Falls prevention of hospitalized older adults in acute medical Units: Evidence based nursing interventions.
Introduction
A fall is a lethal event that results from an amalgamation of both intrinsic and extrinsic factors which predispose an elderly person to the incident (Naqvi et al 2009). The frequency of hospital admission due to falls for older people in Australia, Canada, UK and Northern Ireland range from 1.6 to 3.0 per 10 000 population (WHO 2012). The prevalence of senior citizen’s falls in acute care settings varies widely and the danger of falling rises with escalating age or frailty. Falls of hospitalized older adults are one of the major patient safety issues in terms of morbidity, mortality, and decreased socialization
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A fall can make wide spread consequences on the health service or can be affected seriously by the increased health care utilization. Among the fallers approximately 30% of falls result in physical injury leading to extensive hospitalization with significant hospital expenses (Tzeng & Yin 2010). Preventive care phases can support health services to regulate the spare expenditure to a greater extend. A fall in hospital consequently affects the nursing staff, which lead to impaired job satisfaction, additional work load and startling time consume. As the front line of care, nurses can prevent falls and reduce fall injury rates in acute care unit with available resources (Dykes et al. 2013). This literature review aims to assess the efficiency of planned interventions to reduce the incidence of falls in acute medical units. The discussions of the main findings of the review as well as the recommendations for further research are revealed to conclude this study.
Search strategy (APPENDIX 1)
For the literature review an electronic search was undertaken of articles published in English using the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed and Cochrane databases from 2009 to 2013 were searched for medical subject heading terms, both individual terms and combination of the following
During hospitalizations, falls are amongst the highest preventable consistent adverse events. Preventing such undesirable events, enhances patient overall experience, as well as increased trust in the health care professional team (Fragata, 2011). The importance of fall prevention lies with the many serious unfavorable health outcomes it can pose on the patient. Falls have the potential increase length of hospital stay, limit mobility, independence, but can ultimately lead to health deterioration, including death. Worldwide, falls are the second leading cause of accidental death. In addition to the life-threatening health and safety risks falls have to the patient, it also as a financial impact,
Patient falls in hospitals continue to be a major and costly problem. The definition of a patient fall is an unplanned descent to the floor, assisted or unassisted, with or without injury to the patient. The authors of this article wanted to investigate the effect “missed nursing care” has on patient fall rates and patient outcomes. The authors also looked at hospital staffing as it relates to patient falls and nursing staff having enough time to carry out all nursing responsibilities.
Falls are considered a leading cause of mortality and injury among older adults and majority of the falls occurs while hospitalized. One would think being in the hospital would be one of the safest places for older adults as far as fall prevention is concern due to the fact that hospitals provide staffing around the clock for patients but more and more falls have been occurring in the hospital especially in the older adult population. Fall is an unintended descent to the ground. It raises public and family care liability; it also decreases patient’s functioning because it causes pain and suffering, and increases medical costs (Saverino et al, 2015). The Center for Disease Control
Title: Are Registered Nurses Utilizing Evidence-Based Fall-Preventative Strategies to Reduce and Prevent Falls and Injuries in the Elderly Population
Several national and global campaigns already exist that provide tips and resources for fall prevention. However, statistics continue to demonstrate that falls continue to remain a serious problem in the elderly community. No one can argue that education is the best defense against falls. Nor can they argue that national efforts are not needed. Despite these national campaigns, falls
Falls remains one of the most concern regarding patient safety problems for older adults in the hospital setting. While patient falls is frequently occurring in hospitals, they often cause serious injuries, death, and additional cost. Nobody can prevent all patients falls, but hospitals can significantly reduce the ones they can when implementing a fall prevention program. The purpose of this study is to reduce the incidence of older adults falls at hospitals and evaluate the factors that contribute to the risk of falling. The study will use a retrospective experimental comparison design of two groups in the hospital setting. The patients at the medical unit will receive the risk falls assessment for six-month while patients at the surgical
When individual ages it is inevitable, however falls can be avoidable when taking the correct precautions and safety modifications in ones home. Over the past few decades the lifespan of older individuals have increased. Nursing homes or assisted living facilities have been the answer for people who are less independent. However, some older adults remain in their homes and become the targets of falling. Falls are one of the leading causes of death in older adults 65 and older. Older individuals who experience falling are at risk for serious injuries or fatality. A falls prevention program is necessary to be idealistic for older individuals to prevent, reduce, and eliminate the number of falls so a person can experience a healthy
Fall prevention is a vital aspect of a nurse’s job in the hospital. In this article, it explains hospitals having fall risk assessment tools, but many of them have not implemented interventions to mitigate patient-specific fall risk to these tools. The research problem addressed even though fall prevention should be modified to the individuals risk factors. Hospitals have not implement the use of fall prevention intervention to targeted patient with specific risk factors. Each patient is an individual and may have different risk factors than the patient in the next bed. The gaps in knowledge for fall risk patient are medical personnel don’t consider patient specific fall risk factors in the hospital setting. This study understands little research
Falls among hospitalized patients are a primary concern for all associated health care providers, and different factors contribute to fall during hospitalization. The setting the writer is going to address is hospitalized patients in acute and long term care setting of which the writer has worked both as a floor nurse, and as a nurse manager. The causes of falls in hospital are many, and maybe due to intrinsic factors which is related to the patient’s health status such as confusion, or extrinsic factors which is related environmental obstacles like medical equipment, and also the organizational or workforce factors.
