Prevention of Patient Falls in a Hospital Setting

Introduction

A fall may be described as the situation whereby an individual finds him or herself on the ground involuntarily. Some of the major issues faced by health care facilities include patient falls. Patient safety is every hospital’s priority and this includes ensuring the prevention of patient falls. However, falls constitute a huge percentage of patient safety issues within the hospital setting. Such falls may result in physical harm or death. Indirect effects of these incidents include the fear of falling. It is for this reason that patients try to avoid falling and this is mainly evidenced in decreased mobility. Unfortunately, decreased mobility results in poorly developed muscles. Other effects include postural hypotension and contracture. Falls may also cause complications that would only mean that the patient would stay in the hospital longer for treatment and this implies greater costs to the patient seeking treatment. This paper will assess the prevalence of falls among elderly individuals in the hospital setting and propose strategies to reduce these incidences.

Topic Description and Problem Statement

Patient falls are very common in healthcare facilities and are costly to both the individual and the health sector as a whole. At the individual level, such incidences cause physical harm to the individual. In addition to this, they could cause psychological trauma or cause the victim to become dependent on other individuals. Worst of all, they could lead to death. The effects of such falls depend on the severity of the falls. These falls could also cost the health sector because they would require the use of more resources. As these incidences increase in number, hospitals would need to surrender more of their beds and wards in order to accommodate the increasing number of such patients.

Researchers have tried to explain the reason why falls are prevalent among the elderly (Vieira, Freud-Heritage, & Costa, 2011). One particular argument explains that old age results in alterations in the individual’s ability to perform postural adaptations in order to maintain balance and avoid falls. Other individuals argue that falls may also be associated with calcium and vitamin D deficiencies.

For an individual to avoid falls, one should have postural adaptation abilities. The human body maintains an upright posture by ensuring that the force exerted on the ground is equal to the force exerted in the opposite direction. However, the balance may be disturbed in two ways. Firstly, an individual may feel the need to perform certain postural adjustments in order to maintain stability. Such disturbances are referred to as internal disturbances. The other type of disturbance is referred to as external disturbance. These disturbances are usually unexpected and are subject to the environment. Healthy individuals react swiftly and automatically to such stimuli in order to regain balance. The body may attempt to regain balance by adopting the ankle strategy and the hip strategy. For the body to perform such movements effectively, there must be coordinated communication between the sensory afferents and the central nervous system. Research indicates that the postural adaptation abilities of the elderly may be impaired. For this reason, the necessary postural reactions may be delayed or altered. This may explain the higher incidence of falls among the elderly.

It is suggested that the elderly commonly have insufficient levels of vitamin D in their bodies. Results from particular research indicated that individuals with higher concentrations of vitamin D in their bodies experienced fewer falls as compared to those who had lower concentration levels. Other supporting ideas indicate that calcium and vitamin D supplementation helped to significantly reduce falls among these individuals.

The effect of insufficiency of vitamin D among the elderly may be seen in several ways. Firstly, vitamin D may be said to have an effect on muscle function. Severe vitamin D deficiency may lead to myopathy. This causes severe muscle weakness. Vitamin insufficiency may also be seen as a cause of problems with the nervous system among the elderly. Vitamin D is said to be a key nutrient in the stabilization of neurophysiologic functions. It is suggested that it supports cognitive function and particularly attention (Vassallo, Mallela, & Williams, 2009). Therefore, lack of it is associated with suppressed functions of the cerebral vitamin D receptors (VDR).

Background of the Problem

Research indicates that patient falls are prevalent among the elderly population. It is suggested that there is a strong correlation between age and the incidences of patient falls (Annweiler, Montero-Odasso, Schott, Berrut, Fantino, & Beauchet, 2010). Falls occur almost on a daily basis and have been associated with accidental death among the elderly. A study by Hendriks and his colleagues indicated that about twenty percent of the falls required medical attention (Hendriks, Evers, Bleijlevens, Haastregt, Crebolder, & Eijk, 2008). Falls also come as a cost to healthcare institutions due to the fact that they result in prolonged hospitalizations.

There are several risk factors that contribute to patient falls. Old age is associated with the largest number of falls. Studies have shown that the incidence of falls increases with old age. There seems to be a steady increase in incidences from middle age to old age. Individuals of ages 60 and above were most likely to fall. The risk factor, in this case, involves the physiological changes that cause control issues. This may be in form of postural change and osteoarthritis. Studies have also shown that patients who had a history of previous falls were more likely to experience future falls (Healey, Scobie, & Oliver, 2008).

In medical units where patients have chronic neurologic diseases, there are high incidences of falls. This is due to the fact that the disease itself puts the patient at risk of falls. Other factors that may contribute to these incidences include confusion, impaired judgment, and previous falls. Studies have shown that the majority of the incidences occur during the first week of hospitalization. In a particular study, 70% of the falls occurred during this period. This was mainly due to patient disorientation. Their unfamiliarity with the new environment puts them at risk of falls. Gait instability and amputation may also contribute to falls. Some studies have shown that falls mainly occur during the first few days of hospitalization. This may be because the patient is not familiar with the new environment and needs to adjust to the new environment.

The environment where the patient stays may also pose risks of falling. For example, uneven floor surfaces may pose a risk. Poor lighting is also a risk factor. Hallways that have poor lighting may be hazardous to patients who are visually impaired. The height of the toilet seats and the beds may also prove to be a challenge to some elderly individuals.

