Inpatient Falls: A Widespread Issue in Healthcare
Inpatient falls are a widespread event in healthcare, occurring in all health facilities. This issue has piqued the interest of many medical researchers, resulting in a large amount of data. This work is a study of inpatient falls. The report puts the data of inpatient falls into context and makes preventative recommendations. A review of existing literature explores the effects of patient fall and recommendations to prevent falls.
Keywords: delays of care, ER overcrowding, fall, increased mortality, jeopardize patient safety, national health crisis, nursing care, and staffing shortage
Introduction
Inpatient falls have become an issue of concern in the healthcare facilities globally. The definition of fall is an accidental descent of a patient to the floor that may lead to injury (NDNQI, 2013)). This phenomenon has repercussions on the victims ranging from worsening their already wanting health condition to causing death in severe circumstances. Medical experts have gone ahead to investigate inpatient falls and suggest as well as implement solutions to this health issue. This text is a research paper on inpatient falls based on several objectives. First, the study covers all-inclusive and concentrated physical, psychological, behavioral, socioeconomic, spiritual as well as the environmental assessment of well-being and disorder limits in patients; integrating developmentally besides culturally suitable approaches. Next are the principles of quality improvement, cost effectiveness, and healthcare policy to help develop and initiate effective procedures for the microsystem and broad practice enhancements that would promote the standard of healthcare provision. The third objective is to integrate evidence, inter-professional perspectives and patient preferences in planning, clinical judgment, applying and evaluating outcomes of healthcare. The other objective is to analyze data from all significant sources comprising technology to inform the delivery of care. Fifthly, to collaborate with stakeholders to advance an intervention plan that considers the elements of health, resources availability, and the array of actions that influence the health as well as the prevention of injury, illness, disability, and untimely death. Finally, to develop a safe care setting that effects in desirable patient outcomes. This research on inpatient-falls aims at understanding this problem and recommending the right measures to take.
Purpose
This study handles the pertinent issue of inpatient falls. Inpatient fall risks the health lives of the admitted patients, and currently, accounts for some death cases in hospitals. The rationale of the study is to assess the inpatients, the health facilities and policies appertaining to inpatient falls. Collecting background data on the phenomenon and analyzing statistical information is of the essence in determining the approaches to dealing with inpatient falls. Multifaceted approaches work in handling inpatient falls. I applaud previous efforts on this matter and an approach that is more comprehensive for prevention. Various health practitioners and healthcare administrations have significant policies.
Literature Review
Approximately 424000 people die annually from falls, with most fatalities being adults over 65 years (World Health Organization, 2016). Over 80% cases of fall are in the third world countries. About 37.3 million cases are severe and require medical attention. Prevention of fall requires safe healthcare environments, education, training, and research. Sakai et al. (2016) observed that patient falls within the hospital settings were causing death by resulting to unintentional injury. The patient falls inadvertently without their awareness or that of the doctor. The surface they fall on leads to injury or even death for example if it leads to disconnection of the victim from a current medical machine treatment or fluid flow from an external source.
Cox et al. (2015), examines the extrinsic, intrinsic and staff factors contributing to falls among inpatients. There are risk factors that are intrinsic or extrinsic. The fundamental factors leading to inpatient fall include psychological, physical and biological functioning of the body predisposing the patient to fall. External factors include slippery floors, poor lighting and lack of orientation to the hospital environment. Staff factors entail the irresponsibility of the hospital workforce in charge of the inpatients. Emergency Room (ER) overcrowding also leads to poor aeration triggering other biological factors leading to the fall of a patient. Delays of care further enhance falling. Both factors combined lead to increased mortality. Staffing shortage has led to the national health crisis in some countries.
According to Vaccari et al. (2014), the safety of the environment is of critical significance in preventing falls in the elderly. The reason is that the elderly may have some visual impairment or reduced motor coordination while walking hence may stumble and fall if there are hazards such as obstacles on their path. Their health deteriorates with age, therefore; they are more vulnerable to unpredicted falls. In healthcare facilities, risks jeopardize patient safety, for example, glass bottles in the ward risk causing cuts on the patient if they fall.
Application of Literature Findings into the Practice
Inpatient fall is a problem encountered all over the world and much more in the middle and low-income countries. In America, fall is a common scenario that researchers have put into perspective and the medical practitioners are taking action. The primary area of concern is the hospital environment that may directly lead to inpatient fall. The nursing staff should do away with hazards that increase the risk of fall. The nurses are responsible for the wellbeing of the patients besides attending to the general service chores. Therefore, they can bring under control the external fall factors. On the other hand, the patients need education on the intrinsic factors that lead to fall and the necessary precautions to take to avoid this occurrence. The hospital management should arrange to ease ER overcrowding hence avoid falls in the queue. Delays of care and staffing shortage are major impediments in healthcare to address and avoid congestion. The entire hospital vicinity should be well aerated and tidy. The elderly require guides whether their family members or nurses to lead them around to prevent falls. The healthcare staff is needed to remove hazards that are a threat to people accessing the health facility. The medical experts should offer advice on inpatient fall and consistent medical attention to particular victims of fall. The senior staff, doctors, nurses and the subordinate staff should work harmoniously for the common good of the fall victims. The hospital infrastructure should align to the individual needs especially the protective gadgetry and private medical aids.
