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Implications

References

(Falen, Unruh, & Segal, 2011)

Patient Health Implications

"Hospital falls remain one of the leading causes of patient injuries in the hospital and are a contributor to patient deaths"

For adults age 65 years or older, a fall resulting in a major injury will increase the risk of death by 50% in the following year.

(Falen, Unruh, & Segal, 2011)

(Morello et al., 2013)

Healthcare Costs Associated with Falls

Adverse fall events (AFEs) are estimated to be anywhere from 2.2-17.1 falls per 1000 patient days.

Up to 50% of falls result in minor injuries and up to 10% result in major injuries.

(Coussement, De Paepe, Schwendimann, Denhaerynck, Dejaeger, & Milisen, 2008)

(Falen, Unruh, & Segal, 2011)

(Levinson, 2010)

Major Injuries

  • Moderate to severe lacerations
  • Bone Fractures
  • Head Injury (eg. subdural hematoma
  • Change in Mental Status
  • Joint immobility
  • Severe Bruising and Pain

(Levinson, 2010)

(Voyer, Verreault, Mengue, & Azizah, 2007)

Minor Injuries

-Falls result in increased length of stay.

-The Medicare HAC policy fines hospitals and denies reimbursement for care associated with HACs.

-"Hospital care associated with adverse events and temporary harm events cost Medicare an estimated $324 million in October 2008."

-Shock absorbing floors to prevent injuries, but does it increase the number of falls?

  • Minor lacerations
  • Bruising
  • Redness
  • Mild Pain

(Voyer, Verreault, Mengue, Azizah, 2007)

(Latimer et al., 2013)

(Zecevic et al., 2012)

Fall Rates

(Mion, 2012)

  • >1 million falls each year
  • Highest rates (2012):

-Neuroscience floors (6.12-8.83 falls/1,000 pt days)

-Medical floors (3.48-6.12 falls/1,000 pt days)

"Approximately 2%-12% of all patients have at least one fall during their hospital stay"

(Falen, Unruh, & Segal, 2011)

Parkview Hospital Falls - YTD

(Parkview, 2013)

Randallia - 2.7 falls/1,000 pt days

-Constant care - 2.5 falls/1,000 pt days

-Med/Surg & OB - 0 falls this year

PRMC - 1.2 falls/1,000 pt days

-7 Medical - 1.5 falls/1,000 pt days

-Ped/PICU - 0.3 falls/1,000 pt days

Fall Prevention

“Current fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions.”

(Dibardino, Cohen, & Didwania, 2012)

According to one study, over 50% of all falls and falls with injuries occurred when the patient was getting out of or back into bed.

(Tzeng, Yin, Anderson & Prakash, 2012)

The best fall prevention strategies incorporate Collaborative interdisciplinary practice, Active leadership, Technology Support, Communication, and Hospital-wide culture change.

Fall Risk Assessment

(Bonuel, Manjos, Lockett, & Gray-Becknell, 2011)

Morse Fall Risk Scale

-0-125 point scale

-Low, moderate, high risk classifications

-Scoring basis:

-Fall Hx

-Diagnosis

-Ambulation status (cane/walker/etc.)

-IV fluid therapy

-Gait assessment

-Mental Status

(Swartzell, Fulton, & Friesth, 2013)

Minimize Risks

  • Assist with Ambulation (bathroom, walking)
  • Consider Physical Therapy to improve gait
  • Ambulatory Aid
  • Non-Skid, Fall risk Socks

STRATIFY

-0-5 point scale

-2 or more points = "high risk"

-Scoring basis:

-Hx of falls

-Mental status

-Visual impairment

-Continence/frequency

-Ambulation status

(Swartzell, Fulton, & Friesth, 2013)

  • Do not leave unattended in bathroom or halls
  • Request pharmacist/physician to review meds.