Several studies have also shown that most of these accidents occur during busy hours of the day (Healey, Scobie, & Oliver, 2008). Several factors contribute to the increase in number during this time of the day. Some of the factors include mass movement to the bathroom in the morning. Many falls were also recorded when there were changes in shift activities. Falls were also evidenced during mealtimes. There was a relationship between the intensity of nursing activities and the frequency of falls. This implies that nursing activities also put the patients at risk of falls.

Strategies for Improvement

Due to the prevalence of patient falls among the elderly, there is a need for strategies to be developed to help prevent such incidences. These falls have resulted in huge costs to healthcare facilities. It is for this reason that one of the strategies adopted explores the cost and effect of fall prevention strategies.

One of the strategies to be employed is the occupational therapy assessment. This involves the assessment of the environment within which the individual resides. A study by Scott, Votova, Scanlan, and Close (2007) indicated that patients who received specified medical attention that included occupational therapy assessment experienced fewer falls than those who received usual care only. This assessment involved the study of the patient’s environment such as the ramps and steps within the area of residence, the material used in floor surfaces, the irregularity of outdoor surfaces, and the suitability of the footwear.

To ensure the safety of the patient’s environment, environmental assessment is vital. The environment should be well lit and the floors should be even. When such hazards are realized, it would be important to do some modifications in order to correct some of the issues and make the environment safer. Some patients may require help while moving around. For this reason, it might be necessary to install grab bars. Raising the toilet seat and lowering the height of the bed may also go a long way in reducing patient falls. Adequate lighting should also be installed in order to ensure visibility.

Research has shown that these incidences occur during the first few days of hospitalization (Vassallo, Mallela, & Williams, 2009). In order to reduce these falls, nurses need to help the patients to become more familiar with the new environment. This orientation process may also include educating the patient on the safe use of commode chairs and wheelchairs.

Since patients with a history of previous falls are more likely to experience falls in the future, it is important for the nurses to be extra vigilant and observe such patients in order to reduce the number of falls. Examinations should also be done after a fall in order to identify the actual cause of the fall. This would make the nurses aware of the contributing risk factors. Nurses should also be keen to watch the elderly patients who have bladder problems and are likely to move to the toilet severally. Confused and disoriented patients require equal attention in order to help prevent falls. Nurses should be aware of the patients that are at high risk and employ prevention strategies.

The nurses play an integral part in assisting elderly patients at risk of falling. Therefore, the nurse should be well trained and have the necessary equipment required for assisting dependent individuals. When assessing the patient, it is important for the nurse to check the individual’s physical and mental state. One should also determine the handling methods and tools required. Nurses should also be equipped with knowledge on risk assessment. This would enable them to be aware of the conditions that make the patient at high risk of falling.

Since studies have indicated that vitamin D insufficiency contributes to falls and bone fractures, it would be appropriate to provide vitamin D and calcium supplementation in order to help reduce the number of falls. Sufficient concentrations of the mineral also help the nervous system. One of the evidence of the importance of vitamin D in the body is its ability to stabilize postural equilibrium in elderly individuals. This may help improve the attention capacity without necessarily performing muscular action (Annweiler, Montero-Odasso, Schott, Berrut, Fantino, & Beauchet, 2010).

Conclusion

In the hospital setting, patients are likely to fall involuntarily due to several factors. Studies have shown that the elderly (individuals of ages 50 and above) are more likely to fall. Some of the factors responsible for falls include uneven surfaces, confusion, impaired judgment, muscle weakness, among others. Falls may cause serious injuries or fatalities. They also come as extra costs to health facilities. For this reason, several strategies for reducing incidences of falls have been suggested. The major strategies that may be employed include those that help improve the strength and functional status of elderly patients. Other strategies include those that help reduce environmental hazards in order to help reduce risks of falls. Another strategy is to educate nurses on the proper ways of identifying and monitoring high-risk patients. Environmental assessment is also important in order to identify and eliminate some of the potential factors that may contribute to falls. It may also be useful to modify some things around the patients’ environment in order to ensure their safety. When all these strategies are employed, the frequency of falls is likely to reduce.

References

Annweiler, C., Montero-Odasso, M., Schott, A., Berrut, G., Fantino, B., & Beauchet, O. (2010). Fall prevention and vitamin D in the elderly: An overview of the key role of the non-bone effects. Journal of NeuroEngineering and Rehabilitation, 7(50), 1-13.

Healey, F., Scobie, S., & Oliver, D. (2008). Falls in English and welsh hospitals: A national observational study based on retrospective analysis of 12 months of patient safety incident reports. Qual Saf Health Care, 17(1), 424-430.

Hendriks, M., Evers, S., Bleijlevens, M., Haastregt, J., Crebolder, H., & Eijk, J. (2008). Cost-effectiveness of a multidisciplinary fall prevention program in community-dwelling elderly people: A randomized controlled trial. International Journal of Technology Assessment in Health Care, 24(2), 193-202.

Scott, V., Votova, K., Scanlan, A., & Close, J. (2007). Multifactoral and functional mobility assessment tools for fall risk among older adults in the community, home-support, long-term and acute care settings. Age Ageing, 36(1), 130-139.

Vassallo, M., Mallela, S., & Williams, A. (2009). Falls risk factors in elderly patients with cognitive impairment on rehabilitation wards. Geriatr Gerontol Int, 9(1), 41-46.

Vieira, E., Freud-Heritage, R., Costa, B. (2011). Risk factors for geriatric patient falls in rehabilitation hospital setting: A Systematic review. Clinical Rehabilitation, 25(9), 788-799.