisfaction.

References

[1] Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC geriatrics, 20(1), 140. https://doi.org/10.1186/s12877-020-01515-w

[2] Oliver, D., Healey, F., & Haines, T. P. (2010). Preventing falls and fall-related injuries in hospitals. Clinics in geriatric medicine, 26(4), 645–692. https://doi.org/10.1016/j.cger.2010.06.005

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