Patient fall refers to the patient’s accidental landing on the ground, either when being supported or unassisted by someone who may or may not result in injury.
In Morris and Isaacs’ words, “a fall is an untoward incident in which the patient accidentally comes to rest on the floor” (Morse, 1996).
The fall injury may be mild or severe. Hospitals are taking various preventive steps to avoid falls. This can be in the form of low rise beds, closer distance call lights, placing floor mats, toilets at closer intervals. The patient’s condition should be adjusted to mitigate the risk of patient dropping. It is said that every year 33 percent of adults over 65 years of age drop. Twenty percent of adults experiencing fall experience mild to serious injury. The approximate hospitalization cost to a patient’s demise is around $17,500. Falls were referred to as “an indication of responsive nurse quality” (Castex & Albright, 2010).
Most of the falls occur in and around the bed and bathrooms of the patient, which are sometimes overlooked. Falls from patients are correlated with some very severe consequences. A patient’s fall has a negative effect on his self-confidence, leading to fear of falling and ‘post-fall anxiety syndrome.’ A severe fall reduces the patient’s mobility and restricts his ability to perform daily activities. The collapse of the patient makes him more vulnerable to illness and can have a crippling effect. Even it could lead to death. After one year, 50 percent of people suffering a big fall die. The duty or liability associated with a fall rests with staff at the hospital and the authorities (Simmons, 2010).
The hospital has to bear considerable costs related to dropping admissions. Identifying preventive steps to manage declining rates is of critical importance to hospitals. This paper analyzes whether bed alarms can be used to minimize hospital falls.
Background and Significance of the Issue
Inpatient falls are a significant safety concern in hospitals because the falls can cause severe harm to the patient, have weakening effects, and can even lead to death. The patient’s prolonged stay in the hospital increases the associated costs that the hospital has to bear if the patient stays for a longer duration. The growing demand for patient follow-up, medical needs, and the costs of diagnostic services contribute to the hospital’s increased costs (Hernandez, 2005).
According to the Centers for Disease Control and Prevention (CDC) statistics, in 1994, the decline costs associated with older adults were reported at $20.2bn. This cost is predicted to increase by up to $32.4 billion by the year 2020 (CDC Injury Center, 2006).
Hospitals will bear significant costs related to the falls. 15% to 30% of the falls cause fractures in patients. This involves casting, surgery, or traction costs, and often even leads to death (Lopez & Et. Al., 2010).
The risk factors leading to dropping are a patient’s serious illness, the “patient’s polypharmacy management plan,” patient’s unfamiliarity with its environment, coordination loss, neurological disorder, vision deficiency, lack of adequate nutrition, musculoskeletal issues, and lower hip problems, numerous drugs, cognitive disability, hypotension, depression to name just a few (Dougherty, 2008).
Fall accidents can be very severe, particularly for the elderly. According to the MD, director of the Geriatric Research Education and Clinical Center at the Malcolm Randall VA Medical Center, Ronald I. Shorr, hospital fall rates are around “four to five falls per 1,000 patient days, or around one fall a day in a 250-bed hospital” (Simmons, 2010).
Further, it is also said that one-third of such falls cause injuries out of which 2% is severe. The ‘fallers’ in the hospitals can be classified into frail people and those people who do not wish to bother the nurse. Surprisingly the injuries in both cases are similar because it has been seen that older and frail people have a better knowledge about how to minimize the impact of the fall (Simmons, 2010).
The health care service providers are taking several measures to reduce the number of falls in hospitals. The installation of alarms is doing this, rooms are being designed and planned in a manner to build bathrooms closer to the bed, and fall risk assessments are regularly updated while communicating to the care team and adjusting the time of providing the medication to patients. It means ensuring that follow up care is provided to the patients even after they leave the hospital (Branzan, 2008).
The importance of the patient problem lies in the fact that such falls impact a large number of people and not just the patient. The impact of the falls is on the insurance companies, health service provider, hospital accreditation, families of the patients, and the state agencies. The patients may have to suffer psychological injuries in addition to physiological damages. The recovery may be prolonged, and the costs related to healthcare increases (Branzan, 2008).
The hospital charges associated with a patient who has experienced a fall is 60% higher than patients who have not experienced any fall. The cost associated with falls increases due to various reasons, namely resource utilization, the increase in the chances of unplanned readmission, and an increase in the length of stay.
The greatest number of nonfatal injuries among patients occurs due to falls, and these falls often lead to expensive lawsuits that the hospital authorities have to face, and they heavily increase health care costs. The US Center of Medicare and Medicaid Services in 2008 stopped the reimbursement charges related to the falls that resulted in injuries during hospitalization. A patient can be prevented if necessary precautionary measures are taken. It is expected that even private insurers will undertake policies whereby they would not pay for the injuries that occur from falls due to the negligence of the hospital staff (Lopez & Et. Al., 2010).
It is said that Patient falls have a relation with nurse staffing if the nursing staff is less in number, then the rate of patient fall increases (Whitman & Et. Al., 2002).
The issue has great significance on the nursing staff. This is because the nursing staff is entrusted to take care of the patient, and it is their responsibility to ensure safety for the patients. The increase in the rate of inpatient falls highlights the need for nursing staff training. Five dimensions of nursing strategies have been identified to prevent falls in patients. These are, namely, training and orientation, ensuring improved communication, continuous assessments, proper planning of care, and provisions, ensuring safer environments. Several measures are taken to reduce inpatient falls. This includes a screening of the fall risks, screening of injury risk for patients who have injury risk factors associated with them, fall prevention programs are implemented, a comprehensive assessment is done after fall occurs, safety education is provided to the staff, the underlying disease is treated, environmental and medication adjustments are made. Health care providers are implementing assessment tools to assess the fall risk, are developing strategies to prevent falls, and intervention guidelines are being developed to nurture a safe environment for the patients (Thirumalai, 1998).
