Promotion of Patient Safety and Falls Prevention
Introduction Falls can be problematic for people of all ages, especially for the elderly. Falls are the second most common adverse event within the healthcare system (Quigley, 2006). Falls can result in serious injury and even death. Falls can be costly and most are preventable. Nearly one-third of older adults have experienced a fall, and about one in ten have resulted in a hospital stay due to injury (www.cdc.gov, n.d.). Older adults are more prone to falls and injury than other patients due to their age and accompanying illness (American Society of Registered Nurses [ASRN], 2008). The question is how can nurses promote patient safety and prevent falls?
First we have to identify the risk factors for falls and incorporate them into a plan for reducing falls and instructing in home safety and falls prevention. Some risk factors include: mobility impairment due to weakness or loss of balance, prior strokes, some changes in vision, loss of sensation in feet due to neuropathy, medication usage/misuse, and environmental factors. Therefore, the purpose of this study is to answer the following question, will reducing patient’s risk factors help to prevent falls? Literature Review Several preventive strategies have proven effective to reduce the occurrence of falling and the nurse plays a preventive role by reducing the rate of falling in the elderly community (ASRN, 2008). Regular evaluations can help to identify the high risk patients. Most falls occur at or near the bedside and that the falls occur while walking, trying to climb over bed rails, and accidentally rolling out of bed (ASRN, 2008).
Medications, visual problems, and unsteady gait play a role in the number of falls in the elderly, especially during the night or using the toilet. About 11% of falls occur while toileting and 4% occur while in bed sleeping or repositioning (Tzeng & Yen, 2012). Environmental safety precautions are key to reducing falls. Prescribed psychoactive medications are a potential risk factor, one that can pose a threat to the safety of elderly patients (Swartzell, Fulton, & Manz Friesth, 2013). In a hospital study, 46% of the
fallers were taking one or more benzodiazepines compared with the ones not taking this drug. More of these fallers had this drug prescribed during their current stay, leading researchers to believe that an alternative to night sedation should be sought for the elderly (ASRN, 2008). Research has not shown consistent evidence for effective preventive interventions (Tzeng & Yen, 2012). Interventions need to be implemented along with assessing for risk factors.
Traditional fall prevention strategies, like risk assessment and universal falls precautions have yielded mixed results (Quigley, 2006). Few hospitals have implemented programs that focus not only on falls prevention, but in reducing fall-related injuries (Quigley, 2006). Fall prevention strategies include educating the staff about care, training staff in risk assessment, using alarm devices, monitoring for medication side effects and adjusting doses as needed to promote patient safety (Tzeng & Yen, 2012). Fall-prevention programs have had limited success because not only do patients have increasingly complex disorders or functional deficits, but staff often fail to consider risks such as a patient’s tendency to overstep physical limitations (Tzeng, Mei Hu, & Yin, 2011). None of the assessment tools used to predict falls and assess falls risk can be generalized to all hospital patients (Lovallo, Rolandi, Rossetti, & Lusignani, 2009).Two assessment tools were deemed more interesting from experimental point of view since they were more practical (Lovallo et al., 2009).
Evidence shows that multicomponent interventions can reduce risk for in-hospital falls by as much as 30% (Miake-Lye, Hempel, Ganz, & Shekelle, 2013). Not much research has been done to determine if increasing nutrition and body weight, smoking cessation, and hormone replacement therapy would help to reduce the number of falls (Boye et al., 2012). Osteoporosis is a major cause of broken bones during falls, and altering these factors could lead to a decrease in injury related to falls. Increasing vitamin D in the daily routine may help to reduce bone injury. Purpose The purpose of this study is to test the following hypothesis, if a nurse can alter risk factors for falling, will the nurse be able to prevent the falls from occurring, to explore the relationship between high rate of falls and risk factors. Methods Design This quantitative study will use a prospective design.
Population The setting for this study will be an acute care hospital, using several units throughout the hospital. It will use random sampling of patients that are admitted to the hospital. This study will include men and women with varying health concerns. Procedure Data will be collected through chart reviews and patients will be asked questions based on the falls risk assessment profile that the researcher will chose to use. The risk assessment will be multifunctional, will be able to be used across all units in the hospital, and will be able to be applied to all patients. All answers to the falls risk assessment will then be analyzed. Permission for this study will be obtained prior to commencement of data collection.
References
American Society of Registered Nurses. (2008, January 1). Elderly falls: The nurses preventative role. Journal of Nursing. Retrieved from http://www.asrn.org/journal-nursing/256-elderly-falls-the-nurses-preventative-role.html Boye, N., Van Lieshout, E., Van Beeck, E., Hartholt, K., Van der Cammen, T., & Patka, P. (2012). The impact of falls in the elderly. Trauma, 15(1), 29-35. http://dx.doi.org/10.1177/1460408612463145 Lovallo, C., Rolandi, S., Rossetti, A., & Lusignani, M. (2009, November 13). Accidental falls in hospital inpatients: evaluation of sensitivity and specificity of two risk assessment tools. Journal of Advanced Nursing, 690-696. Miake-Lye, I., Hempel, S., Ganz, D., & Shekelle, P. (2013). Inpatient fall prevention programs as a patient safety strategy [Supplemental material]. Annals of Internal Medicine, 158(5), 390-397. Quigley, P. (2006). Bundle of interventions targeting high-risk patients reduces falls and fall-related injuries on medical-surgical units. Retrieved from http://www.innovations.ahrq.gov/content.aspx?id=2648 Swartzell, K. L., Fulton, J. S., & Manz Friesth, B. (2013). Relationship between occurrence of falls and fall-risk scores in an acute care setting using the Hendrich II Fall Risk Model. Medsurg Nursing, 22, 180-187. Tzeng, H., Mei Hu, H., & Yin, C. (2011, November-December). The relationship of the hospital-acquired injurious fall rates with the quality profile of a hospital’s care delivery and nursing staff patterns. Nursing Economics, 29(6), 299-316. Tzeng, H., &