Recommendations from Evidence-Based Data
Prevention of inpatient falls a challenge that has financial implications, and the healthcare providers should confront it. One of the key recommendations is video monitoring (Votruba et al., 2016). The video involves connection of all the wards beds, wards and the entire vicinity of the health facility with video cameras into a control center where technicians will track the movements of patients whether deliberate or inadvertent. Tzeng & Yin (2015), suggest that engagement of patients is an effective strategy to reducing falls in hospitals. The nursing staff should be patient-centered and put extra efforts to reach out to the vulnerable patients. These nurses should be available for the patients and guide them as they move around especially to the washrooms. We should address staffing shortage adequately to avoid national health crisis.
Tzeng & Yin (2015), also discuss the Hendrich II Fall Risk Model. The design highlights seven risk factors of falling: Confusion, altered elimination, symptomatic depression, dizziness, anti-epileptics, the standing assessment test and male gender factor. The 13 Universal Fall Precautions according to Agency for Healthcare Research and Quality (AHRQ) are significant measures to apply:
- Ensure patients are familiar with the care environment
- Observe safe approved practices of handling patients in that particular hospital
- Patients to demonstrate call light use
- Fix secure handrails in patient rooms
- Always lock the hospital bed brakes
- Provide patients with comfortable, non-slip footwear
- Keep the care area tidy and well aerated
- Keep the floors tidy and dry
- Ensure that the luggage of the patients is within reach
- Keep stationary wheelchairs locked
- The call light should be within patient's reach
- When a patient is at rest maintain the hospital bed at a small position and while on transit raise it to a comfortable level
- Hospitals can use supplemental lighting in patient care areas.
Patients are required to observe the following precautions:
- Wear shoes or slippers which cannot slide every time they get out of bed
- Call the nurse for help whenever they feel weak or dizzy.
- Consult the nurse before going to the bathroom.
- Avoid leaning on movable objects such as wheelchair or tray table for support.
- To use their glasses and hearing aids at all times.
- Utilize the handrails in the hallway and washrooms.
- Make sure personal things and communication gadgets are within reach especially call buttons.
Awareness of the fall risk factors is a measure to prevent this problem by avoiding the risks. Gregory (2013) outlines the intrinsic and extrinsic factors that lead to falling. The natural fall factors include visual impairment, previous falls, imbalance, muscle weakness, fear and chronic conditions such as dementia, diabetes, stroke and arthritis. Extrinsic fall risk factors to watch out on include particular medications, poor lighting, slippery surfaces, misuse or failure to use assistive devices, and absence of stair handrails and bathroom guardrails. Moreover, the caregivers should ensure home safety by engaging a medical professional to assess and modify the home environment, eliminating any hazards. There is need to evaluate the healthcare system: the health facility, the staff, the administration and the patients. The socioeconomic status of the system matters a lot. Are these components able to relate well to the economic state of the nation? The physical aspect of the system touches on the infrastructure of the health facility, the health situation of the patients and the willingness of the nursing staff. If we formulate appropriate policies to align the trio, then we will prevent inpatient fall. A result-oriented approach can work nicely. The behavioral aspect will also help in implementing effective measures. The doctors and nurses should conduct themselves professionally and go ahead to empathize with the patient who is susceptible to falling. The patient also needs to be cooperative and inquisitive to get maximum benefit from the caregiver. The family caregivers should be gracious, patient and knowledgeable about the condition of their dependents. Spiritual care is vital for the patient to influence their emotions and perceptions positively. Some illnesses are resistant to medical interventions and are believed to have spiritual causes hence such demand spiritual solutions. Therefore, mere medicine and care provision does not suffice. Religious leaders such as priests are involved and even allowed to visit and pray for the sick.
The Joint Commission's Recommendations
The Joint Commission (2015) recommended the following actions to prevent inpatient falls and the resultant injuries:
- Create awareness of the need to prevent inpatient falls
- Form an interdisciplinary team for preventing falls
- Utilize standard tools of identifying fall risk factors, for example, Morse Fall Scale and Hendrich II Fall Risk Model
- Develop an individual care plan for a patient
- Standardized practices such as personal education of the patient and hand-off communication
- Conduct post-fall assessments to help improve patient care and preventive measures
Measures Currently Used to Improve Patient Safety
Patient safety team refers to a team of nurses in charge of the patients' movements to ensure the security. For instance, if the patients need to visit washrooms the nurses watch their movements to keep them safe. Nicolas, Gayanilo & Bellas (2016) observed that a contract between the patient, their family, and a therapist works well. The nurse takes full responsibility for the patient in need of the services. This care provision is typical of the cases of epilepsy where the patients have a high likelihood of falling due to various negative stimuli. Some medications such as X-rays trigger lowering of the patients. Therefore, at admission, the hospital management issues the patient and his or her family are with a contract, which they read and sign to give consent to the possible risks. The healthcare facilities also have unique rooms such as the washrooms for the vulnerable patients to ease crowding. Prohibiting painful stimuli such as loud music and smoking in the healthcare premises keeps the patient in excellent comfort.
