Quality Measure : Fall Prevention

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,

Falls are one of the major patient safety problems that every facility encounter on a day to day basis. An aging patient population, combined with multiple diagnosis and medications are prime contributing factors for patient fall. Other contributing factors are shortage of nursing and auxiliary staff, ineffective work environment and shortage of appropriate equipment. According to the Joint Commission around 30-50 percent of the falls happening in the hospitals have resulted in injury to the patients. Since Joint Commission started keeping records of fall from 1995 to 2012, it has been reported that there were 659 fall related death or permanent disability, which were voluntarily reported as a

The Center for Disease Control (CDC) reported that more than one third of adults 65 and older fall each year. Half of the elderly people, who fall, do so repeatedly. Aside from the health problems related to falls, nearly $20 billion of direct medical costs are associated with fatal and non-fatal falls (Larson & Bergmann, 2008).

Every year, about one third of everyone over the age of 65 falls, and do not report it to their doctors. Falls are the leading cause of fatal and nonfatal injuries in older people (Falls Among Older Adults). Falls become more common as people age because their bones become more brittle and their muscle mass decreases. In society today, the baby boomers are aging, which means falls will continue to increase in frequency. When a person falls, it doesn’t just affect the victim; it affects everyone. In 2012, approximately $30 billion went towards medical costs that were associated with falls (Falls Among Older Adults). To prevent more people being injured and more money being spent, there has to be a change.

Each year, one out of three elderly people fall (U.S. Centers for Disease Control and Prevention [CDC], 2015). The CDC (2015) also reports that once an individual has fallen, the chance that they will fall again doubles. Falls also contribute to an increase in direct medical costs. The CDC (2015) states, “Direct medical costs for fall injuries are thirty-four billion dollars annually. Hospital costs account for two-thirds of the total.” The amount of elderly people who fall each year along with the economic costs that result from falls indicates that preventing patient falls remains an important goal for healthcare workers including nurses. Nurses can use the nursing process—assessment, diagnosis, planning, intervention, and evaluation—to prevent patient falls and meet the fall prevention standards set by various regulating bodies.

According to the reports published by the Centers for Disease Control and Prevention Injury Centre (2007), falls are the third most common cause of unintentional injury death across all age groups and the first leading cause among people 65 years and older. A hospital can be a dangerous and erratic place for inpatients because of its unfamiliar

In the mid 90’s the American Nurses Association (ANA) developed nursing quality indicators that show a connection between nursing care and patient outcomes. Patient injury rate, noted to be most often caused by falls, was promoted as a nurse sensitive indicator, a measure of quality that links patient outcomes with availability and quality of professional nursing services (Quigley, Neily, Watson, Marilyn, & Strobel, 2007). The ANA maintains that nurses are responsible to assess patient’s risk for falls

Patient falls have been a long debated healthcare issue throughout time and measured as a nursing sensitive issue. The National Quality Forum (NQF) has endorsed patient falls with an injury with the steward of the American Nurses Association (NFQ: Quality Positioning Systems, 2014). All patient falls are documented per 1,000 patient days via the measurement description (NQF: Quality Positioning Systems, 2014). The target population that accounts for the total number of patient falls is in the medical-surgical, step-down, critical care, critical access, surgical, medical and adult rehabilitation units (NQF: Quality Positioning Systems, 2014). The Center for Control and Disease (CDC) has reported that every seventeen seconds, an elderly patient will have a fall in a hospital (Hill & Fauerbach, 2014). The majority of falls are associated with patients ambulating from a bed, chair, or toilet without the proper assistance (Shorr, Chandler, Mion, Waters Liu Daniels, et al., 2012). There is a new regulation published by the Center for Medicaid Services. It states that injuries acquired through a fall in an organization will be held responsible for those medical costs (Hill & Fauerbach, 2014). In fact, in 2010, there was approximately $30B in hospital costs related to patient falls (Hill & Fauerbach, 2014). With the increasing number of patient falls in acute care settings and the change of healthcare coverage, does the use of bed alarms reduce the risk of falls of

