Risk Management: Patient Falls

Patient falls are some of the most commonly reported safety risks in hospitals. Falls are the most frequent adverse events, with approximately 700,000 to 1,000,000 patient falls reported annually in the United States (LeLaurin & Shorr, 2019). Out of these annual falls, about 250,000 end up in injuries, while up to 11,000 end up in patient deaths (LeLaurin & Shorr, 2019). Studies show that approximately 2% of hospitalized patients fall at least once during their admission, while one out of four lead to injury and 10% cause severe injury (LeLaurin & Shorr, 2019). This makes patient falls a critical risk issue for any healthcare facility that requires a proactive approach to mitigate and manage. Strategies to mitigate patient falls include identifying patients’ risks for falling, involving relevant staff in the process of determining the scope of risk, mitigation strategies, and how to prevent the risks from happening.

Identifying Patients At Risk of Falls

Identifying patients at risk of falling will involve using several approaches and techniques such as reviewing patient records and giving patients interviews and fall-risk tests. Studies have highlighted various characteristics of patients who have the highest risk of falling including patients of advanced ages above 85 years, instability in the patient’s gait, recent fall incidents, confusion and or agitation, patients who are receiving drugs that may cause adverse reactions, and patients with neurocardiovascular instability (Morris & O’Riordan, 2017). Patients who have cognitive and physiological issues such as those with neurocardiovascular instability, advanced ages, and with frequent bowel movements pose a high risk of falling due to the nature of their diseases, while others who receive certain medications can get confused or even lose balance and fall.  These traits are crucial in identifying patients at risk and can assist in taking a proactive approach to fall prevention. For instance, patients who already have a reported fall suggest that they need to be checked on to prevent another fall. The identification of these traits will require a review of the patient’s clinical records to identify issues such as gait instability from previous diagnoses, the patient’s age, and cardiovascular instability. Incident records are also potentially beneficial sources of information for patient falls since they include such information as which specific patients fell, what put them at risk, and how to mitigate the risks. Practitioners and other patient care staff such as nurses can use the incident reports to know where they should be more attentive while using the information to brainstorm strategies on how to mitigate risk. In addition to patient records, practitioner examinations and interviews can also be valuable sources of information that can be used to identify patients’ risk for falling. Physicians and nurses can identify which patients are at risk by interviewing them and conducting various standard patient-fall tests such as the Five Times Sit to Stand test, the Single Leg Stance test, and the Time Up and Go test (Mayo Clinic, 2018). Interviews can be beneficial for identifying a patient’s risk for falling, but due to the potential of missing crucial information, they need to be supplemented with additional simple tests.

The Five Times Sit to Stand test is a common test that uses different names depending on the institution or scholar. The test involves asking a patient to sit in an armless chair and record how fast they can stand and sit down in five repetitions (Mayo Clinic, 2018). The test seeks to evaluate the patient’s strength since this is a crucial predictor of whether patients can support themselves enough not to fall (Mayo Clinic, 2018). If a patient struggles to finish the test or takes too long, then the patient is said to have a higher risk of falling, and should therefore be provided with additional support when sitting and standing to prevent potential falls from occurring during their movement within the hospital. The single leg stance test is used to test a patient’s balance and involves asking the patient to stand on one leg with their arms crossed while the practitioner times how long it takes for the patient to put their other leg down or support themselves with their hands (Mayo Clinic, 2018). When a patient quickly puts their leg down or cannot support the stance at all, this means they have an increased risk of falling, and should therefore be given more attention for prevention purposes. The time up and go test evaluates the patient’s gait, and involves asking the patient to stand from a seated position and walk about three meters and return to their seat (Mayo Clinic, 2018). The practitioner evaluates the patient’s gait and the time taken to complete the exercise, which informs the practitioner if the patient is at higher risk of falling or not. Collectively, the patient records, incident records, interviews, and risk tests will provide adequate information on the risk of a patient falling, while brainstorming will determine the course of action.

Staff Involved In The Process

      The main staff members involved in the whole process will be physicians and nurses because they are the ones who interact with the patients the most. Physicians and nurses will conduct the tests and evaluations, while also undertaking the fall prevention strategies. Additionally, physicians and nurses will also be responsible for filling out risk registers with identified risks and actual falls for further evaluation and assessment.

Fall Prevention Strategies

       Fall prevention begins with identifying the patients’ risk levels for falling and then adopting prevention strategies. Patients with a high chance of falling will require nurses to constantly check on them to ensure they do not have to move alone. Gait aids and other supporting equipment can be provided for those at risk, while nurses and physicians provide them with physical therapy, occupational therapy, strength training, and balancing techniques (Mayo Clinic, 2018). These strategies will assist in reducing the risks of patient falls, hence promoting safe and quality care. 

References

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in geriatric medicine, 35(2), 273-283. doi: 10.1016/j.cger.2019.01.007

Mayo Clinic. (2018). Evaluating patients for fall risk. https://www.mayoclinic.org/medical-professionals/physical-medicine-rehabilitation/news/evaluating-patients-for-fall-risk/mac-20436558#:~:text=Identified%20risk%20factors%20for%20falls,medications%2C%20environment%20and%20other%20factors.

Morris, R., & O’Riordan, S. (2017). Prevention of falls in hospital. Clinical Medicine, 17(4), 360. doi: 10.7861/clinmedicine.17-4-360