According to The Joint Commission, hundreds of thousands of patients fall in hospitals and Nursing Homes each year. Many patients in long-term care are there in the first place because of injuries sustained in a fall or because they have fallen repeatedly. Falls are one of the major reasons for patient’s to be re-admitted back to an acute care facility, which ultimately will have a significant negative effect on reimbursements for long-term care facilities starting in 2019. Decreasing falls in the elderly patient population requires a well-defined strategy, training and consistent use of basic safety techniques.
The Cost of Patient Falls
Individuals who suffer a fall may suffer serious injury, such as a fractured hip or wrist or a head injury. Lacerations can occur if the patient comes in contact with the edge of a bed or knocks a glass flower vase to the floor. Skin shearing may occur due to the fragility of an elderly patient’s epidermis. The Joint Commission notes that one study found a fall with an injury increased in-patient facility length of stay by an average of 6.3 days. Further, the average cost of a fall in which an injury is incurred is $14,000. The American Health Lawyers Association reports that recent settlements for injuries incurred by long term care patients ranged from $205,000 to $620,000. In addition, there is the cost to the patient in terms of pain and disability, the stress on the family, and the guilt and remorse suffered by the nurses responsible for safeguarding the patient.
Elderly Patients Are at Higher Risk
The elderly are more at risk of falls. They are more likely to have balance problems or need assistive devices to walk around. Muscle strength, flexibility and coordination may be problematic for an elderly person. Elderly people are statistically more likely to be on multiple medications, which may have such side effects as lower blood pressure or dizziness. Diuretics may mean an increased frequency of bathroom visits and some medications can cause diarrhea. In the acute care hospital, the elderly are more susceptible to confusion, whether from medications such as narcotics or from being in unfamiliar surroundings. In long-term care facilities, it is often the elderly patient who can no longer live independently – whether from physical disability or mental impairments such as dementia – who needs long-term care in the first place.
Best Practices for Reducing Falls
In 2009, the National Guidelines Clearinghouse published a number of best practice recommendations for fall prevention in long term care. These include:
- Develop a specific program aimed at reducing falls. This should take into account the patient population, the environment of the long term care facility, and the numbers, skills and experience of the caregivers. If your facility does not have such a program, volunteer to start one.
- Assess fall risks on admission and after a fall. If a patient does fall, determine the most likely reason for the fall to have occurred. Make changes to prevent a fall from happening again.
- Develop exercise programs for long term care patients, particularly strength training. Tai chi can also help with balance and coordination problems.
- Conduct medication reviews – patients who are taking certain medications, such as benzodiazepines, antidepressants, selective serotonin reuptake inhibitors (SSRIs) or multiple medications should be considered at high risk for falls.
- Educate patients who are at increased risk and who are mentally competent. This can include safe transfer techniques, basic fall prevention such as not getting up abruptly from a sitting position or the use of assistive devices.
- Conduct regular environmental assessments and modification – reduce clutter, ensure lighting is adequate and clean up spills promptly.
The Top Two
Of all the possible strategies a nurse can use to prevent patient falls, the top two are probably a careful and thorough patient assessment at regular intervals and the consistent use of basic safety techniques. The first helps ensure that patients who are developing balance problems, worsening dementia, medication side effects or confusion from hypoxia will be identified as early as possible. Each time you walk down the hall, make it a practice to glance in the patient rooms on each side. You will be surprised how much information you can glean in a three-second snapshot. Always practice the basics: put up side rails, lower the bed, engage wheel locks and make sure patients can reach call lights, water or other items on the bedside table. Use bed alarms and use them at a short interval, such as two or three seconds.
Protecting elderly patients from falls in long-term care requires unceasing vigilance on the part of nurses and CNAs. Reducing falls can prevent a readmission to an acute care hospital or an extension of what was planned to be a temporary stay in long term care. Regular training on fall prevention and always practicing what you learned in a training will help keep your patients safe.