The National Database for Nursing Quality Indicators is an organization that allows hospitals to compare nursing quality of national, state, and regional for similar units and hospitals (Cherry & Jacob, 2017). This organization uses criteria used to grade and improve quality such as patient falls, use of physical restraints, nosocomial infections, nursing care hours provided per patient day, and nurse satisfaction surveys (Cherry & Jacob, 2017). The Quality and Safety Education for Education was established to educate registered nurses to constantly improve the safety and quality in the facilities they work (Cherry & Jacob,

Falls are one of the most common inpatient adverse events. According to the World Health Organization, a fall is defined as an event that results in a person coming to rest inadvertently on the ground or floor or other lower level (WHO 2016). In 2012, the cost of fall injuries totaled more than $36 billion. As the population ages, the financial toll for older-adult falls is projected to reach $59.6 billion by 2020. (NCQA 2015). Fall-related injuries account for up to 15 percent of rehospitalizations in the first month after discharge from hospital (Currie). Based on data from 2000, total annual estimated costs were between $16 billion and $19

The Center for Disease Report (CDC) for Mortality and Morbidity Weekly has reported falls as being the leading cause of injury among the elderly adult. According to stats released by the CDC, there are an estimated one to three falls that occur among the elderly resulting in a direct medical cost of $30 billion yearly. According to Barbour et al. (2012) falls often result in significant consequences for the elderly adult patients including, hip fracture, brain injuries, limited functional abilities, and reductions in physical activities. Barbour et al. further reported that falls are more commonly seen in an older adults with some form of arthritis condition that results in poor neuromuscular functioning. Falls, as reported by Barbour et al. states that the incidence of falls within the fifty United States was highest among adult with arthritis condition as compared to a person without arthritis.

It is estimated that 1 in 3 adults over 65 years of age will fall each year (Stanford Health Care, 2016). By the time seniors reach 80 years, the risk of falling is 1 in 2 persons (Stanford Health Care, 2016). Broken bones mean more medicine, doctors’ visits, and surgeries, increasing healthcare costs to both individuals and the medical system (Jang, M. S., Lee, Y. S., & Kim, J. T. (2014). In 2013, the cost for treating fall-related injuries was more than $34 billion in the U.S. (NCSL, 20116). That money pays for the 2.5 million emergency room visits, for 700,000 hospitalizations, and toward the 25,000 deaths per year as a result of falls (NCSL, 20116).

Meaning that facilities need nurses who will follow evidence based protocols that will keep patients safe and save the facility money down the line. Inpatient falls is an event that no facility is happy about, it reflects negatively on the nurses and Medicare and Medicaid wont pay for the injuries sustained, “Medicare and Medicaid Services that hospitals will no longer be reimbursed for certain nosocomial conditions (U.S. Department of Health and Human Services, 2008). These hospital-acquired conditions, also called never events, include the cost of treating injuries obtained from hospital falls” (Graham, 2012). In order to prevent hospital falls, evidence based care suggests that through medication management, environmental aids, fall alarms and future technology such as video monitoring and fall prevention teams, the rate of hospital falls can be greatly

Evaluation of the project outcome is critical in assessing whether the fall reduction programs are productive and of benefit to the participants or in other words, assessing the general value of the program (Miake-Lye et al., 2013). In this case, the rate of falls and potential resultant injuries and the overall adoption of fall prevention practices are critical components of quality improvement of the program. They are crucial parameters for evaluating the success of the implementation project as well as learning from the successes and the challenges herein. In the case of this project, it is anticipated that there will be a decrease in the rate of falls among the patients. It is also expected that the number and severity of injuries due to

A quality-focused dashboard synthesizes data that measures quality and patient safety initiatives that the main emphasis is on clinical outcomes (Boivin, 2015). Among the examples include the nursing sensitive indicators data such as falls with injury, hospital acquired pressure ulcers, central line-associated blood streaminfection (CLABSI), etc. This data will aid to determine the efficacy of a facility’s clinical guidelines or protocols in the prevention of the occurrence of any hospital acquired complications (Mazzella-Ebstein & Saddul, 2004).