Inpatient Falls and Bed Alarms - Dissertation Example

? Inpatient Falls and Bed Alarms Table of Contents Table of Contents 2 Introduction 3 Background and Significance of the Issue 5 PICO Question 8 Comparing and Contrasting Evidence from Literature 9 Conclusion 12 References 13 Introduction Patient fall refers to the unexpected landing of the patient on the ground either while being assisted by someone or unassisted that may or may not result in injuries. In the words of Morris and Isaacs “a fall is an untoward event in which the patient comes to rest unintentionally on the floor” (Morse, 1996). The injury from the fall can be minor or severe. Hospitals take various preventive measures to prevent falls. This can be in the form of low rise beds; call lights placed at closer distance, placing floor mats, toilets at closer intervals. The environment surrounding the patient should be modified to minimize the impact of the fall of the patients. It is said that 33% adults over the age of 65 fall every year. 20% of the adults who experience the fall suffer moderate to extreme injuries. The hospitalization cost estimated for the fall of a patient is about $17,500. Falls have been referred to as “nurse sensitive quality indicator” (Castex & Albright 2010). Most of the falls occur in and around the patient’s bed and in the bathrooms and are often unobserved. Patient falls are associated with certain very serious consequences. The fall experienced by a patient has a negative affect on his self confidence and result in fear of falling and ‘post fall anxiety syndrome’. A serious fall reduces the mobility of the patient and restricts his ability to perform daily activities. The patient’s fall makes him more susceptible to diseases and may have debilitating affect. It may even lead to death. 50% of the people who experience a major fall die after one year. The accountability or liability associated with a fall lies with the hospital staff and the authorities (Simmons, 2010). The hospital has to bear significant costs associated with patients’ fall. It is extremely important for hospitals to identify preventive measures to control fall rates. This paper analyzes on whether the introduction of bed alarms can reduce the inpatient falls. Background and Significance of the Issue Inpatient falls are a major safety issue in hospitals because the falls may result in severe injury to the patient, have debilitating affects and may even lead to death. The patient’s prolonged stay in the hospital increases the associated costs that the hospital has to bear if the patient stays for a longer duration. The greater need for follow up care of patients, surgical needs and the costs associated with diagnostic purposes adds to the increased costs for the hospital (Hernandez, 2005). According to reports by Centers for Disease Control and Prevention (CDC), the fall costs associated with older adults was estimated at $20.2 billion in 1994. This cost is predicted to increase up to $32.4 billion by the year of 2020 (CDC Injury Center, 2006). Hospitals have to bear large costs associated with the falls. 15% to 30% of the falls cause fractures in patients. This involves the cost of casting, surgery or traction and at times even leads to death (Lopez & Et. Al., 2010). The risk factors that contribute to falls are the severe illness of a patient, the “poly pharmacy treatment strategy of the patient” , unfamiliarity of the patient with his surroundings, balance deficit, neurological disease, visual deficit, lack of proper nutrition, musculoskeletal problems and lower hip problems, multiple medication, cognitive impairment, hypotension, depression to name a few (Dougherty, 2008). The injuries from falls can be very severe especially for the older people. According to the MD, director of the Geriatric Research Education and Clinical Center at the Malcom Randall VA Medical Center, Ronald I. Shorr, the fall rate in hospitals is about “four to five falls per 1,000 patient days, or about a fall per day in a 250-bed hospital” (Simmons, 2010). Further it is also said that one third of such falls cause injuries out of which 2% is severe. The ‘fallers’ in the hospitals can be classified into people who are extremely weak and those people who do not wish to bother the nurse. Surprisingly the injuries in both cases are similar because it has been seen that older and frail people have a better knowledge about how to minimize the impact of the fall (Simmons, 2010). The health care service providers are taking several measures to reduce the number of falls in the hospitals. This is being done by installation of alarms, rooms are being designed and planned in a manner to build bathrooms closer to the bed, and fall risk assessments are regularly updated while communicating to the care team and adjusting the time of providing the medication to patients. It means ensuring that follow up care is provided to the patients even after they leave the hospital (Branzan, 2008). The significance of the issue of patient falls lies in the fact that these falls have an impact on a large number of people and not just the patient. The impact of the falls is on the insurance companies, health service provider, hospital accreditation, families of the patients and the state agencies. The patients may have to suffer psychological injuries in addition to the physiological injuries. The recovery may be prolonged and the costs related to healthcare increases (Branzan, 2008). The hospital charges associated with a patient who has experienced a fall is 60% higher than patients who have not experienced any fall. The cost associated with falls increase due to various reasons namely resource utilization, the increase in the chances of unplanned readmission and increase