Patient safety is among the primary concerns in healthcare settings, and one of the safety issues is patient falls. A fall is defined as “an unplanned descent to the floor (or extension of the floor [e.g., trash can or other equipment]) with or without injury to the patient and with or without assistance” (Tucker et al., 2019, p. 113). Falls may result in various injuries, such as fracture, functional decline, traumatic brain injury, and placement in nursing homes, and are “the leading cause of accidental death in people over 65 years old” (Lasater et al., 2016, p. 545). Falls also increase the cost of health care because of the necessity to treat preventable injuries. Therefore, healthcare organizations are concerned about falls prevention to improve patient safety and reduce healthcare costs. This paper will discuss the risk factors of patient falls and evidence-based solutions to this issue. Further, it will explore the role of nurses in preventing falls and identify stakeholders with which nurses should collaborate to address this safety problem.
Factors Leading to Patient-Safety Risk
Fall risk factors may be classified into two groups: intrinsic and extrinsic factors. Intrinsic factors include such patient characteristics as age, sex, previous falls, balance impairment, gait, ADL disabilities, stroke, cognitive impairments, Parkinson’s disease, and incontinence (Kwan et al., 2016). It has been found that the risk of falls increases with age, with patients aged 65-74 years having a fall probability of 32% and those aged over 80 years having a 37% fall probability (Kwan et al., 2016). As for the history of falls, patients with previous falls are at higher risk of falls than those without past falls (Kwan et al., 2016). Extrinsic factors are related to patients’ environment and include such factors as home hazards, the use of assistive devices for walking, and inappropriate footwear (Morone et al., 2018; Kwan et al., 2016). The most important of these factors, namely, history of falls, secondary diagnosis, walk assistance, parenteral therapy, mental status, and gait are included in the Morse scale used to assess a patient’s individual risk of falls (Nadia & Permanasari, 2018). Thus, falls risk factors are multiple and depend on both patients’ and environmental conditions.
Evidence-Based Solutions
The first step in addressing the problem of patient falls is the identification of patients at risk and risk assessment. According to Morone et al. (2018), older patients with conditions increasing the risk of falls should undergo a multifactorial fall risk assessment. Particular patient characteristics that need to be assessed include gait, balance, mental status, reflexes, as well as cerebellar, extrapyramidal, and cortical function (Morone et al., 2018). When a patient falls occur, it is crucial to analyze the type of the fall to select the most appropriate preventive strategies (Morone et al., 2018). Depending on the cause, falls are categorized into the following types: “accidental, unanticipated physiological, anticipated physiological, or intentional” (Morone et al., 2018, p. 151). Accidental falls occur due to environmental obstacles; unanticipated physiological falls result from patients’ health issues that were unknown before, and anticipated physiological falls are caused by known patient conditions.
Based on the identified risks, healthcare professionals should implement appropriate evidence-based practice solutions, addressing multiple risk factors. Such practices as minimizing the use of psychoactive drugs, gait and balance training exercises, and vitamin D supplementation have proven to be effective in preventing patient falls (Morone et al., 2018). In addition, it is necessary to manage patient conditions identified during the multifactorial risk assessment, such as visual impairment, urinary abnormalities, inappropriate footwear, or hazardous home environment (Morone et al., 2018). Evidence shows that interventions that address both health issues identified during clinical assessment and problems found during individual risk assessment are the most effective in preventing falls (Morone et al., 2018). Thus, evidence-based solutions for fall prevention include multifactorial risk assessment and addressing the detected risks in hospital and community settings.
The Role of Nurses in Addressing Patient-Safety Risk
Nurses have a leading role in addressing the safety issue of patient falls. They spend more time caring for patients than any other healthcare professional, and they are engaged in a team responsible for patient treatment (Nadia & Permanasari, 2018). Nurses can help coordinate care to increase patient safety and reduce healthcare costs by adhering to the best practices aimed at preventing patient falls. For example, they are involved in fall risk assessment using the appropriate instruments, such as the Morse scale (Nadia & Permanasari, 2018). Nurses are responsible for informing patients about the risk of falls and for providing them with the necessary assistance. Furthermore, communication among nurses is essential for ensuring patient safety. Tucker et al. (2019) found out that nurses frequently experience problems with communicating with each other, which resulted in poor care coordination and puts patient safety at risk. Therefore, the nurses’ role in addressing fall prevention lies not only in educating and caring for patients but also in effectively communicating with the interprofessional team.
Stakeholders
Nurses should collaborate with a variety of stakeholders to implement evidence-based solutions to the issue of patient falls. First of all, they should educate patients and their families about the risk of falls and available strategies for preventing them. Secondly, nurses need to collaborate with doctors and pharmacists when it comes to adjusting patients’ medications and administering vitamin D (Lasater et al., 2016). Nurses should also work along with social workers and doctors to implement such fall prevention strategies as exercise programs, motivational interviewing, and environmental assessment (Lasater et al., 2016). Finally, nurses should effectively communicate with each other to share information about existing safety issues and the ways of addressing them.
References
Kwan, E., Straus, S., & Holroyd-Leduc, J. (2016). Risk factors for falls in the elderly. In A. Huang & L. Mallet (Eds.), Medication-related falls in older people (pp. 91-101). Adis.
Lasater, K., Cotrell, V., McKenzie, G., Simonson, W., Morgove, M. W., Long, E. E., & Eckstrom, E. (2016). Collaborative falls prevention: Interprofessional team formation, implementation, and evaluation. The Journal of Continuing Education in Nursing, 47(12), 545-550.
Morone, G., Federici, A., Tramontano, M., Annicchiarico, R., & Salvia, A. (2018). Strategies to prevent falls. In G. Sandrini, V. Homberg, L. Saltuari, N. Smania, & A. Pedrocchi (Eds.), Advanced technologies for the rehabilitation of gait and balance disorders (pp. 149-158). Springer.
Nadia, P., & Permanasari, V. Y. (2018). Compliance of the nurse for fall risk assessment as a procedure of patient safety: A systematic review. KnE Life Sciences, 4(9), 207-219.
Tucker, S., Sheikholeslami, D., Farrington, M., Picone, D., Johnson, J., Matthews, G., Evans, R., Gould, R., Bohlken, D., Comried, L., Petrulevich, K., Perkhounkova, E., & Cullen, L. (2019). Patient, nurse, and organizational factors that influence evidence‐based fall prevention for hospitalized oncology patients: An exploratory study. Worldviews on Evidence-Based Nursing, 16(2), 111-120.