Hendrich II Fall Risk Model (HIIFRM)

-0-16 point scale

-5 points or more = "high risk"

-Scoring Basis:

-Confusion/Disorientation/Impulsivity

-Symptomatic Depression

-Dizziness/Vertigo

-Male gender

-Anti-epileptics

-Benzodiazepines

-Ambulation (Get Up & Go)

Swartzell, Fulton, & Friesth, 2013)

NDNQI Falls; Falls with Injuries

  • Support Stockings (min. orthostatic hypotension)
  • Avoid Restraints
  • Adequate Lighting
  • Bed in lowest position
  • Pathways free of clutter/spills
  • Consistent assessment of mental status and fall risk
  • Fall risk band

Hourly Rounding

The Four (or five) P's Approach

Technology and Fall Prevention

(Mion, 2012)

Pain - "Are you having any pain?"

Potty - "Do you need to use the restroom"

Position - "Are you comfortable?"

Possessions - Observe and "Do you have everything you need?"

Psychological - Assess orientation

(Berg, Sailors, Reimer, O'Brien, & Ward-Smith, 2011)

A,B,C,D,E Approach

A-Activity What is the patient doing?

B-Bathroom Bathroom needs

C-Comfort Comfort needs

D-Dietary Is the patient hungry?

E-Environment Possessions in reach, decluttered floor, adequate lighting, etc

(Berg, Sailors, Reimer, O'Brien, & Ward-Smith, 2011)

Bed/Chair Monitoring Systems

Integrated Connection Systems

Multifaceted approach that connects patient to caregiver using a variety of technological systems.

(Falen, Unruh, & Segal, 2011)

(Choi, Lawler, Boenecke, Ponatoski, & Zimring, 2011)

Created by: Bobby Phillips, Alyssa Tucker, and Philip Roberts

Goal: To ensure knowledge of various aspects of falls, including: NDNQI, interventions, prevention methods, costs, etc.

Target Audience: Nursing students pursuing a career in high quality patient-centered care.

Date of Production: October 24, 2013

Risk Factors

Patient-Related (Intrinsic)

Environmental (Extrinsic)

  • Furniture on Wheels
  • Cluttered Pathways
  • Poor Lighting
  • Slippery/Wet Floors
  • Height of Furniture
  • Obstructive view of patient from nurse's station.
  • Medical Devices
  • Poorly Fitted Clothing
  • Lack of Ambulatory Aids
  • Impaired Gait
  • Age
  • Hx of Falls
  • Impaired Cognition
  • Impaired Vision
  • Weakness (especially legs)
  • Hypotension
  • Urinary frequency, urgency, and/or incontinence
  • Acute Event (eg. MI, PE)
  • Pharmacological
  • Polypharmacy
  • Sedative/Hypnotic
  • Cardiovascular

(Mion, 2012)

( Mion, 2012)

The National Database of Nursing Quality Indicators: Falls

Definition

NDNQI Goals

"An unplanned descent to the floor (or extension of the floor, e.g., trash can or other equipment) with or without injury. All types of falls are included, whether they result from physiological reasons or environmental reasons."

  • Data collection and comparison for quality improvement purposes in hospitals.

(NDNQI, 2013)

  • Analyze data to show the relationship between nursing staff and patient outcomes.

(NDNQI, 2013)

NDNQI Fall Injury Definitions

  • None - no obvious s/sx - negative CT/x-ray
  • Minor - dressing applied, wound cleaned, ice/elevation needed
  • Moderate - resulted in splinting, wound closure, muscle/joint strain
  • Major - resulted in surgery, casting, traction, neuro consult, internal injuries, blood products required for pts with coagulopathy
  • Death - resulting from fall NOT from physiological event causing the fall

(NDNQI, 2013)

NDNQI Data Collection

Quality Indicators

-Standardized definitions for reliability and validity.

-Unit based.

-Quarterly reporting.

-Data collection, compilation, analyzation.

-Quarterly reports posted to NDNQI website.

-Identifies problem areas.

-Nursing hours per patient day

-Catheter associated UTIs

-Hospital acquired pressure ulcers

-VAP

-Annual nursing survey

-Voluntary nursing turnover

-Falls

-Falls with injuries

(NDNQI, 2013)

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