Introduction
This report aims to critically focus on an aspect of risk management within the clinical setting. The discussion will be based on patient falls and the target group will be nurses or other health care professionals. A critical discussion of the identified risk management will be included, a rationale for choice provided supported by relevant evidence, and finally an evaluation of how the risk management package could be used within the health care setting to minimize the identified risk in practice.
The Risk management package will be included as an appendix. The use the relevant literature in this report will be used to support the discussion.
Methodology
The information presented in this report was obtained concerning the information provided by the United Kingdom Department of Health and other literature materials that address the issue of patient falls. There is no formal research that was carried out but the information is enriched by well-thought-out ideas about fall risk management that are beyond what different researchers have obtained.
Discussion
The subject ‘patient at risk of falls’ was considered in this research because various researches have shown that patient falls need more weighty attention than what is presently accorded. There has been researching carried out on the subject over the past couple of decades and all have underscored the significance of patient falls risk. According to the UK Department of Health ( 2009, 1), the past three decades of research have expanded the understanding of common risk factors predisposing to falling and have provided paramount knowledge for the prevention of falls, including specific strength and balance training. As stated by Tideiksaar (1997, 8), patients especially in an inpatient setup nurse non-fatal injuries that culminate from falls. Patient falls have been a major issue in the clinical setting and are responsible for increased healthcare expenses in many health care institutions. These falls have even led to many lawsuits in nursing. Falls are responsible for the heavy financial burden experienced by hospitals. According to the Department of Health (2009, 2), Patient falls have even resulted in deaths and over 50 thousand people die annually due to patient falls. Many types of research have underscored the significance of patient falls because of their serious implications. According to Ali and colleagues (2004, 21), the risks associated with patient falls can be addressed and managed well in order to mitigate them.
The UK Department of Health (2009, 3) describes patient falls as loss of physical balance that might cause the patient to land on the ground. Such results are regarded as falls for purposes of risk management if they are proved to be unintentional, uncontrollable, and non-purposeful acts that cause the patient to land on the ground or on an object (Hendrich et al, 1995, 135). There is usually a fall response team whose responsibility is to evaluate the fall when it occurs and minimize the chance of it recurring in the future. This team is only active when the fall occurs because it evaluates the causes of the fall only when it arises. Various risk factors have been associated with the patient’s falls or risks of falling. According to Skelton & Todd (2004, 17), these factors are could be categorized into intrinsic and extrinsic factors both of which are affected by exposure to risks. The intrinsic factors are those factors inside the body of the patient that may cause falls. They are also referred to as psychological factors that relate to the internal traits of the patient (Innes &Turman, 1983, 32). The extrinsic factors are those factors outside the body of the patient that may cause patient falls (Rawsky, 1998, 472). Extrinsic factors may include loose electrical cords, external lighting, and hazardous activities among others. The intrinsic factors may include muscle and strength weakness, visual disturbances, gait disorders, chronic disease, age, and mental status alterations among others.
Some factors necessitate fall prevention interventions and are used in assessing fall risks. Whenever these factors are experienced, fall prevention interventions are undertaken. The standard fall prevention interventions are necessary for the following situations. Firstly, in the case of mobility impairment, fall prevention interventions are necessary because mobility impairments are likely to cause falls. There are also visual impairments that are likely to cause patient falls (Cohen &Guin, 1991, 315-319). Agitation like sleep disturbance, frequent toileting, and use of drugs like an antihistamine, cardiac drugs, and drug treating nocturia among others are likely to cause patient falls. Besides the standard fall prevention management, there are also high fall risk prevention interventions that are applied to patients who have many fall risk factors. They also apply to those who have already fallen due to various factors. These prevention measure calls for the nursing staff to make use of the available technology for risk prevention (Hoskin, 1998, 12). These technologies may include alarms at exit, bed, and chair with alarms among others. There is also the use of video camera surveillance to help identify the fallen patients and those at risk of falls. The nursing staff is also expected to remove all kinds of hazards from the environment, evaluate the intrinsic and extrinsic factors, and treat the medical condition that will arise among others. Patients should also be educated on the kind of exercise that they should take and home safety measures among others.
