BLACK ELK MEDICAL CENTER

Patient safety is one of the nation's most imperative health care

issues. A 1999 article by the Institute of Medicine estimates that
44,000 to 98,000 people die in U.S. hospitals each year as the
result of lack of in patient safety regulations. Inhibiting falls
among patients and residents in acute and long term care
healthcare settings requires a multifaceted method, and the
recognition, evaluation and prevention of patient or resident falls
are significant challenges for all who seek to provide a safe
environment in any healthcare setting. Yearly, about 30% of the
persons of 65 years and older falls at least once and 15% fall at
least twice. Patient falls are some of the most common
occurrences reported in hospitals and are a leading cause of
death in people ages 65 or older. Falls often result in serious
injuries, such as fractures. For that reason, the impediment of
accidental falls is essential. The aim is to describe the design of a
study that assesses the effectiveness of prevention and
intervention strategies implemented to lessen multiple fall risk
factors in independently living older persons with a high risk of
falling.
For decades, hospitals and other health care organizations have
integrated to understand the contributing causes of falls, to
minimize their occurrence and resulting injuries or deaths. Today,
organizations have begun reaching out to each other for
collaboration on the best ways to prevent falls. Of those who fall,
as many as half may suffer moderate to severe injuries that
reduce mobility and independence, and increase the risk of
premature death. The mortality and financial burdens attributed
to patient falls in hospitals and other healthcare settings are
among the most serious risk management issues facing the
healthcare industry. For the patient and resident, consequences
include, but are not limited to, fracture, soft tissue or head injury,
fear of falling, anxiety, and depression
When making an attempt to analyze and implement intervention
strategies to falls, we must first examine the factors that cause
these incidents. It is generally accepted that patient falls are
caused by multiple factors. Another popular classification scheme
of falls is based on the assumption that they result from a
complex interaction of intrinsic and/or extrinsic risk factors.
Intrinsic risk factors for falls consist of changes that are part of
normal aging in addition to acute or chronic conditions. Causes of
these specific falls are impairments in balance, gait, muscle
strength, visual acuity and cognition, chronic diseases and use of
psychotropic medication. In addition to intrinsic, are the opposing
extrinsic factors. Extrinsic risk factors for falls are part of the
resident's environment and are most likely to be seen in areas
such as the bedroom, bathroom, dining room and hallways.
Environmental factors account for up to one-half of all falls
among elders. The risk of environmental hazards contributing to
falls is greatest in those individuals with poor ambulation and
transfer abilities, which may result in a inequality between the
individual's mobility potential and the design of the surrounding
environment. For example, individuals with poor gait are at a
greater risk of loss of balance and falling while walking on waxed
or slippery floors than those individuals with usual gait.
Due to the fact that the rate of falling increases partly with
increased number of pre-existing conditions and risk factor, fall
risk assessment is a useful guideline for practitioners. One must
also determine the underlying etiology of “why” a fall occurred
with a comprehensive post-fall assessment. Fall risk screeners
and post-fall assessment are two interrelated, but distinct
approaches to fall evaluation, both recommended by national
professional organizations.
With the numerous intrinsic and extrinsic factors leading to falls,
it is probable to regard each factor and recognize constructive
steps and safe interventions proven effective for preventing falls.
Here are several interventions that can be employed in the best
interest of the medical center:
• Inform and educate patients and /or family members
regarding a plan of care to prevent falls.
• Observe environment for potentially unsafe conditions, such
as loose carpeting and water on the floor. Notify appropriate
department(s) of hazardous conditions.
• Consider peak effect for prescribed medications that affect
level of consciousness, gait and elimination when planning
patient care
• Instruct the patient to wear non-skid footwear, considering
the type and condition of footwear such as ill-fitting shoes or
incompatible soles
• Place assistive devices such as walkers and canes within a
patient’s or resident’s reach.
Intervening falls can reduce the financial burdens attributed to
patient falls in hospitals and other healthcare settings are among
the most serious risk management issues facing the healthcare
industry.
Fall risk assessments tools, which help to identify those patients
at risk of falling, play a vital role in reducing the number of falls.
The basis for this assessment is that if patients at high fall risk
can be acknowledged, then proper interventions can be instituted
to minimize this risk. Assessment tools may also assist in
stratifying or targeting the urgency and types of interventions
required, and play a role in raising staff awareness of the risk of
patients/residents falling. A fall risk screener also promotes the
ability of staff to use time and resources more competently, and
allows the staff to identify specific risk factors and initiate more
effective fall prevention strategies.
Preliminary fall risk assessments should be completed upon
admittance to the hospital or care homes since patients are
subject to a change of condition, fall risk factors are subject to
adjust as well. In effect, reassessment of fall risk needs to be an
ongoing process and should be completed whenever
patients/residents experience a change of condition or
medication, daily/every shift in certain high-risk
patients/residents, and immediately post-fall.
Initial fall risk assessments should be completed upon admission
(within two hours of admission). Since patients/residents are
subject to "a change of condition" (in other words, acuity of
illness, medication and co-morbidity changes affecting mobility,
cognition, etc.), fall risk factors are subject to change as well. As
a result, reassessment of fall risk needs to be an ongoing process
and should be completed whenever patients/residents experience
a change of condition or medication, daily/every shift in certain
high risk patients/residents (for example, recent confusion, taking
sedatives, recent fall, temporary acute illness, etc.), and
immediately post-fall. The purpose of the post-fall assessment is
to identify the circumstances or cause(s) of the fall, identify the
presence of new risk factors, and plan appropriate interventions
to prevent further falls. Post-fall assessments are beneficial in
detecting and eliminating precipitating factors for falls (in other
words, remember that falls are a marker of underlying disorders).
The notion of common precautions has been used successfully by
several facilities. This idea acknowledges that all patients, even
"low-risk" individuals, are potentially at certain risk of falling.
Thus, low-risk individuals would receive universal precautions
(such as setting bed at lowest level, ensuring that
patients/residents have necessary items/call bells within easy
reach, assessing/eliminating potential environmental hazards,
etc.) For those people "at-risk", interventions should be more
specific and based on identified risk factors (such as maintaining
regular toileting, re-orienting confused individuals, and assessing
for need of side rails as enablers, need for ambulatory aids, need
for sensor alarms, need for hourly rounds or one-to-one nursing,
need for room re-location close to nursing station, etc.) It's
significant to remember that as risk factors transform,
interventions may have to change as well.
Additionally all staff should be required to complete
competencies. As noted above, there is no single fall prevention
care plan that will work for all patients and residents and for all
situations or settings. Based on a falls risk assessment, the
healthcare team should tailor patient-specific prevention
strategies.
Because patients fall in a variety of situations, and these falls are
due to innumerable causes, there cannot be one routinized care
plan to prevent falls. Although some prevention strategies are
obvious and may be used with many patients, other patients
present more of a challenge and demand creative and innovative
solutions to ensure patient safety.

REFERECENCES
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