Patient falls in inpatient settings
Falls are a common mechanism of trauma and injury for patients. It is estimated that the incidence of falls in US hospitals is between 4 and 12 falls for every 1000 patient days. The problem is especially common amongst elderly patients aged over 65 years residing in nursing homes due to their frail status (Currie, 2008). It is estimated that 100 to 200 falls occur every year in a nursing home with a bed capacity of 100. Other estimates suggest that between half and three-quarters of elderly persons living in nursing homes fall each year. These residents often have multiple falls. The average incidence of falls per resident is approximated to be 2.6 falls per year. Although this patient population constitutes approximately 5% of persons aged over 65 years, they account for 20% fall-related deaths in this age group (Center for Disease Control and Prevention, 2012). Notably, the true estimates and consequently, the true impact of falls is unknown because many cases are never reported (Currie, 2008).
Definition of the problem and its relevance to nursing and client outcomes
The American Nurses Association (ANA) defines a patient fall as any unplanned descent to the floor or to an extension of the floor such as a trash can, with or without injury, which occurs due to physiological or environmental reasons. Falls can be clustered into various groups. Morse (1997 as cited in Currie, 2008) categorized patient falls into 3 clusters, anticipated physiologic falls, unanticipated physiologic falls, and accidental falls.
Patient falls are a significant problem in health care settings. Whilst they can occur even in the community, in the inpatient settings, they are construed to be preventable adverse events that result from medical errors (Currie, 2008). Medical errors are classified into errors of execution, planning, commission, omission, monitoring, and latent errors. A fall due to an error of execution may result from the failure to implement a planned action for instance, placing items within the patient’s reach. An error in planning, on the other hand, may be due to the planning of inappropriate activities for the patient. Meanwhile, errors of commission result from actions taken for instance, a patient falling following electroconvulsive therapy. An error of omission occurs due to actions not taken. In the case of patient falls, it might occur due to the failure to assess a patient for the risk of fall and injury thus preventing the institution of preventive measures. Falls due to monitoring errors occur when patients are not monitored for the purpose of identifying the risk for fall or injuries related to a previous fall. Latent errors are associated with the prevention of fall and injury. They occur when an agency or institution does not implement the appropriate standards, training, or provide support for processes meant to prevent falls and injuries (Currie, 2008).
Patient falls occur due to patient-related, environmental and an interaction of these factors. Patient-related risk factors include balance problems, gait instability, poor health status, age, confusion, agitation, previous history of falls, some sedative and hypnotic medications, urinary incontinence and frequency amongst others. Environmental factors encompass all factors related to the physical environment such as poor lighting, individual staff, technical, and organizational systems and culture. Particular emphasis has been laid on the system factors of nurse knowledge, nurse staffing, and the safety culture of an organization (Lopez et al., 2010).
Falls adversely affect the health outcomes of patients. Injuries are estimated to occur in 6-44% of all inpatient falls. These injuries can be serious, inconsequential or fatal. It is approximated that 15–30% of all patient falls cause fractures that require a cast, surgery or traction. The incidence of more serious injuries like brain injury and death is approximated to be 2-8%. According to a report by the institute of medicine (IOM), adverse events, a category under which patient falls fall, are responsible for an estimated 48, 000-98, 000 patient deaths every year in the US (Currie, 2008). The incidence of serious injuries is higher amongst the elderly population in long-term care facilities. Therefore, falls lead to functional decline, disability, and reduced quality of life. They may additionally induce a fear of falling in victims. The latter may lead to a further loss of function, feelings of hopelessness, depression, and social isolation (Center for Disease Control and Prevention, 2012). In addition to causing trauma, falls escalate health care costs. For instance, based on estimates for the year 2000, the total annual costs for minor fall-related injuries ranged between $16- $19 billion. The costs of fatal injuries for the same year were approximated to be $170 million (Currie, 2008).
Conclusion
In conclusion, falls are a common mechanism of trauma and injury for hospitalized or institutionalized patients. They are construed to be preventable adverse events when they occur in health care settings. They thus present a significant problem for nurses and nursing as a profession. This is especially because they adversely affect the health outcomes of clients.
References
Center for Disease Control and Prevention (2012). Falls in nursing homes. Retrieved from
http://www.cdc.gov/HomeandRecreationalSafety/Falls/nursing.html
Currie, L. (2008). Fall and injury prevention. In R.G. Hughes (Eds.), Patient safety and quality:
An evidence-based handbook for nurses. Rockville (MD): Agency for Healthcare
Research and Quality.
Lopez, K. D., Gerling, G. J., Cary, M. P., & Kanak, M. F. (2010). Cognitive work analysis to
evaluate the problem of patient falls in an inpatient setting. Journal of the American
Medical Informatics Association, 17(3), 313-321.
