Though there is consensus that improvement must be made in the area of injury due to patient falls, how to reduce patient injury due to falls has raised questions about effective solutions to this problem.
According to the Agency for Healthcare Research and Quality, accidental falls contribute to patient complications in 2% of hospital stays. Specifically in the state of Washington, where potential legislation aims to reduce the risk of patient falls, falls are found to kill or injure a few dozen patients per year. The American Nurses Association said in a statement: “Falls are a leading driver of healthcare costs, especially for the elderly. What’s more, Medicare and Medicaid do not reimburse hospitals for costs associated with injuries from inpatient falls, essentially increasing unreimbursed hospital healthcare costs.” Obviously, patient falls cause an impact to both patient safety and quality of care, and may affect hospital reimbursement.
A recent fall case in Washington raised some of the concerns at the forefront of the falls prevention debate. A patient was badly injured after he fell while being medicated with a sleeping pill (zolpidem). A study has found that hospital patients taking zolpidem are four times more likely to fall. Some hospitals have begun phasing out zolpidem as a sleeping pill because it makes patients more likely to fall.
Most hospitals rely on a fall risk assessment for their patients to determine the level of fall prevention care required. However, changes in patient status – such as the use of medication that increases fatigue or confusion – must cause a re-evaluation of a patient’s risk. For hospitals that continue to offer zolpidem, its use may lead to a patient that was previously classified as a low fall risk becoming a high fall risk, leading to additional protocols or care depending on the hospital’s fall prevention plan.
Studies show that more nurses result in fewer patients falling. Nurses in Washington have supported legislation requiring higher staffing levels. But hospital management is concerned about the cost of this requirement, although the hospital did add 29 more nurses at the hospital where this fall occurred. Additionally, that hospital’s Chief Nursing Officer says “What we have found is it has much less to do with staffing ratios than with having good solid reliable processes in place and following those every single time.”
Many of these processes involve bed alarms – which some studies have shown to be ineffective at preventing falls. Additionally, as a nurse states, “You still need a person to be close enough nearby to be able to respond to the alarm.”
When looking at the causes that result in an issue impacting the organization’s goals, the analysis step may seem like the most difficult part to get through. However, in many cases, especially where patient safety, staffing, funding and reimbursement come into play, it can be even more difficult to determine which solutions should be implemented to reduce the risk of the issue recurring, especially when studies may offer conflicting or confusing evidence about the effectiveness of various interventions. In this case, it is particularly important that organizations determine the required reduction in risk (in this case, most hospitals are attempting to end patient injury due to falls) and the solutions (interventions) that will result in that reduction based on the needs and available resources of the organization.
Most importantly, after a specified time period, the solutions need to be evaluated for effectiveness, based on carefully determined criteria. In this case, whatever intervention is selected to reduce injury from patient falls should be evaluated against the number of injuries due to falls at that facility. If the risk has not been reduced as desired, additional interventions are in order.
To view the fall issue discussed here in a Cause Map, with notes about solutions under consideration for reducing fall risk, please click “Download PDF” above. Or click here to read more.