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What Goes Up, May Sometimes Fall Down

Millions of older people – those 65 and older – fall each year. A sample of the Centers for Disease Control and Prevention (CDC) data highlights falls as they occur inside or outside of the hospital:

  • 2.8 million older people are treated in emergency departments for fall injuries each year
  • 1 out of 5 falls causes a serious injury such as broken bones or a head injury.
  • >95% of hip fractures are caused by falling, usually by falling sideways
  • Falls are the most common cause of traumatic brain injuries
  • The direct medical costs for fall injuries are $31 billion annually.
    • Hospital costs account for two third of the total.

Often, a patient admitted to the hospital may be asked by nursing or medical staff to request a bathroom break or to ambulate around the hallways. Before being admitted to a hospital, patients typically go to the restroom on their own. Having to use a call light or request for assistance is new to many patients.

CHPSO Events Reports on Falls

Nearly 100,000 fall-related events exist in the CHPSO database. In 2016, CHPSO member hospitals contributed more than 18,000 fall-related safety reports. A breakdown of reports by age, gender, and location of where falls happened are listed below based on a sample of 1000 reports:

Events by Gender

  • 65% involved males and 35% involved females.

Events by Age

  • 48.9% adult (18-64 years)
  • 16.1% mature adult (65-74 years)
  • 14.5% older adults (75-84 years)
  • 8.8% aged adults (85+ years)
  • 8.7% child (1-12 years)
  • 2.6% adolescent (13-17 years)
  • 0.4% neonate (0-28 days)
  • 0.2% infant (>28 days <1 year)

Reports by Location

Below is a sampling of the falls in the CHPSO database:

  • A patient was being moved to a gurney after surgery with four people assisting but the gurney was not locked. While pulling the patient over the gurney, the gurney moved away from the surgical table and the patient fell on the floor.
  • A patient identified as high risk for a fall was placed nearby the nurse’s station. Engineering activated and checked the bed alarm prior to placing the patient in the room. The patient got out of bed and the alarm did not sound. The patient took a hard fall on his hip, back, and head.
  • A pediatric patient was intubated on an operating room table. Without assistance, the physician removed the head of the bed while holding the patient’s upper body. The patient fell off the bed head first.
  • A patient was in recovery after a successful surgery. The patient was alert and received discharge instructions. The patient dressed himself and walked to restroom with steady gait. Patient got dizzy and light-headed and fell in the bathroom.
  • A patient was found on the floor after calling for help. The patient stated that she pushed the call light but no one responded and patient could not wait. The patient attempted to go to the bathroom by herself and fell. The call light was not working properly and the facilities management team was called to fix it immediately.

Patients had falls in the hospital settings due issues like the following:

  • Bed alarm failed, not activated or refused by the patient
  • Wet floor due to urine or water from sink or shower
  • Tripping over or the misuse or malfunction of furniture, devices or equipment
  • Patient refused to use call light because she felt she didn’t need assistance
  • Assisted by family
  • Certain medications such as benzodiazepines, antipsychotics, and sedatives
  • Dizziness, hypotension
  • Slipped, tripped, fainted or lost balance
  • Sitter not available or stepped away
  • Reached for an item
  • Gurney brakes failed or not locked

The most common activity performed at the time of the fall was ambulation; frequent destinations were bed to bathroom, bedside commode to bed or from bed to bedside commode. Falls involving bedside commode occurred when the patient was left after being assisted to the bedside commode to give more privacy to the patient. In addition, bathroom falls happened when the patient was left alone for privacy. The assistant who had helped the patient to the bathroom was waiting for the patient outside the bathroom door.

Prevention and Resources

According to the Joint Commission, preventing falls is difficult and complex, but there is a considerable body of literature on how to reduce the risk of falls.

Prevention efforts can be made by increasing staff assistance and awareness in the units. Patients need to be better educated on effects that new tests, treatments, environment or activity can have on patient’s energy and ability to ambulate safely. Families should be encouraged to have patient use their walker or assistive devices. It is important to target the prevention efforts to patients or visitors who may be at risk, such as the elderly and infants being carried by visitors.

Below are resources your healthcare organization may consider reviewing:

The Hospital Quality Institute (HQI): Eliminating Falls Toolkit

Hospital Improvement Innovation Network (HIIN): Falls

  • CHPSO, a division of HQI, works alongside the HSAG/HQI Partnership in the HSAG Hospital Improvement Innovation Network (HIIN). For questions regarding your participation in the HIIN, please email info@hqinstitute.org.

Agency for Healthcare Research and Quality (AHRQ): Preventing Falls in Hospitals: A Toolkit to Improving Quality of Care

The Joint Commission: Target Solutions Tool for Preventing Falls

CHPSO’s other falls related articles:

References

Falls with Injury Change Package. Health Research and Educational Trust (HRET). 6 April 2017. http://www.hret-hiin.org/resources/display/falls-with-injury-change-package

Important Facts about Falls. Centers for Disease Control and Prevention. 10 February 2017. https://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

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