Page 58 nursing.elitecme.com Complete Your CE Test Online - Click Here Falls are also the most common cause of traumatic brain injury (TBI) (Centers for Disease Control, 2017). Statistics pertaining to falls in hospitals in the United States Every year, an estimated 700,000 to 1,000,000 people in the United States fall while hospitalized. A patient fall is defined as an “unplanned descent to the floor with or without injury to the patient (Agency for Healthcare Research and Quality, 2013c). Falls with serious injury are consistently among the Top 10 sentinel events reported to The Joint Commission’s Sentinel Event database. This database contains over 465 reports of falls with injuries since 2009, with the majority of falls occurring in hospitals (The Joint Commission, 2015). Nursing consideration: Statistics pertaining to falls globally and within the United States are alarming. Education regarding fall prevention should include statistical information so that staff members can appreciate the scope of the problem. However, many nurses “tune out” lengthy descriptions of statistical data. When incorporating this type of information in education programs, it will have more of an impact on staff members if data pertaining to falls in their own work settings is discussed. Some organizations are fearful that sharing such data will overwhelm employees, violate confidentiality, or make the organization “look bad.” However, nurses and other healthcare professionals cannot correct a problem without knowing its extent. While maintaining patient confidentiality educators must relay pertinent data. Nurses (and all adult learners) are more likely to learn and to put into practice what they have learned, if they know the extent of a problem and how their actions can make a difference (Avillion, 2015). Impact of falls Sharon is an active 66-year-old. She enjoys an active social life and exercises regularly. One afternoon after returning from a brisk walk, she trips in her kitchen and falls abruptly to the floor. Although she is not hurt, the fall frightens Sharon. “What if I really hurt myself and no one is around to help me? I could lie here for hours and no one would know.” As a result of this fear, Sharon begins to be refuse invitations to social activities and is even less active around the house. Sharon assumes that if she doesn’t “move around” as much, she will be safer. In fact, Sharon’s lack of exercise is putting her at risk for other health problems and additional falls. Falls have considerable impact on the patients who fall, as well as on their loved ones, the healthcare professionals responsible for the patients’ safety and well-being, and on the organization as a whole. As of 2008, the Centers for Medicare and Medicaid Services no longer reimburse any hospital-acquired conditions that increase the length of stay in hospitals. Thus, hospitals are now responsible for the additional medical costs of patient injures that are the result of falls (Chu, 2017). According to the Centers for Disease Control and Prevention (2017), one out of five falls leads to a serious injury, such as broken bones or head injury. Adjusted for inflation, the direct medical costs for fall injuries are $31 billion annually, with hospital costs accounting for 66% of the total cost (Centers for Disease Control and Prevention, 2017). How are direct fall-related costs calculated? Direct medical costs include fees for hospital and nursing home care, physicians and other healthcare professional services, rehabilitation, community-based services, use of medical equipment, prescription drugs, and insurance processing. However, direct costs do not account for the long-term effects of these injuries, such as disability, dependence on others, time lost from work and personal responsibilities, and reduced quality of life (Centers for Disease Control and Prevention, 2016). In addition to monetary costs, another cost of falling is fear. Many people who fall, even if they are not injured, become afraid of falling. This fear may lead the person to reduce the extent of their everyday activities, including those activities that gave them pleasure and contributed to the quality of their interpersonal relationships. Individuals who had experienced a fall often become more sedentary. Lack of movement and exercise puts them at risk for additional health problems, such as heart disease. When someone is less active, he or she loses strength, becomes, weaker, which increases the risk of falling (Centers for Disease Control and Prevention, 2017). Nursing consideration: In addition to patients’ pain and suffering related to injury, increased length of stay, and healthcare costs, patient falls may lead to lawsuits that can result in settlements of millions of dollars (Chu, 2017). Nurses must be aware that there are legal ramifications due to falls. Fall risk Angela is a professional development specialist who has just been assigned the task of developing a series of education programs on fall prevention for her organization’s nursing department. In addition to gathering relevant statistical data, Angela wants to highlight risk factors for falls. She also wants this information to draw attention to the problem, not just be information that nurses feel they already know. In order to do this, Angela works with the organization’s Nursing Research Council to initiate research that identifies the risk factors existed in patients who fell over the past 18 months. This way, Angela can make the information “real” and show the nurse-learners what factors contributed to falls within their place of employment. Angela is correct in providing information that will have the most meaning to the nurses who will be attending her education programs. It is important to understand which patients are most vulnerable to falling and what puts them at higher risk of falling. Although all people are at risk for falls, there are some factors that not only increase the risk of falling, but also affect the type and severity of injury that occurs after a fall. These risk factors include (World Health Organization, (2016): ● ● Age: Age is considered to be one of the key risk factors for falls. Older adults have the highest risk of death or serious injury resulting from a fall. The risk increases with age. In the United States, 20% to 30% of older adults who fall sustain moderate to severe injuries, such as hip fractures and head injuries. Risk level for older adults may be due to physical, sensory, and cognitive changes associated with aging in conjunction with environments that make falling more likely (e.g. steps, clutter in the home, etc). ● ● Gender: Gender risk varies among countries. In some areas, males are more likely to die from falls than females, while females suffer more non-fatal falls. Research shows that older women and younger children are more prone to falls and increased severity of injury. Throughout the world, males consistently have higher death rates from falls. This may be due in part to higher levels of risk-taking behaviors and hazards associated with certain occupations, such as construction work. ● ● Occupations: The risk of falls increases with the hazards associated with certain jobs. For example, people who work at elevated heights are at higher risk for falls. Nursing consideration: When teaching patients and families about fall prevention, it would be wise to assess risk associated with the types of jobs they have or leisure activities in which they participate. Patients and families would benefit from this type of risk analysis and from learning how to decrease risks associated with occupations or leisure activities. ● ● Socioeconomic factors: Various socioeconomic factors have been linked to falls. These include issues such as poverty, overcrowded housing, single parenthood, and young maternal age. ● ● Unsafe environments: Unsafe environments could mean various things to various people. For example, homes and work places that are cluttered, poorly lit, or unsanitary are associated with an increased risk for falls. Broken or uneven steps also pose a danger. This is especially true for people with poor balance or impaired vision.