in the length of stay. The greatest number of non fatal injuries among patients occurs due to falls and these falls often lead to expensive lawsuits that the hospital authorities have to face and they heavily increase health care costs. The US Center of Medicare and Medicaid Services in 2008 stopped the reimbursement charges related with the falls that resulted in injuries during hospitalization. The patient falls can be prevented if necessary precautionary measures are taken. It is expected that even private insurers will undertake policies whereby they would not pay for the injuries that occur from falls due to the negligence of the hospital staff (Lopez & Et. Al., 2010). It is said that patient falls have a relation with nurse staffing. If the nursing staff is less in number then the rate of patient fall increases (Whitman & Et. Al., 2002). The issue has great significance on the nursing staff. This is because the nursing staff is entrusted to take care of the patient and it is their responsibility to ensure safety for the patients. The increase in the rate of inpatient falls highlights the need for nursing staff training. Five dimensions of nursing strategies have been identified to prevent falls in patients. These are namely training and orientation, ensuring improved communication, continuous assessments, proper planning of care and provisions, ensuring safer environments. Several measures are taken to reduce inpatient falls. This includes screening of the fall risks, screening of injury risk for patients who have injury risk factors associated with them, fall prevention programs are implemented, comprehensive assessment is done after fall occurs, safety education is provided to the staff, the underlying disease is treated, environmental and medication adjustments are made. Health care providers are implementing assessment tools to assess the fall risk, are developing strategies to prevent falls and intervention guidelines are being developed to nurture a safe environment for the patients (Thirumalai, 1998). PICO Question The PICO question in this paper is “Would requiring the use of bed alarms for all fall risks patients decrease the amount of falls in patients while they are in the hospital?” The patient problem in this case is the inpatient falls. The fall is generally seen in frail patients and old patients. The falls are major concern for the hospital since the fall results in injuries which increases the costs the hospital has to bear as the patients have to be treated for a prolonged period after the fall occurs. The intervention that is being planned is the introduction of bed alarms to prevent the fall. Comparison involves choosing the best alternative out of several alternatives available to reduce patient falls. The outcome specifies the actual desired results that need to be achieved. Comparing and Contrasting Evidence from Literature In Derrick’s (2008) master’s thesis “Hospital Based Patient Falls: A Clinical Engineering Perspective” the primary aim of the research paper has been to reduce the number of falls and to reduce the impact of the fall. Multiple factors have been cited as the reason for falls. These factors are namely gait deficit, gender, age, elimination needs, fall history, location and time, medication, mental health, medications and patient to nurse ratio. A study that was conducted on inpatient falls in Midwest Tertiary Care Hospital revealed that factors as for example primary diagnosis, location, medication and primary diagnosis determined the risk of falling of patients. Various risk assessment tools and preventive programs were identified. This research paper establishes the fact that the preventive measures can reduce patient falls to a certain extent. A research paper by Tzeng (2007) “Heights of Occupied Patient Beds: A Possible Risk Factor for Inpatient Falls”, cites the high beds of the patient as a potential reason leading to their fall. The paper stresses that a better design of physical facility can reduce patient falls and it should incorporate safety measures (Tzeng & Yin, 2007). According to a research paper by Castex & Albright (2010) “A Quality Improvement Project to Examine the Use of Bed Alarms on a Medical-Surgical Unit” use of bed alarms had reduced patient falls by 13% to 20%. This was found from three studies conducted on the use of bed alarms to reduce falls. The medical surgical unit in Ochsner Medical Center had purchased beds in 2010 that were fitted with bed alarms (Castex & Albright, 2010). According to JCAHO’s Hospital Accreditation Programs’ “Potential 2005 National Patient Safety Goals & Requirements” bed alarms should be installed for patients who have high risks of falling (Hill Rom Services, 2006). According to a research paper “Reducing Patient falls in Inpatient Setting” by Dougherty (2008) the use of bed chair alarms sets off an alarm when a patient tries to get out of the bed or a chair. These kind of alarm systems are used for patients who have fall history, the bed mobility of these patients are unsafe, patients are in a confused state of mind, have cognitive deficiencies and are not capable of ringing the call bell. The alarm would be set in a manner that it would trigger off only if enough weight was lifted off from the surface indicating the patient’s attempt at getting out of the bed. Prior studies that have been conducted believe that such kind of alarm systems can significantly reduce the patient falls and the related injuries. A book written by Morse (1996) titled as “Preventing Patient Falls” patient falls are unacceptable and therefore introduction of various technical developments like the bed alarm system is essential. Techniques related to alteration of bed design are essential. The book “Reducing