Page 58 Complete Your CE Test Online - Click Here Course overview Falls are a major concern for all healthcare facilities. Falls can not only cause injury and mental anguish for patients, but can also be financially devastating to the organizations where falls occur. Falls not only affect patients, but can also affect visitors, volunteers, and employees. The ability to initiate a good fall assessment program and develop strategies for fall prevention requires an interdisciplinary approach and the commitment of everyone involved, including patients and families. This education program will provide information to help develop and initiate a fall assessment program and preventive strategies to safeguard patients from the danger of falling. Introduction Scenario 1 Cheryl is a senior staff nurse working on a 40-bed adult oncology unit. She was a member of a task force that recently completed a revision to the organization’s fall prevention program. Since the implementation of the new fall prevention program, the incidence of falls has decreased significantly. Cheryl is proud of the work that the task force has accomplished, and she feels that she has contributed to improving patient care, as well as to organizational effectiveness. One afternoon, Cheryl is preparing to educate a patient and his family about the medication regimen the patient will follow after discharge. As she walks toward the patient’s room, she is startled to hear a scream and a loud “thud.” She turns in the direction of the commotion and sees that a visitor has tripped and fallen to the floor, and that his cane is lying nearby. He is writhing in pain and after diagnostic assessment, it is determined that he broke his left arm as a result of the fall. Cheryl is horrified and realizes that the fall prevention program did not address the issue of visitor or employee falls. She realizes that the safety of visitors, volunteers, and employees should be part of any safety initiative. Scenario 2 David is a rehabilitation nurse specializing in the care of stroke patients. He knows that his patients are at high risk for falls because of age and neurological compromise. He also knows that the incidence of falls on the unit has not decreased despite the best efforts of every RN. David is concerned that the nursing assistants on his unit have not been part of the development of the fall prevention program and do not have as much knowledge of fall prevention as he would like. He knows that every member of the team is essential to patient safety. David approaches his manager with a proposal to develop and implement a continuing education program designed for nursing assistants and their role in fall prevention. Scenario 3 Sandy is an RN who has worked on the obstetrics unit of her hospital for 10 years. She loves her work and rejoices in helping new families bond over the birth of a baby. She is also grateful that her unit has not had to deal with a patient fall for over two years. Sandy and her coworkers have, unfortunately, become rather complacent about fall prevention. They believe that “no one ever falls on our unit.” Today, however, Sandy enters a patient’s room in time to see her trip over a piece of furniture and strike her head on the edge of the nightstand before landing on the floor. The patient suffers a concussion and an extended length of hospital stay. Scenario 4 Nick works in the post-anesthesia care unit of a large outpatient surgery clinic. It is an especially busy day and the unit is short-staffed. One of his patients, Mrs. Mason, had a partial right mastectomy and is nearly ready for discharge. The charge nurse tells Nick, “Just give the patient her clothes. She’s a nurse and won’t need much help or teaching.” When Nick gives Mrs. Mason her belongings, she appears dazed and does not respond when he tells her she can get dressed. In the midst of their hectic day, Nick and the charge nurse hear a moan and turn to see Mrs. Mason sitting on the floor. She is tearful and when they reach her, she says, “I can hardly move and no one even checked on me except to tell me to get dressed. I’m going to report all of you. This isn’t the way to take care of patients.” The preceding scenarios illustrate the various ways falls can occur and/ or have an impact on nurses. Many nurses, when they think of patient falls, may picture an older adult with mobility problems and perhaps some confusion as those who are among those most likely to fall. Older adults are at higher risk for falls, but that does not mean that falls do not occur in patients of all ages and diagnoses. Examine the preceding scenarios from a critical thinking perspective. Scenario 1: Cheryl and her colleagues are justifiably proud of the work they have accomplished on their inpatient fall prevention program. However, as with any program, there will always be new issues that arise. The task force did not address the process for dealing with non-patient falls. This is an important aspect of developing a culture of safety. Scenario 2: David works on a unit with a patient population that is at high risk for falls. He recognizes that everyone on the healthcare team plays a significant role in preventing falls and enhancing safety. David has shown significant initiative by not only identifying a problem, but also by proposing a solution for which he will assume the leadership role. Scenario 3: This scenario shows how dangerous complacency can be. Because they have an excellent fall prevention record, Sandy and her colleagues have become a bit too complacent in their efforts to prevent falls. In this case, the patient’s fall had significant impact. The lesson here is that ongoing vigilance is imperative! Scenario 4: “Never assume” is the lesson to be learned from this scenario. Being busy and short-staffed is never an excuse to skimp on patient care. Nick and his charge nurse made the assumption that because the patient was a nurse, she somehow needed less than average assessment. The result was an adverse event. Falls are a major concern for all healthcare facilities. Falls can lead to injury, suffering, increased lengths of stay, reduced quality of life, increased costs, and even legal action. Therefore, it is imperative that nurses and all of their healthcare coworkers take steps to develop and initiate effective fall prevention strategies. Incidence and prevalence of falls It is important to understand the overall incidence and prevalence of fall occurrence, not just the type of falls that take place in healthcare settings. Identification of the reasons people fall in the home or other private settings helps to increase the body of knowledge concerning how and why people fall. It can also help to identify those at high risk for falls in healthcare settings and to develop effective fall prevention strategies. Statistics pertaining to falls globally Globally, falls are a significant public health concern. It is estimated that 420,000 fatal falls occur every year globally, making it the second leading cause of unintentional injury death after road traffic injuries. Over 80% of fall-related deaths occur in low and middle-income countries, with regions of the Western Pacific and South East Asia accounting for more than 66% of these fatalities. Death rates are highest among adults over the age of 60 years in all areas of the world (World Health Organization, 2016). Of those falls that are not fatal, about 37.3 million falls are severe enough to require medical attention. The highest fall morbidity occurs in people aged 65 years or older, young adults aged 15-29 years, and children aged 15 years or younger (World Health Organization, 2016). Statistics pertaining to falls in the United States Annually, millions of older people (those who are 65 years old and older) fall in the United States. Based on available data, it is estimated that more than one out of four older adults fall each year, but fewer than half tell their healthcare providers about falls. Falling once doubles the chances of falling again (Centers for Disease Control, 2017). Every year, 2.8 million older adults are treated in emergency departments for fall injuries. Over 800,000 patients are hospitalized annually because of a fall, most often due to injuries to the head and hip fractures. Every year, at least 300,000 older adults are hospitalized for hip fractures, and more than 95% of hip fractures are caused by falling.