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strategies to prevent falls and injuries in nursing homes and hospitals

by Rein Tideiksaar, PhD

Falls that institutions are working to prevent (so they never happen) are called Never Events.

Falls are common occurrence among elderly acute hospital patients and nursing home residents. Within the hospital setting, reported fall rates range from 2.2 falls per 1000 patient days on general acute medical wards and up to 20 falls per 1,000 patient days on geriatric and rehabilitation units. Up to 30% of hospital falls result in injury. In the nursing home, approximately 75% of residents fall each year; the annual incidence for falls is: 1500-3000 per 1000 residents. Around 4% of nursing home falls result in fractures, whereas other serious injuries such as head trauma, soft-tissue injuries, and severe lacerations occur in about 11% of the cases.

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In addition to potentially devastating patient and resident outcomes associated with falling, there are also disturbing economic outcomes. As of October 2008, the Centers for Medicare and Medicaid Services (CMS) announced that Medicare will no longer pay the extra costs of treating preventable errors or injuries resulting from falls. Many other insurance carriers and secondary payers are following CMS's lead. Fall-related injury (or death) are covered in the list of "Never Events" published by CMS, which are defined as "errors in medical care that are clearly identifiable, preventable, and serious in their consequences". As a result, hospitals and nursing homes will be responsible for the treatment of impacted patients and residents. Most significantly, the facility will be burdened by being responsible for 100% of the cost of such treatment. As a consequence, it's important that facilities address the problem of falls, especially injurious falls.

Key Components of Fall Prevention

No hospital or nursing home will be able to prevent all falls, but there is a great deal that can be done to reduce fall risk and thereby the total number of injurious falls. The ability to prevent falls is largely dependent upon:

  • Caregivers adhering to a clinical process or practice of care regarding fall prevention, which assists in identifying factors contributing to falls and finding solutions to reducing the risk of falling.

  • Ongoing caregiver education regarding fall prevention in order to increase caregiver confidence, knowledge, skills, and ability to identify patients and residents at risk of falling and to select appropriate interventions for the prevention of falling.

  • Providing administrative support for fall preventionactivities, which includes:
    • Promoting a culture of fall prevention that includes an atmosphere of "no shame, no blame" in which caregivers are not blamed for falls, but rather falls are looked at as an opportunity to do things better.

    • Appointing a caregiver who can support, coordinate, and champion prevention initiatives.

Consequently, having in place an organized clinical approach or process, educational activities and administrative leadership represent the foundation of a successful fall prevention program.

Steps to Reduce Falls

While there is no guarantee to preventing falls or shielding oneself against liability, providers can take certain steps to better protect their patients and residents from falls and injury.

Step 1: Identify the extent and circumstances of falls and injurious falls within your facility (i.e., who falls, location of falls, time or when falls take place, and why falls occur).

Step 2: Assess fall risk in all patients and residents and identify those at increased fall risk, especially those at risk for injurious falls.

Step 3: Based on the above steps, design appropriate multidisciplinary strategies and care plans to reduce fall and injury risk.

Step 4: Consider the use of "safety technology" (e.g. fall alarms, hip protectors, etc.) to assist in preventing falls and injury.

Step 4: Monitor outcomes and redesign care plans as needed in those patients and residents who continue to fall or suffer injury.

To help facilities in their fall prevention efforts and reduce the likelihood of never events, SeekWellness.com offers facilities a number of helpful tools and products:

Fall Risk Assessment Tools

Fall Management/Injury Prevention Products

Posted May 2010

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