the Risk of Falls in Your Health Care Organization” by the Joint Commission Resources cites a list of the various kinds of alarms that can be used to reduce the fall rates. These are namely, bed exit alarms, voice alarms that instruct the patient on not getting up because a nurse is already on her way to the patient, chair exit alarms, torso supports, freedom splints, mitts, anti slip footwear and anti skid floor mats. The author states that the use of alarms system can reduce the fall rates. Lippincott Williams & Wilkins (2007) has stated in “Best Practices: Evidence-Based Nursing Procedures” that the introduction of a pressure pad alarm can help in restraining a high risk patient. The pressure sensor pad is placed under the bed linens. When the patient tries to get out of bed the pressure is reduced which sets off an alarm. Another alarm device is worn by the patient above the knee. This kind of alarm system can effectively reduce fall rates among patient (Lippincott Williams & Wilkins, 2007). The study of these various research papers and the comparison and contrast with the preventive measures in various medical centers have clearly established the fact that the adoption of preventive measures can decrease the number of patient falls and the evidences from the existing literature also suggests that use of bed alarms can significantly reduce patient falls. Conclusion Hospitals have to bear extremely high costs when the inpatients suffer falls and have to stay for a longer duration. The patient fall can cause injuries ranging from minor to severe damages. The inpatient falls have several negative impacts. The patients lose their confidence and the hospital has to bear additional costs. The hospitals are taking various preventive measures to control the fall rates. Inpatient falls is a crucial issue that hospitals face. This is because they have to bear a lot of costs associated with the falls. These costs are associated with the follow up care, diagnostic costs and surgical costs. There are several risk factors that contribute to the fall of patients. Data related to inpatient falls reveal the enormous costs associated with the falls and the high fall rates. Thus, it has become essential to control the fall rates. There are various preventive measures for controlling fall rates. This paper primarily deals with whether the use of bed alarms can reduce the fall rates in hospitals. Past evidences on the basis of available literature on preventive measures of hospitals who have already introduced the bed alarms suggest that bed alarms are effective in reducing the fall rates. References Branzan, C., (2008). Introduction. The Relationship of Patient Falls to Prevention Policies in Hospitals: A Case Study. Retrieved Online on January 31, 2011 from http://digitalcommons.pace.edu/cgi/viewcontent.cgi?article=1003&context=dyson_mpa Castex, J. & Albright M., (2010). Background. A Quality Improvement Project to Examine the Use of Bed Alarms on A Medical-Surgical Unit. Retrieved Online on January 31, 2011 from http://academics.ochsner.org/uploadedFiles/Research/Nursing/finalbedalarmposter.PDF CDC Injury Center, (2006). Multifaceted Program to Prevent Falls. Activity Report 2001. Retrieved Online on January 31, 2011 from http://www.cdc.gov/ncipc/pub-res/unintentional_activity/07_state_programs.htm Derrick, P. D., (2008). Abstract. Hospital Based Patient Falls: A Clinical Engineering Perspective. Retrieved Online on January 31, 2011 from http://digitalcommons.wayne.edu/dissertations/AAI1450537/ Hernandez, S. A., (2005). Abstract. Reducing Inpatient Falls: Implementing an Inpatient Fall Prevention Pilot Program. Retrieved Online on January 31, 2011 from http://www.nursing.arizona.edu/Library/HERNANDEZ_SA.pdf Hill Rom Services, (2006). Consequences of Patient Falls. Patient Falls In HealthCare: Ergonomic Intervention. Retrieved Online on January 31, 2011 from http://www.google.co.in/url?sa=t&source=web&cd=7&ved=0CEcQFjAG&url=http%3A%2F%2Fwww.iienet.org%2Fuploadedfiles%2Fergo_community%2Fcase_studies%2F202pres.pdf&rct=j&q=use%20of%20bed%20alarms%20to%20reduce%20inpatient%20falls&ei=GYdHTfu5HcrJrAeh5OGSBA&usg=AFQjCNE-3QkZaJSuDH4CHWJejFlz8xLT_g&sig2=2Lb27QXNF1yiRbtI8kD34Q&cad=rja Lippincott Williams & Wilkins, (2007). Best Practices: Evidence-Based Nursing Procedures. Lippincott Williams & Wilkins. Lopez, K. D. & Et. Al., (2010). Introduction. Cognitive Work Analysis to Evaluate the Problem of Patient Falls in an Inpatient Setting. Retrieved Online on January 31, 2011 from http://www.sys.virginia.edu/ggerling/Publications%20%28.pdf%29/Cognitive%20work%20analysis%20to%20evaluate%20the%20problem%20of%20patient%20falls%20in%20an%20inpatient%20setting.pdf Morse, J. M., (1996). Preventing Patient Falls. SAGE. Simmons, J., (2010). Reducing in Hospital Patient Falls. HealthLeaders Media. Retrieved Online on January 31, 2011 from http://www.aging.ufl.edu/files/Reducing%20In-Hospital%20Patient%20Falls%20-%20HealthLeaders%20Media.pdf Thirumalai, A., (1998). Introduction. Nursing Compliance with Standard Fall Prevention Protocol among Acute Care Hospital Nurses. Retrieved Online on January 31, 2011 from http://digitalcommons.library.unlv.edu/cgi/viewcontent.cgi?article=1191&context=thesesdissertations Tzeng, H. M. & Yin, C. Y., (2007). Background. Heights of Occupied Patient Beds: A Possible Risk Factor For Inpatient Falls. Retrieved Online on January 31, 2011 from http://deepblue.lib.umich.edu/bitstream/2027.42/72643/1/j.1365-2702.2007.02086.x.pdf Whitman, G. & Et. Al., (2002). Research Objective. Patient Falls: What is the Impact of Nurse Staffing and Nursing Staff Interpersonal Processes? Retrieved Online on January 31, 2011 from http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102274141.html Read More