Fall prevention is important in both hospital settings and at home because they can result in fractures, head trauma, soft tissue trauma, prolonged rehabilitation, emotional trauma, loss of confidence, and high patient readmission rates (Oliver, Daly, Martin, & McMurdo, 2004). For the healthcare providers, fall prevention is an essential practice because poor prevention measures can result in increased anxiety or guilt among the staff and litigation from the injured patient’s family if the fall occurs within the hospital.
The elderly population is at a significant risk for adverse events when they fall in contrast to other age groups. According to Fuller (2000), elderly patients are 10 times more likely to require hospitalization after falls than young children or adults. They are also eight times more likely to die because of the injuries caused by the fall (Fuller, 2000). Therefore, all elderly patients should be thoroughly examined to determine the causes of their fall because their medical conditions, pharmaceutical treatment, and difficulty in performing activities of daily living may contribute to those falls.
For example, an elderly patient with over 60 years of age I worked with had experienced a fall prior to her hospitalization. According to an assessment with the Falls Risk Assessment Tool (FRAT), her score revealed a medium risk for falling again, mainly because she was overweight and lacked mobility. Because those factors could result in her readmission, she was not discharged immediately upon treating her injury. Instead she was assigned physical rehabilitation to improve her mobility, and the dietitian engaged her in patient education about proper nutrition to help her lose weight.
In addition, the patient’s medical history and current treatment were assessed because instability can be a consequence of serious health issues in elderly patients, such as myocardial infarctions and acute exacerbations (Fuller, 2000). In this case, the patient was taking three drugs to regulate her blood pressure, prevent blood coagulation, and regulate respiratory functions. While interviewing the patient, it became evident that the patient was using herbal remedies without consulting a physician, which increased risks for internal bleeding. With that information, it was possible to review her prescribed treatment and educate the patient about the dangers of combining herbal remedies with conventional treatments. Before the patient was discharged, her home was also inspected to suggest organizational improvements that could reduce her risk of falling and hospital readmission.
According to Oliver et al. (2004), falls are also common in hospital settings, and healthcare facilities have reported rates between 2.9 and 13 falls per 1,000 bed days. However, because it is difficult to identify and reverse all factors that could have contributed to the fall, Oliver et al. (2004) suggest a post-fall assessment is a better protocol for targeted interventions in working with patients.
In my experience, the healthcare facility’s environment is modified to prevent patients from falling whenever possible because failure to provide a safe environment for the patients is a legal liability for the institution. However, patients do occasionally fall in the hospital, but because the institution has policies and preventions in place to protect it from legal actions, the staff did not experience job dismissals or disciplinary actions. Despite the professional adherence to expected standards in patient assessment, I remember a colleague who took personal blame for a patient’s fall, which reflected in her confidence, emotional state, and further performance. Although my colleague managed to recover, many nurses are at risk for burnouts because they will frequently experience scenarios in which they will personally blame themselves for negative treatment outcomes, even though they had performed a thorough assessment.
References
Fuller, G. F. (2000). Falls in the elderly. American Family Physician, 61(7), 2159-2168.
Oliver, D., Daly, F., Martin, F. C., & McMurdo, M. E. (2004). Risk factors and risk assessment tools for falls in hospital in-patients: a systematic review. Age and Ageing, 33(2), 122-130.