Other measures involved to enhance patient safety include quality improvement policies. In various hospitals, health policies guide the course of action with a common goal of providing quality health services. Well-defined models are useful and the components of the healthcare system coordinate to achieve results. Categorically in the issue of falling, much research, data is available thus forming a basis for policy development. Through the data, the professional collaborates in their intervention plans to the challenges of the medical field. The rationale of the studies is to create safe care environments free of inpatient falls.
The National Database of Nursing Quality Indicators (NDNQI) went ahead to categorize the falls with an aim to create awareness among the healthcare organizations on the risks to check through their staff (Vincent et al., 2015). First, there are intentional falls by the patient for unclear personal reasons such as in psychiatric units. Next, there are pediatric falls where infants fall in the process of learning to stand during the process of development. To counter these falls adequate adult supervision is necessary and the surface on which the babies walk furnished with soft material to prevent injuries. The third category is baby drop whereby a baby rolls off the edge of a bed or furniture and unfortunately falls. This fall is prevented by making sure that that the mother or caregiver in the ward is alert and while with the baby and when asleep. Lastly, patients fall outside the bed and the care room, especially in the washrooms. This kind of fall can be prevented by installing preventive gadgets and devices in the toilets and monitors the moves of the patient.
Outcomes Data Related to the Measures
Between 0.7-1 million inpatients fall every year, a report by the Agency for Healthcare Research and Quality (Butcher, 2013). This data indicates that inpatient fall is real in all healthcare centers. Furthermore, the report stated that the drops increase operational costs of hospitals by over $ 13,000 and the length of hospitalization by approximately six days. This price reflects on the expenditure of the government. 30-50% of falls result in injury (Joint Commission, 2015). The injuries range from minor to serious infirmities. Godlock et al. (2016) admitted that the Patient Safety Team is an intervention that reduced the rate of inpatient fall by a great deal from 1.90 to 0.69 for every 1000 occupied bed days. Studies indicate 62% decrease in falls with injury and 35% reduction in the fall rate (Health Research & Educational Trust, 2016).
Advantages and Disadvantages of the Measures
Patient safety teams ensure there are individuals specifically assigned the duty of ensuring safety for the patients. Their concern is to see that patients do not succumb to any fall. The security team offers the patients a geographical orientation of the hospital premise upon admission when the patient's health status has improved to reduce chances of falling for being displaced or sliding. However, the fall may result from the side effects of medicine prescribed by the doctor. Orientation is not possible in the cases of severe illnesses; instead, the patient demands exceptional personalized care. Regarding predicted falls, prevention, medication or appropriate therapy is administered to the victim in time. The disadvantage of safety teams is that they may be unreliable in some cases or inconsistent in service delivery. For instance, if they are on leave and replaced by other staff members who do not have the details of the patient.
Medical contracts are significant for the risky medications that have dire side effects on a patient to shield the doctor from blame where there is no free treatment. The disadvantage is that an erroneous doctor may take cover under this contract and may encourage irresponsibility careless physicians.
Appropriate hospital infrastructure is vital in preventing accidents of falling, for instance, fixing handrails at the right places. Embracing patient-friendly amenities such as washrooms is an advantage to curb falls. The junior staff should always make sure the facility is tidy avoid slippery floors. Video-monitory will help report emergency cases of fall hence the doctors can act accordingly to prevent death or further injuries. The demerit of videos is that it may encourage laxity and cases of post-fall attendance on the patients.
The greatest responsibility is on how patients conduct themselves because there are times of the night when they have to be left alone. Leaving their great gadgets and personal baggage near the patient will reduce the chances of standing and walking which would expose them to the risk of falling. The communication alarms and telephone are of fundamental importance in the case of sudden discomforts that would lead to falling. The demerit is that the patient may lack guidance on using vital resources at night while alone. All that is important is the patient to follow instructions. However, their medical conditions or aging may be a significant obstacle.
Conclusion
This paper presents a comprehensive research on inpatient fall. The introduction highlights the objectives of the study. I stated the purpose of the survey. The literature review presents the facts about inpatient fall from the previous studies. An application of the literature findings focuses on the significance of the secondary data to this research. I have made recommendations on the problem of inpatient fall based on existing data. I acknowledge the current measures to ensure patient's safety I have also analyzed the merits and demerits of the preventive measures of inpatient fall. Inpatient fall is a global problem that needs attention and solution. The patients, the medical practitioners, and the society have a role to play in improving this situation.
References
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Appendix A
Questionnaire
How to prevent in-patient fall at your Health Facility
What is the prevalence rate of in-patient falls at your healthcare center?
Which factors contribute to in-patient falls as noted in your healthcare facility?
How do you utilize the available resources to curb inpatient falls? Are there other resources you intend to purchase or install towards this course?
State and explain the activities that contribute to health and prevention of injury, illness, disability and premature death.
What measures are you taking to prevent in-patient falls?
How can we engage technology to provide solutions to in-patient falls?
Make recommendations on how to check the issue of in-patient falls in healthcare facilities.
