Page 60 nursing.elitecme.com Complete Your CE Test Online - Click Here Nursing consideration: Home assessment prior to discharge from an inpatient setting is important to facilitating safety. Such assessment could also be a recommendation made by healthcare providers in office and outpatient settings. Specific health conditions have also been linked to an increase risk of falling. Such conditions include (Centers for Disease Control and Prevention, 2017; World Health Organization, 2016): ● ● Weakness of the lower extremities. ● ● Impaired mobility. ● ● Impaired balance. ● ● Vitamin D deficiency. ● ● Use of medications that affect judgment, balance, and/or cognition such as tranquilizers, sedatives, antidepressants, and some analgesics. ● ● Impaired vision. ● ● Foot pain. ● ● Improper footwear related to disease, financial hardship, or lack of knowledge about fall prevention. ● ● Alcohol or substance use or abuse. ● ● Neurological or cardiac conditions. ● ● A combination of poor mobility, cognition, and vision, especially among people who live in long-term care or chronic care facilities. Most falls are due to a combination of risk factors rather than a single item. The more risk factors a person has, the greater are the chances of falling (Centers for Disease Control and Prevention, 2017). Nursing consideration: There are identifiable risk factors for falls. However, nurses and other healthcare professionals should never become complacent about what type of patient does (and does not) fall. Any patient, regardless of age, diagnosis, or gender, may fall. That is why it is so important that the fall risk of all patients be assessed. Critical thinking question: How can nurses improve their assessment of a patient’s fall risk factors? There is no simple answer to this complex question. In inpatient settings, risk is generally assessed in conjunction with the hospital environment and the patient’s condition in the acute care setting. However, assessing risk factors confined to inpatient conditions is not enough. Since lengths of inpatient stay are getting shorter and shorter, nurses must begin discharge planning upon admission. What factors in the patient’s home environment increase the risk of falls upon return home? Nurses must know about the discharge environment’s risk factors and take steps to help reduce or eliminate them. A home evaluation by members of the physical and/ or occupational therapy departments may be warranted. Nurses and therapists will need to provide patients and families with education about safety at home as needed. So in other words, the healthcare team’s responsibility for safety initiatives is not confined to the inpatient setting. Discharge education can and must include teaching about ways to increase patient safety. The development of a fall assessment process Julia is the nurse manager of a neurological rehabilitation unit. Her primary patient populations are patients who have had strokes, sustained spinal cord injuries, or other conditions that impact neurological status. These patient populations are at high risk for falls. Julia is the chairperson of the recently established task force to revamp the organization’s fall assessment process. She has experienced some resistance from her staff nurses. They feel that their unit (and their ability to provide care) will look “bad” because their patients are at higher risk for falls and their unit has one of the highest fall rates in the organization. Julia, however, knows that it is essential to take steps to improve fall assessment and fall prevention initiatives. She recruits a number of staff nurses (including some members of her staff) from various units to serve on the task force. Patient populations vary from unit to unit. Julia wants to develop an assessment programs that meets the needs of these varied populations and the nurses who work with them. Accrediting and quality improvement organizations fall prevention statements The Center for Medicare and Medicaid Services (CMS) identified falls as a Hospital-Acquired Condition (HAC) in 2008. A HAC is defined as a complication or comorbidity or major complication or comorbidity that is the result of hospitalization. It is high volume and/or high cost, and is reasonably preventable used evidence-based guidelines. Thus, CMS will no longer cover the cost of care related to consequences of inpatient falls based on the presumption that falls are preventable (Quigley & White, 2013). The Joint Commission requires hospitals that are accredited to conduct fall risk assessment in order to identify patients’ risk for falls while hospitalized so that appropriate preventive measures can be taken. The Joint Commission began to monitor sentinel events in 1995. From that time through the year 2012, 659 falls associated with death or permanent function loss were voluntarily reported to the Joint Commission. Since these data are voluntarily reported, it is probable that the actual number of such events is much higher (Quigley & White, 2013). The National Quality Forum (NQF) has deemed injury falls to be “never ever” events. Such falls are linked to increased morbidity and mortality rates and affect reimbursement of costs. The NQF collects data on death and serious disability associated with these types of falls (Quigley & White, 2013). The Agency for Healthcare Research and Quality (AHRQ) serves as a resource for evidence-based practice. The AHRQ advocates a fall prevention approach that is consistent with a systems approach designed to improve safety and reliability of care. The agency believes that prevention strategies must address the multiple risk factors that exist and include multi-component interventions for fall prevention. In other words, no single action or strategy can prevent falls and/or enhance safety (Quigley & White, 2013). The National Database for Nursing Quality Indicators (NDNQI) is an external data base to which many organizations report fall data as part of quality improvement initiatives. This provides organizations with the opportunity to perform an external benchmark comparison with similar types of nursing units/departments, assess their performance, and identify ways to improve safety (Quigley & White, 2013). Nursing consideration: There are many organizations that serve as repositories for fall data. Nurses should be aware of which ones their organization uses in order to make use of them as resources for evidence based practice and quality improvement. Suggestions for developing fall assessment programs Jane is the director of nursing for a 300-bed rural community hospital. She knows that falls have been increasing on the nursing units and her boss tells her to “fix” the problem. Jane wishes there were one simple way to implement a fall assessment process. That way, all patients could be assessed using the same tool and time would be saved. What Jane does not understand, however, is that assessment can vary depending on the patient population being assessed. Her nurse managers are working with her to develop a process that has a basic foundation that is flexible enough to be adaptable for different patient populations. Such a process should take into consideration age, diagnosis, and risk factors. The nurse managers are having a hard time convincing Jane, who wants something developed “right away so that everyone can be doing the same thing.” A situation such as the one facing Jane and her managers is not uncommon. Jane is under pressure to find a “quick fix.” The nurse managers want to develop a program that is grounded in evidence, so that patients can be properly assessed. Fall assessment, like any other assessment component, is a process that must be individualized to the patient. Minnesota Falls Prevention Initiative. Falls are due to multiple factors and a holistic approach for their prevention is necessary (Minnesota Falls Prevention Initiative, no date given). The Minnesota Falls Prevention Initiative is an excellent resource for professionals. It offers information about screening, assessment, research done on fall assessment tools, and interventions by risk factor. The tool or tools that work best for a specific unit or units should be used. An organization may want to adopt a fall assessment program that includes several tools, or a combination of tools, to capture necessary data based on