The PICO question in this paper is, “Would requiring the use of bed alarms for all fall risks patients decrease the number of falls in patients while they are in the hospital?”
The patient problem, in this case, is the inpatient falls. The fall is generally seen in frail patients and old patients. The falls are a significant concern for the hospital since the fall results in injuries, which increases the costs the hospital has to bear as the patients have to be treated for a prolonged period after the fall occurs. The proposed intervention is the installation of bed alarms to avoid the fall. Comparison means choosing the best option out of many possible alternatives to minimize patient falls. The result determines the desired results currently to be achieved.
Comparing and Comparing Literary Facts
In Derrick’s (2008) master’s thesis, “Hospital-Based Patient Falls: A Clinical Engineering Perspective,” the primary aim of the research paper has been to reduce the number of falls and to reduce the impact of the fall. Multiple factors have been cited as the reason for falls. These factors are namely gait deficit, gender, age, elimination needs, fall history, location and time, medication, mental health, medications, and the patient to nurse ratio. A study that was conducted on inpatient falls in Midwest Tertiary Care Hospital revealed that factors, for example, primary diagnosis, location, medication, and initial diagnosis, determined the risk of falling of patients. Various risk assessment tools and preventive programs were identified. This research paper establishes the fact that preventive measures can reduce Patient falls to a certain extent.
A research paper by Tzeng (2007), “Heights of Occupied Patient Beds: A Possible Risk Factor for Inpatient Falls,” cites the high beds of the patient as a potential reason leading to their fall. The paper stresses that a better design of physical facilities can reduce patient falls, and it should incorporate safety measures (Tzeng & Yin, 2007).
According to a research paper by Castex & Albright (2010), “A Quality Improvement Project to Examine the Use of Bed Alarms on a Medical-Surgical Unit,” the use of bed alarms had reduced patient falls by 13% to 20%. This was found from three studies conducted on the use of bed alarms to minimize falls. The medical-surgical unit in Ochsner Medical Center had purchased beds in 2010 that were fitted with bed alarms (Castex & Albright, 2010).
According to JCAHO’s Hospital Accreditation Programs’ “Potential 2005 National Patient Safety Goals & Requirements,” bed alarms should be installed for patients who have high risks of falling (Hill Rom Services, 2006).
According to a research paper “Reducing Patient falls in Inpatient Setting” by Daugherty (2008), the use of bed chair alarms sets off a notification when a patient tries to get out of the bed or a chair. These kind of alarm systems are used for patients who have fall history, the bed mobility of these patients are unsafe, patients are in a confused state of mind, have cognitive deficiencies and are not capable of ringing the call bell. The alarm would be set in a manner that would trigger off only if enough weight was lifted off from the surface, indicating the patient’s attempt at getting out of the bed. Prior studies that have been conducted believe that such kinds of alarm systems can significantly reduce the patient falls and the related injuries.
Morse wrote a book (1996) titled “Preventing Patient Falls” patient falls are unacceptable, and therefore the introduction of various technical developments like the bed alarm system is essential. Techniques related to alteration of bed design are crucial.
The book “Reducing the Risk of Falls in Your Health Care Organization” by the Joint Commission Resources cites a list of the various kinds of alarms that can be used to reduce the fall rates. These are, namely, bed exit alarms, voice alarms that instruct the patient on not getting up because a nurse is already on her way to the patient, chair exit alarms, torso supports, freedom splints, mitts, anti-slip footwear, and anti-skid floor mats. The author states that the use of alarms systems can reduce fall rates.
Lippincott Williams & Wilkins (2007) has stated in “Best Practices: Evidence-Based Nursing Procedures” that the introduction of a pressure pad alarm can help in restraining a high-risk patient. The pressure sensor pad is placed under the bed linens. When the patient tries to get out of bed, the pressure is reduced, which sets off an alarm. Another alarm device is worn by the patient above the knee. This kind of alarm system can effectively reduce fall rates among Patients (Lippincott Williams & Wilkins, 2007).
The study of these various research papers and the comparison and contrast with the preventive measures in various medical centers have established the fact that the adoption of preventive measures can decrease the number of patient falls and the evidence from the existing literature also suggests that use of bed alarms can significantly reduce patient falls.
Hospitals have to bear extremely high costs when the inpatients suffer falls and have to stay for a longer duration. The patient fall can cause injuries ranging from minor to severe damages. The inpatient falls have several negative impacts. The patients lose their confidence, and the hospital has to bear additional costs. The hospitals are taking various preventive measures to control fall rates. Inpatient falls a crucial issue that hospitals face. This is because they have to bear a lot of costs associated with the falls. These costs are associated with follow-up care, diagnostic costs, and surgical costs. Several risk factors contribute to the fall of patients. Data related to inpatient falls reveal the enormous costs associated with the falls and the high fall rates. Thus, it has become essential to control fall rates. There are various preventive measures for controlling fall rates. This paper primarily deals with whether the use of bed alarms can reduce fall rates in hospitals. Past evidence based on available literature on preventive measures of hospitals who have already introduced the bed alarms suggests that bed alarms are effective in reducing fall rates.
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