Falls are one of the most common causes of injury to patients and 10% of fatal falls
for those over age 65 occur in the hospital. The Robert Wood Johnson Foundation
discussed findings that had been published in the New England Journal of Medicine
that found that clinician interventions, especially by those trained in preventing
patient falls, can reduce patient falls (at least for those age 70 and older) when
compared to those patients where clinicians have not received this training. In
2000, the Joint Commission issued a Sentinel Event Alert. At that time, they had
been tracking sentinel events for four years. They had reviewed 22 cases related
to fatal falls in 24-hour care settings. Most of the patients reviewed were elderly,
with half being older than 80 years of age. One-third of all these cases involved
falling from a bed. Others occurred while walking, in the bathroom, or from a commode,
gurney, or chair. Seventeen of these 22 individuals had an altered mental status
when they fell.
As part of their efforts to prevent patient falls, the Veteran’s Administration
(VA) has produced a toolkit that is useful to nurses. Included in the toolkit is:
- Information for designing a falls prevention and management program
- Effective interventions for high-risk fall patients
- How to implement hip protectors for high-risk fall patients and
- Information on educating patients, families and staff on falls and fall-injury prevention.
Because nurses are at the bedside, they can do the most to assess the risk for falls
and implement preventive measures.
The Minnesota Hospital Association used the work of the Veterans Integrated Service
Network 8 Patient Safety Center along with Minnesota Adverse Health Event Learnings
to develop a “Road Map to a Comprehensive Falls Prevention Program”.
This includes practical suggestions for using the toolkit to develop a program for
a healthcare organization.
The Pennsylvania Patient Safety authority published an article titled “Medication
Assessment: One Determinant of Falls Risk (Vol 5, No. 1, March 2008)”. In
this article, they discuss how medications have compounding effects that increase
the potential for falls or the potential for harm from falls. Commonly prescribed
medications, including antidepressants, anxiolytics/hypnotics, and insulin and oral
hypoglycemic increase the risk of falling by causing changes in cognitive and physical
function, dizziness, balance difficulties, confusion, and sedation. Routine medication
assessment and reassessment as part of identify fall risk is important when intervention
are implemented to prevent patient falls.
References: Preventing Falls
