Hospital System Approach At Decreasing Falls with Injuries

Sylvain Trepanier Julie Hilsenbeck

A Hospital System Approach At Decreasing Falls with Injuries

And Cost Executive Summary

► Falls and fall-related injuries continue to challenge every health care organization.

^ Falls are a nurse-sensitive quality outcome.

^ Patient falls are a leading cause of injuries in hospitals, considered to be among the most expensive adverse event, and continue to be a patient safety concern.

^ Researchers analyzed the impact of a standardized fall prevention program across 50 acute care hospitals in 11 states.

^ The implementation of a stan­ dardized multifactorial program for adult patients appears to have reduced falls with injuries by 58.3% over a 2-year period, allowing for a potential cost avoidance reduction of $776,064 in 2013 dollars.

SYLVAIN TREPANIER, DNP, RN, CENP, is Senior Director of Patient Care Services, Tenet Healthcare Services, Dallas, TX.

JULIE HILSENBECK, DNS, RN, is Senior Director of Patient Care Services, Tenet Healthcare Services, Dallas, TX.

P ALLS AND FALL-RELATED injur­ ies continue to challenge health care organizations around the world to pro­

vide safer environments. Falls re­ main a primary health concern for older adults (Resnick & Junlapeeya, 2004], Risk factors for falling in­ clude age-related changes such as sensory alterations, muscle weak­ ness, gait and balance disturban­ ces, use of four or more prescrip­ tion m edications, alteration in activities of daily living, depres­ sion, and history of falling. As the population continues to age, the risk factors are almost inescapa­ ble. The time for serious inquiry into fall prevention and mitigation strategies is now.

International research demon­ strates falls in inpatient acute care settings continue to be a safety threat. Research, however, fails to demonstrate how hospital fall pre­ vention programs actually reduce fall rates (Koh, Hafizah, Lee, Loo, & Muthu, 2009; Lee, Chang, & Mackenzie, 2002; Semin-Goossens, van der Helm, & Bossuyt, 2003). In their groundbreaking report, Agostini, Baker, and Bogardus (2001) collected and described existing evidence on current pa­ tient safety practices. Since falls

and falls with injury are a serious threat to our patients, and create a cost burden for hospitals, there is a need to identify the quality and financial impact of a standardized fall prevention program for adult patients in the acute care setting. The results of a quality improve­ ment study aimed at identifying the effectiveness of a multifactori­ al fall prevention program in the acute care setting for adult patients is reported in this article.

Implications of Falls For the purpose of this study,

a fall is defined as “an uninten­ tional coming to rest on the ground, floor, or other lower level, but not as a result of syncope or over­ whelming external force” (Agostini et al., 2001, p. 281). Furthermore, we define and differentiate between an accidental, anticipated, and unanticipated fall (Morse, 2009) (see Table 1). Patient falls are a lead­ ing cause of injuries in hospitals, considered to be among the most expensive adverse events, and con­ tinue to be a patient safety concern (Evans, Hodgkinson, Lambert, & Wood, 2001; Paradis, Stewart, Bayley, Brown, & Bennett, 2009). When a fall occurs, there are mul­ tiple possible resulting complica-

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Table 1. Falls Definitions

Accidental Fall

A fall that occurs unintentionally (e.g., slip, trip). Patients at risk for these falls cannot be identified prior to a fall and generally do not score at risk for falling on a predictive instrument. These falls may be prevented through providing a safe environment.

Unanticipated Fall

A fall that occurs when the physical cause of the fall is not reflected in the patient’s assessed risk factors for falls.

Anticipated Fall

A fall that occurs in patients whose risk factor score indicated the patient is at risk of falling. Controlled sliding down a wall to the ground or utilization of a physio­ logic structure is considered a fall.