Polished wood and tile floors are a slip hazard. Make sure that flooring has enough resistance to prevent slipping. Carpeting is ideal, but non-slip mats are also a good choice for bathrooms and kitchens. Just be careful of transitions that might be a trip hazard.
Falls are the most frequent and devastating accidents in older adult (WHO, 2004). There are different interpretations related to falls. For instance, according to healthcare professions fall is an event leading to ill health and injuries, whereas older adults define it as a loss of balance (Zecevic et al., 2006). Approximately, 28% to 35% older adults age 65 years and older fall each year (WHO, 2007). Around 85% of these falls occurs in the home among older adults living independently (Tideiksaar, 1987). Falls accounts for 40% of all fatal injuries (Rubenstein, 2006). Fall is a reason for 25% of all hospital admissions, 40% of all nursing home admissions and 40% of those admitted do not return to independent living (Learn not to fall,
Falls can have an overwhelming effect on legal, economical, ethical, and political situations. Many questions arise as to how to keep patients safe when they are at risk for falls. “A fall is described as a sudden, unintentional, downward movement of the body to the ground or other surface; when a patient falls, he or she is at risk of serious injury, disability, and possibly death” Huey-Ming, 2012). Falls happen during the day, afternoon, at night and do not subside do to the amount of staff. Falls happen when patients are ambulating, transferring, getting up without assistance, reaching for personal items, along with many different reasons. It is our job and duty as health care professionals to ensure patients remain safe during their hospital stay. As we learned in my previous literature review, patients that have had previous falls tend to fall more than those who do not, falls will increase the patients stay when there is or isn’t an injury obtained.
Patients’ safety is a priority in today’s health care system. The Centers for Medicare and Medicaid Services announced that hospitals will no longer be reimbursed for certain nosocomial conditions, thus placing a great demand on healthcare systems to prevent hospital-acquired health related injuries such as falls (U.S. Department of Health and Human Services, 2008). Nosocomial conditions, such as falls are conditions that are preventable that occur in the clinical or hospital setting. A fall is an unexpected event in which the participant comes to rest on the ground, floor, or lower level (Amador & Loera, 2006). Fall related accidents, injuries and death remain a major problem among hospitalized patients. It is estimated that one out of three adult patients over the age of 65 will fall (CDC, 2014). Falls have detrimental effects and impact on patients’ health and outcome as well as hospitalizations costs. Falls have attributed to broken bones, fractured hips, fear of walking alone, brain trauma, and even death. In 2012, the direct medical costs of older adult falls were $30 billion (CDC, 2014). According to Tzeng, Yin, & Grunawalt (2008), even the length of stay is affected, with inpatient falls with injury resulting in a 7.5-day increase in total length of stay. The attributed cost of falls, increased in injuries and prolonged hospital stay have a great impact on Advanced Practice Nurses’ (APNs) practice. The focus of this paper is to discuss evidenced-based
Approximately 30% to 40% of people older than age 65 fall at least once a year. Of those who fall, 5% to 10% will sustain a head injury, a fracture, or laceration.” (Capetuzi) Elders falling is one of the fastest rising problems in the United States and it is responsible for many hospitalizations. Not only are falls dangerous but they are also costly to the victim and their family. A fall can increase an elder’s dependence and make it much more likely that they will sustain another fall. Elders who fall and are not tended to immediately can suffer from pressure damage and hypothermia. In addition to physical harm, fall victims have reported having less confidence, as well as a greater limitation of activities following a fall.
Although several national and professional organizations have developed evidence-based guidelines that set forth strategies for reducing falls,10,11 consistency in implementation of these strategies has been limited. Findings from 188 medical-surgical units in 48 hospitals across the United States found that risk-specific interventions (such as ambulation and medication management) are not being implemented consistently.12 This finding is in line with our research where we have identified that elements of nursing care are being regularly missed in acute care hospitals. We have conducted 3 studies of missed nursing care, the first being a qualitative focus group study on 5 patient units,13 the second a quantitative study in 3 hospitals,14 and the third, an expansion of the 3-hospital study in 10 hospitals with diverse characteristics (eg, size, teaching status).15 The results of these studies showed that a substantial amount of standard required nursing care is being left undone and that the patterns of missed care are similar across hospitals. Ambulation of patients 3 times per day (or as ordered) was the most frequently reported element of missed nursing care with 76% of nurses reporting this action being frequently or always missed. Similarly, Callen and colleagues16 found that 73% of patients did not walk during their