According to Evans and colleagues (1999, 109), there are also post-fall actions that occur when the patient has already fallen. These are nursing and medical interventions that help assess the injuries and treat them and prevent their future occurrences. Nursing entails assessing the injuries, informing the physicians, following the policies put by the organization regarding monitoring of the patient, informing the other team members of what has transpired, evaluating the internal and the extrinsic factors, and compiling the incident report among other actions. Technology is also applied as appropriate in order to prevent repeat falls in the future. Mahoney (1998, 701 ) stated that Medical intervention entails treating the assessed injuries, coming up with diagnostic interventions to help treat the fall contributing causes, determining the possible cause, consultation made from appropriate services, and treating for pain among others.
The occurrence of fall risk affects the patient outcome and the National Health Service (NHS) in several ways. For patient outcome, as stated by Morse (1997, 26), there is increased awareness about the falls; patient strength, balance, and mobility are also improved, increased ability to recoup balance loss, proper hydration and nutrition, and fall injuries minimization among others. For NHS, there is an interdisciplinary approach that is instituted to carry out fall prevention and management. There are also experts that are made available to deal with fall prevention and management (Ash et al, 1998, 12). The program of fall prevention and management also gets improved in terms of development and evaluation (Campbell & Robertson, 2006, 63). Currently, as mentioned in this discussion, fall risks are managed through standard and high-risk fall prevention interventions, post-fall interventions, and fall risk assessment procedures. There is also minimal education about patient falls and related injuries and other associated risks.
Evaluation
The risk management package for falls that is used in dealing with the risk of patient falls seems to be incomplete and in a higher sense wanting. However, the suggested measures attached as an appendix will fit best in dealing with patient falls. The suggested package will be evaluated by assessing the number of cases of patient falls that will be curbed long before they occur. To get this number, the current reported cases will be compared with the cases after the implementation of the suggested package. The reduced number of cases after the package is implemented will indicate the efficiency of the package.
Conclusion
The risk of patient falls is a matter that requires urgent attention than what is accorded at the moment. Clinical institutions should come up with falls risk management practices that are more reliable and likely to reduce the cases of patient falls. The current reported cases of death could be minimized if correct measures are undertaken.
Reference List
Ali, A., Morris, RO., Skelton, DA. & Masud, T. (2004). Falls Services in the UK – A Survey of UK Geriatricians. Manchester: National Conference on Falls and Postural Stability.
Ash, K., Macleod, P. & Clark, L. (1998). A Case Control Study of falls in the Hospital setting. Journal of Gerontological Nursing. 12, 7-15
Campbell, AJ, & Robertson, MC. (2006). Implementation of multifactorial interventions For fall and fracture prevention. Age Ageing. 2006; 35(2): 60-64.
Cohen, I. &Guin P (1991) Implementation of a patient fall prevention program. Journal of Neuroscience Nursing. 23(5): 315-319
Department of health. (2009). Falls and fractures: Exercise Training to Prevent Falls. UK: COI for the department of health.
Evans, D., Hodgkinson, B., Lambert, L., & Wood, J. (1999) Fall Prevention: a systematic review. Clinical Effectiveness in Nursing 3, 106-111
Hendrich, A., Nyhuis, A., Kippenbrock, T., et al, (1995). Hospital falls: Development of a Predictive model of clinical practice. Applied Nursing Research, 8. 129-139.
Hoskin, A.F. (1998). Fatal falls: Trends and Characteristics. Statistical Bulletin.
Innes, EM. &Turman, WG. (1983) Evaluation of patient falls. Quality Review Bulletin. 9, 30-35.
Mahoney, JE. (1998). Immobility and falls. Clinics in Geriatric medicine. 14(4): 699-726
Morse J. (1997). Preventing patient falls. Thousand Oaks, CA: Sage.
Rawsky, E. (1998). Review of the literature on falls among the elderly. Image, 30(1), 472.
Skelton, DA. & Todd, C. (2004). What are the main risk factors for falls amongst older People and what are the most effective interventions to prevent these falls? How should interventions to prevent falls be implemented? WHO: Denmark.
Tideiksaar, R (1997). Falling in old age. Its prevention and management. (2nd Ed). New York: Spinger Publishing.