Fall Prevention Measures for Inpatient Hospitalizations

1. Fall Prevention Measures for Inpatient Hospitalizations By Danielle Coots

2. Abstract • The act of a patient falling out of bed is a safety concern which is observed as being a preventable occurrence of patient harm in any acute hospital setting. It is important that nurse take the proper precautionary measures to keep patients safe from injuries. • Fall prevention programs have been developed with a universal multidisciplinary action which is nursing centered and include physical patient assessment, risk identification, level of patient’s cognitive function and ability of mobility independently. • Falls by an older patient can affect many different actions including a patient’s well-being related to cognitive, physical, social or mental status changes.

3. Direct Consequences of Falls: minor to sever injuries, increased hospitalization stays, cost of healthcare and insurance increases, direct need for unintentional rehab or nursing home admission once discharged, fear of getting out of bed, depression, low amount of confidence in care, decreased quality of life, and low patient satisfaction scores. • Falls can decrease the amount of mobility a patient will process and result in ambulating difficulty, decreased movement in bed, and increased risk for the development of skin sores. (Graham, 2012)

4. “Since October 2008, Medicare has no longer reimbursed acute care hospitals for the costs of additional care required due to hospital-acquired injuries” (Tzeng, 2011, p. 137) • “About 30% of patients who fall sustain physical injury leading to longer lengths of stay and higher hospital costs” (Tzeng, 2011, p. 137)

5. In hospitalized patients over the age of 65 years, how do personalized alarms compare to the use of the Hendrich II Fall Scale when calculating/determining a patient’s fall risk? PICO Statement

6. Methods • Extensive research was conducted with the use of the SUNY Institute of technology library database within which the Medicine/Nursing/Health reference links were applied to the search of data. CINAHL, MEDLINE and Health Source where primarily used for research. Key phrases and words were applied to find data including: fall, fall prevention, fall assessments, hospitalization, inpatient, older adults, sixty-five, interventions, safety, hospital safety, falls and safety, Hendrich, Hendrich II Fall Risk Model. From here topics were specified to be point specific and involve inpatient hospitalizations and the influence for nurses. All research articles used are peer reviewed as well as data analyzed is past 2009.

7. Nursing Interventions • Bed alarm • Personal alarm • Call bell in reach • Bed in lowest position and locked • Good lighting • Ambulation equipment • Hourly rounding • Yellow Protocol • Yellow Protocol • Gown • Socks • Bracelet and sticker • Over bed signs and sign on door • Educating patients and their families

8. Physical injuries affecting stability of the patient’s gait and balance, or need for transferring; visual impairments, cognitive impairments. • Patient misunderstanding or refusing to follow directions when ambulating or getting out of bed. • If the patient is incontinent, • Improper nutrition intake, • Intake of many medications • Altered environmental issues; including poor lighting, • Cluttered rooms, • Not using the call light, • Lack of needed assistance • Shortness of unit staffing and nursing judgment. (Graham, 2012) Nursing Interventions Increase the Risk of Falls in Patients

9. Hendrich II Fall Risk Model • The Hendrich II Fall Risk Model was designed to allow nurses to assess the potential risk of falls in a large number of adult patients within the acute care setting. It provides a time frame which is current and can accurately determine fall risk factors that a patient my process or experience. The Hendrich II Fall Risk Model incorporates the results of a patient into a system which is current and well-organized for analyzing. Ultimately the Hendrich II Fall Risk Model is both sensitive as well as specific. Meaning it has a 74.9% accuracy with determining high-risk patients correctly; as well as scoring patients as not a potential fall risk at about 73.9%. (Hendrich, 2013)

10. Hendrich II Fall Risk Model Advantages Disadvantages • Quick to Administer • Focused Interventions • Built into Regular Electrical Documentation Systems • Determines Risks for Falling • Gender • Mental and Emotional status • Elimination Difficulty • Symptoms of Dizziness or Vertigo • Categories of Influencing Medications • Get-Up-and-Go Test Ability • “Found to be the most sensitive and specific” (Ang, et al., 2011, p. 1985) • Primary Prevention of Falls Only • Only Considers Current Risk and Not Past History • Considering Men a Higher Fall Risk then Women • Falsely Ranking Patients as High Fall Risks Who are Not • Sensitive to Patients Diagnosis • Possible Lack of Understanding by Staff

12. In the Research • Computerized fall assessments alone did not prevent patient falls and interventions were the main key factor. Hendrich II Fall Risk assessment did enable nurses to provide individualized education as well as personalized targeted strategies. (Ang, et al., 2011) • Women are about 58% more likely to sustain a fatal fall compared to men. Yet men are 46% more likely to die from a fall then women. (Ambrose, et al., 2013) • “Routine universal approach is inappropriate as an intervention in preventing patient falls” (Ang, et al, 2011, p.1991). • Twelve studies conducted found pervious falls, medications, impaired strength, balance and gait were most highly contributed to falls. Hendrich scale does not take previous falls into consideration. (Ambrose, et al, 2013)

13. In the Research • Over a one year study, approximately 46% of patients who scored as a no fall risk according to the Hendrich II scale fell. There is an inability to properly and accurately assess a patient’s clinical ability to fall. (Swartzell, Fulton & Friesth, 2013) • Related to lack of inter-rater reliability, lack of validation in specific patient populations and settings or improper understanding by the primary nurse. (Swartzell, et al., 2013) • Hendrich II Fall risk score showed controversy in classifying a patient with depression, the presence of dizziness and the use of benzodiapines at home compared to in the hospital. (Ivziku, Matarese & Pedone, 2010)

14. Results/Conclusion • Evidence has shown through this research that there is still a large need for further developing the Hendrich II Fall Risk Model’s accuracy. Yet this is a great stepping stone in the health care field for bringing better awareness to nursing staff about patient risk factors. • “Though the findings are statistically significant, the clinical concern remains that a large percentage of patients who fell were scored as low task using the HIIFRM instrument” (Swartzell, Fulton, & Friesth, 2013, p.185). • Limitations were to the amount of up to date information that is available on the use of the Hendrich II Fall risk Model in clinical practice. • Several research articles used noted the same limitations in the amount of current data that has been collected on the use of the Hendrich Model.

15. Acknowledgments I would like to acknowledge SUNYIT for the research data Bassett Medical Center for allowing me to assess and analyze the current available research and supplying items.

16. Reference Ambrose, A., Paul, G., & Hausdorff, J. (2013). Risk factors for falls among older adults: A review of the literature. Elsevier, 75, 51-61. Ang, E., Mordiffi, S., & Wong, H. (2011). Evaluating the use of a targeted multiple intervention strategy in reduction patient falls in an acute care hospital: A randomized controlled trial. Journal of AdvantancedNursing,67(9), 984-1992. Graham, B. C. (2012). Examining evidence-based interventions to prevent inpatient falls. MEDSURG Nursing, 21(5), 267-270. Hendrich, A. (2013). Fall risk assessment for older adults: The hendrich II fall risk model. Patient Safety Organization, (8), Ivziku, D., Matarese, M., & Pedone, C. (2010). Predictive validity of thhendrich fall risk model ii in an acute geriatric unit. 48(2011), 468-474. Swartzell, K., Fulton, J., & Friesth, B. (2013). Relationship between occurrence of falls and fall-risks scores in an acute care setting using the hendrich ii fall risk model. MEDSURG, 22(3), 180-187. Tzeng, H. (2011). Nurses' caring attitude: Fall prevention program implementation as an example of its importance. Nursing Forum, 46(3), 137-145. doi:10.1111/j.1744-6198.2011.00222.x