Falls: Why Worry?

The safety of your patient/client is at risk!

  • Those who fall are more likely to fall again!

It costs your hospital!

  • Charges for fall related inpatient hospitalizations involving Kentucky residents (safeky.org):
     2005: $ 121,102,944
     2014: $  366,503,660
     

For more information:
Centers for Disease Control and Prevention
www.cdc.gov/Features/FallRisks/

 

Intrinsic fall risk factors:

 

  • Reduced balance/Gait instability
  • LE weakness
  • Previous fall history
  • Impaired judgment
  • Psychoactive meds: narcotic, hypnotics
  • Urinary incontinence

 

Extrinsic fall risk factors:

  • Environmental
    • Wet Floors
    • Dark Room
    • Clutter
  • Call light not in reach
  • Bedside commode not in reach
  • Non grip footwear
  • Glasses not available

National Center for Patient Safety Falls Toolkit (2004).
http://www.patientsafety.gov/SafetyTopics/fallstoolkit/index.html

 

Slider Assess Risk of Falling and Fall Prevention Tools

Perform standardized fall risk assessment for all patients on admission and whenever patients' clinical status changes.

Communicate clearly: Identify risk with floor transfers.

Communicate clearly: Identify risk to patient, family, and next environment of care during transitions.

Communicate clearly: Identify at every shift the patients most at risk of moderate to serious injury from a fall.

Institute for Healthcare Improvements. Fall Prevention. Available at http://www.ihi.org/explore/Falls/Pages/default.aspx. Accessed May 9, 2012.

 

Things to consider: Choosing an appropriate fall risk assessment tool to identify those at risk for falls must take into consideration psychometrics of the tool, generalizability to acute care and feasibility.

Kim EAN, Mordiffi SZ, Bee WH, Devi K, Evans D.Evaluation of three fall-risk assessment tool in an acute care setting.JAN.2007;60(4):427-435.

Institute for Healthcare Improvements. Fall Prevention. Available at http://www.ihi.org/explore/Falls/Pages/default.aspx. Accessed May 9, 2012.

Screening instruments and forms

Fall T.I.P.S. (Tailoring Interventions for Patient Safety)


Dykes, et al. Fall prevention in acute care hospitals. JAMA. 2010;304(17):1912-1918.

Dykes, et al concluded that the use of the fall prevention tool kit significantly decreased the rate of falls in the hospital setting.

Morse Fall Scale, Morse


Morse, J. M. (1997). Preventing patient falls. Thousand Oaks, Sage Publications.
http://www.patientsafety.gov/SafetyTopics/fallstoolkit/
media/morse_falls_pocket_card.pdf

Fall Risk Factors are taken into consideration and totaled to determine a total score. The fall risk factors and target interventions needed for that patient/client are then implemented to reduce risks. This tool is used: upon admission, when the patient/client has experienced a change of condition, when the patient/client is transferred to a new unit, and after a fall.

  • Sensitivity .83, Specificity .68, for predicting falls
  • Interrater Reliability 83-100%
  • Cut off threshold score to indicate intervention: >45

 

Interventions

Several risk factors associated with acute care are also part of the general risk factor list on the main page. If you are looking for any of the following risk factors, please see the main page.

For setting-specific risk factors and the appropriate interventions, read on.

Extrinsic Risk Factors

Inpatient environmental hazards:

Facility managers ensure:

  1. Lighting, locked doors
  2. Handrails secure, sturdy tables
  3. Clean dry floors
  4. Adequate equipment check out
    • Transporting plinths
    • Wheelchairs

Home/environmental hazards:

If your patient/client's fall has resulted from environmental or home hazard, provide an educational home/environmental hazard assessment hand out and information on utilizing community resources such as:

  • Agricultural extension
  • Community Action Agency
  • Area Agency on Aging
  • Faith community

Consider an educational print out to offer your patient/client and a referral to Physical Therapy/Occupational Therapy.

Make your therapist a part of the patient/client's team.

Urinary incontinence:

Urinary incontinence programs:

  • Hourly toilet checks
  • Bedside commodes
  • Reminder signs in room

If your patient/client has fallen due to inability to get to the bathroom in time, refer to urinary stress incontinence expert.

  • In addition to medical management consider a referral to Physical Therapy.

Make your therapist a part of the patient/client's team. (pdf)

 

Additional Considerations

You may need to consider the following:

Flag your high risk patients!

Bedside alerts of fall risk patients whose cut off scores indicate a "high risk" patient/client for falls.

Dykes, et al. Fall TIPS: strategies to promote adoption and use of a fall prevention toolkit. AMIA. 2009: 153-157.

Use your judgment.

Assess:

  • Patient/client's medical status changes
  • Cognitive status changes
  • Change of floor
  • Change of meds
  • After a fall
  • After a near-fall

Note what is NOT effective in reducing the risk of falls:

Use of bedrails (as the primary approach)

Instead use:

  • Lower beds
  • Mat/mattresses on the floor
  • More frequent supervision

van Leeuwen M, Bennett L, West S, Wiles V, Grasso J. patient falls from bed and the role of bedrails in the acute care setting. Aust J Adv Nurs. 2001 Dec;192:8-13.

 

Chair or bed restraints

Instead, consider bed and/or chair alarms

 

Minimizing mobility

Instead, early and frequent mobilization is needed

 

Patient/Client Education

Distribute educational prints out to your patients/clients.

Please refer your patients to the "Adults and Families" section of this website for tips on falls.

How do I react if my patient/client falls?

  • Immediate patient/client assessment
  • Document, communicate
  • Huddle approach
  • Drill down for the root causes
  • Document
  • Assess patient/client for future risk
  • Engage family
  • Avoid a culture of blame
  • Make a plan for change as needed

Institute for Healthcare Improvements. Fall Prevention. Available at http://www.ihi.org/explore/Falls/Pages/default.aspx. Accessed May 9, 2012.