Calling the Shots: Nursing News and Notes

Making Fall Rates Fall

Making Fall Rates Fall

Tuesday, February 28, 2017

According to the Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control, falls are a major cause of injury and death among U.S. citizens over age 65, and represent considerable added costs for hospitals, as indicated by the following startling statistics:

  • Each year, one in four adults older than age 65 falls.
  • For hospitalized patients, falls are the most common safety incident, with occurrence rates of 1.7 to 25 falls per 1,000 patient days.
  • Sadly, 30% to 51 % of those falls result in some form of injury.
  • The average cost for a fall injury is $30,000.
  • In 2015, costs for falls to Medicare alone totaled over $31 billion. Falls are pretty costly for everyone.

What factors contribute to falling?

Many risk factors can contribute to falling. Usually it’s a combination of these risk factors that leads to a fall, and the more risk factors a patient has, the greater their risk of falling. Risk factors are commonly categorized as extrinsic or intrinsic. Extrinsic risk factors are modifiable; while some intrinsic risk factors aren’t.

Extrinsic risk factors include:

  • Dim lighting
  • Hazardous stair design
  • Improper assistive device use
  • Lack of grab bars in the bathroom
  • No handrails on stairs
  • Obstacles
  • Psychoactive medication use
  • Slippery surfaces
  • Tripping hazards.

Intrinsic risk factors include:

  • Advanced age
  • Balance problems
  • Chronic conditions (arthritis, dementia, diabetes, incontinence, Parkinson disease, stroke)
  • Fear of falling
  • Gait disturbances
  • History of falling
  • Muscle weakness
  • Poor vision
  • Postural hypotension.

Who’s at risk for falling?

By performing a fall risk assessment, clinicians can determine who’s at risk for falling. A variety of tools exist to help clinicians assess a patient’s fall risk, such as the Morse Fall Scale, Hendrich II Fall Risk tool, and the Johns Hopkins Fall Risk Assessment Tool. The CDC also developed the Stay Independent brochure for older adults that contains a fall risk self-assessment tool that’s helpful especially in the ambulatory care setting.  

When screening for falls, clinicians should ask the patient if they fell in the past year? If they answer “yes”, then ask how many times? Ask if they suffered any injuries. And then ask if he/she ever feels unsteady when standing or walking, and whether they worry about falling.

If the patient answers “no” to these key questions, they are most likely at low risk for falling. The CDC recommends teaching patients at low risk for falling about fall risks and the importance of vitamin D and calcium in promoting bone health. They also encourage participation in strength and balance exercises.

If the patient answers “yes” to any of the screening question, the clinician should assess his gait, strength, and balance. If the clinician identifies a gait, strength, or balance problem, and the patient has a history of falling but didn’t sustain an injury, he/she is at moderate risk for falling. In addition to teaching the patient about fall risks and the importance of vitamin D and calcium in promoting bone health, the CDC recommends reviewing the patient’s medications to see if modifications in the treatment regimen can be made to reduce the patient’s risk for falling. Additionally, the patient should be referred to physical therapy to improve gait, strength, and balance or to a community fall prevention program.

If the patient has a history of two or more falls or sustained an injury as a result of a fall, the patient is identified as high risk for falling. The CDC recommends the following interventions for those patients identified as high risk:

  • Conduct a multifactorial risk assessment that includes a physical examination that assesses for postural dizziness and hypotension, medication review, cognitive screening, visual acuity testing, feet and footwear problems, and use of mobility aids.
  • Teach the patient about fall risks, vitamin D and calcium.
  • Manage and monitor hypotension.
  • Modify medication regimen.
  • Address foot and footwear problems.
  • Optimize vision.
  • Optimize home safety.
  • Refer to physical therapy to enhance functional mobility and improve strength and balance.
  • Provide a follow-up care within 30 days to review the plan of care, assess and encourage fall risk reduction behaviors, discuss and address adherence barriers.

What strategies help prevent falls in the hospital?

A variety of strategies can help clinicians prevent falls when patients identified at risk for falling are hospitalized:

  • Institute universal fall precautions to make sure that the environment is safe and the patient is comfortable. Orient the patient to the room and the call light to help prevent falls related to an unfamiliar environment.

  • Assess the patient’s risk for falling using a standardized fall risk assessment tool, on admission, after a change in a patient’s condition, transfer from another unit, or a fall.

  • Check the patient for potential danger hourly during the daytime and evening and every two hour overnight to comply with universal fall precautions. Correct potential dangers in the patient’s room:

    • Provide adequate nighttime lighting.

    • Place the patient’s personal belongings and assistive devices within reach.

    • Keep the bed in the lowest position so that the patient can reach the floor easily when he gets out of bed. This position also reduces the distance to the floor in case the patient falls.

    • Lock bed’s wheels.

    • Keep the patient’s area uncluttered.

    • Keep floor surfaces clean and dry.

  • Instruct the patient to rise slowly from a supine position to avoid dizziness and loss of balance.

  • Advise the patient to wear well-fitting, nonskid footwear.

  • Have a gait belt readily available, if needed for use during ambulation or transfer.

  • Assist the patient with early and regular ambulation if his condition allows.

  • If needed, regularly schedule assistance with toileting.

  • Review medications that contribute to a fall.

  • Use a chair or bed alarm, if needed to alert staff that the patient is attempting to get up without assistance.

What strategies have been particularly helpful for reducing falls in your facility? We’d love to hear your success stories!

For additional information on fall prevention, be sure to check out our ‘Reducing the Risk of Patient Falls’ online CE course from the Lippincott Professional Development Collection competency validation software.  This course is from the Patient Safety program set which was co-developed in partnership with Joint Commission Resources (JCR) and is accredited for 1 hour of CE credit.    

Click HERE to check out a free preview and learn more about institutional subscriptions of Lippincott Professional Development Collection for your facility.   

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