How do you expedite the recovery of a hospitalized patient? Regardless of the ailment, one common denominator is increased mobility. Linked to decreased length of stays, walking increases the odds of home discharge and fewer hospital-acquired morbidities. Yet falls are among the most common inpatient injuries and the most commonly reviewed Sentinel Event by The Joint Commission. So how do you balance the importance of mobilizing a patient while taking the necessary steps to prevent a fall that could lead to an even more severe injury? While a universal solution may not exist, implementing these fall prevention measures will effectively reduce their incidence.
The Impact of Falls During a Hospital Stay
It’s estimated that between 700,000 and 1,000,000 people in the United States fall in the hospital each year.¹ Although some falls don’t result in patient harm, one-third cause injuries including fractures, lacerations and internal bleeding.² As you might expect, this increases the length of stays and the cost of care.
In addition, even a “no harm” fall, one that doesn’t cause physical harm, can create problems including stress, especially among older patients and their families. This often leads to restricted activities, a further loss of strength and reduced independence.
Why Do Falls Occur During Inpatient Care?
Falls are most common with elderly patients, especially those with delirium or who have underlying problems with strength, mobility, or balance. However, falls can also occur in non-elderly patients who are acutely ill. Further, medications are a leading cause of falls for patients of all ages, especially those who are taking psychoactive medications.
The psychoactive medications that are often associated with increased fall risk include:³
- Eszopiclone, Zaleplon and Zolpidem
In addition, there are other "culprit" medications that increase the risk of falls. These include certain over-the-counter drugs frequently utilized by patients that encompass various classifications and well-known brands like:
- Sedating antihistamines - Benadryl, Nyquil or Tylenol PM
- Medications for vertigo, motion sickness, or nausea - Antivert, Scopace, and Phenergan
- Oral medications for itching - Benadryl
- Muscle relaxants - Flexaril
- Antidepressants - Paxil CTA
How Do You Prevent Falls During Inpatient Care?
Although certain aspects of fall prevention are highly routine, like many areas of care, preventing falls necessitates the management of numerous variables that vary from patient to patient. The crucial factor lies in identifying these discrepancies.
Assess For Fall Risk Upon Admission
Using an assessment tool helps to identify patients at risk and is the baseline for developing a personalized care plan. Although there are a variety of different tools, each checklist includes risk factors for falls and a numerical scale that predicts the risk. CTA
Key Fall Risk Factors
These seven areas are commonly associated with increased fall risk and require special attention:
When it comes to falls, history tends to repeat itself which makes the use of patient history an important factor. All patients with a history of falls in the past three months are considered at higher risk for future falls.
In addition, those that require mobility assistance through the use of canes or walkers are more likely to experience an inpatient fall.
The Impact of Medications
As noted above, some medications contribute to an increase in fall risk. The risk assessment will identify the drugs that are the most common culprits. If possible, the type and dosage of the drug can be adjusted. If not, the increased risk level must be noted and dealt with accordingly.
Patients that require more frequent toileting have a greater risk of falls.
Depending upon the unit a patient is admitted to, there are other common issues to guard against. For example, a patient admitted for surgery may have IV lines or other tubing during their recovery period that elevate fall risks.
In addition, patients with vision problems that don’t have their glasses handy may be completely stable and capable of walking to the bathroom, but not notice something on the floor that they trip and fall over.
Lastly, clutter in the patient's room is another fall risk that can be avoided.
Conversely, when it comes to the physical environment, there is a consistent factor that remains unaffected by individual patients. The positioning of doorways, handrails, toilets, flooring, and furniture placement remains unchanged. But, there are instances where the design may not be optimal. In such cases, proactive measures can be taken to minimize potential issues. It is worth noting that temporary or floating nurses may not possess the same level of familiarity, underscoring the significance of reviewing any distinct room or corridor designs as a crucial step in mitigating risks.
Falls aren’t only an issue in inpatient settings. With nearly 3.5 million patients expected to receive home healthcare this year, it's important to implement in-home fall prevention strategies.
These strategies include a range of measures and are similar to the steps taken in inpatient settings. It includes decluttering living spaces, porches, and sidewalks, as well as the removal of potentially hazardous area rugs and the secure placement of electrical cords to minimize tripping hazards along walking areas. In addition, with 70% of home healthcare patients aged 65 and above, and nearly half with five or more chronic ailments, the impact of medications is significant. Notably, lightheadedness is a potential side effect of medications, especially with changes in dosages or the types of medication being administered.
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