Fall Prevention among High Risk Patients - Research Paper Example

 Fall Prevention among High Risk Patients Abstract The heightened concern regarding the issue on falls in the inpatient setting enabled research on risk factors on falls and fall management strategies to be extensive and many fall prevention programs had been proposed at the course of time. This study will identify the patients at high risk for falls in a community hospital setting and present a fall prevention program for this vulnerable group. A descriptive, non-experimental, retrospective case study is proposed, and data will be collected within a five-year span through the hospital records. Descriptive statistics will be applied in data analysis. Its convenience sampling technique presents its weakness in terms of sampling bias, and poor generalizability of the findings to represent the entire population of people who are at high risk for falls. Keywords: falls, risk factors, fall prevention, fall prevention strategies Statement and Significance of the Problem The purpose of this study is to identify fall prevention strategies for patients who are at high risk for falls. Prior to this, identification of patient population who are at high risk for falls shall be conducted. After the identification of fall prevention strategies, this study will then formulate a Falls Prevention Program that is specifically designed for this vulnerable group. This study aims to reduce the incidence of falls among the populations who are at high risk for falls in the hospital setting. It is in line with the national safety goal of the Joint National Accreditation of Healthcare Organizations (JCAHO, 2005) in “reducing the risk for patient harm resulting from falls”. About 28,000 cases of falls annually are reported in community hospitals across England and Wales, and any person of all age group, especially the geriatric population, are at risk for falls (Healey et al, 2007). It is entailed with negative consequences such as loss if independence, injuries and death (Cameron et al, 2010), including legal consequences for the healthcare professional as clinical negligence (Oliver et al, 2008). There is certainly a need to heighten the vigilance in minimizing, if not eliminating, all incidences of in-hospital falls, especially to population at high risk, and one step closer to this goal is through this study by raising awareness about this problem and propose solutions in minimizing falls, more specifically for patients at high risk. Literature Review A fall is an incident when a patient “unexpectedly comes to rest on the ground, floor or another level” (Haines et al, 2007). Falls are a major safety concern for hospitals, which accounts to 32.3% of incidents related to safety, and 35.3% of those incidences resulted to harm and even death (Healey et al, 2007). Medicaid has a greater utilization costs resulting from falls (Shumway-Cook et al, 2009). Fortunately, there are already a vast number of studies which were addressed for falls and fall prevention is already a part of the nursing curriculum a long time ago. Researches in risk identification for falls are abundant especially the studies among the elderly population. The study of Rubenstein (2006) tabulated the risk factors for falls from the most frequent to the less common; the most prominent risk factor is weakness, followed by balance deficit, gait deficit, visual deficit, limited mobility, cognitive impairment, impaired functioning and postural hypotension. Other risk factors identified by Faulkner et al (2009) are height, fear of falling, “fast-paced walking speed”. Lee & Stokic (2008) investigated the risk factors for falls in patient undergoing rehabilitation identified the diagnoses of stroke, amputation and large co-morbidities as additional risk factors for falls. Among the postmenopausal women, the risks factors for falls were related to age, education, hearing status, history of fracture and hypothyroidism (Barrett-Connor et al, 2008). In terms of visual deficit, visual field loss appears to be the specific risk factor for falls (Freeman et al, 2007). Medication use was also a risk factor for falls, particularly neuroleptics, anti-arrhythmia drugs, sedatives, diuretics and digoxin (Van der Velde et al, 2007). Researches in fall prevention are also abundant, and many fall prevention strategies and programs were already formulated and tested. To include all fall prevention strategies available will consume much of this paper, but the most widely used and popular tool in fall prevention is the Prevention of Falls Network Europe (ProFaNE) project (Lamb et al, 2005). Most studies in fall prevention consist of exercise, vitamin D supplementation, withdrawal of medications associated with falls, and surgery (e.g. cataract surgery) which were seen to reduce the number of falls (Gillespie & Handoll, 2009). A study conducted by Cameron et al (2010) presents a multi-factorial approach (intervention is specific only to the specific risk factor/s identified) to be effective, though previously critiqued to be ineffective (Hendriks, 2009). Withdrawal of drugs associated with falls was found to be effective, wherein the greatest effect of fall incidence reduction is on cardiovascular drugs (Van der Verde et al, 2007). Research Question “What are the fall prevention strategies among high risk patients?” The population of interest is the patient group who are at high risk for falling. High risk patients are those who have the most common risks for falls, namely patients who have weakness, balance deficit, gait deficit, visual deficit, limited mobility, cognitive impairment, impaired functioning and postural hypotension (Rubenstein, 2006). On the other hand, fall prevention strategies refer to the interventions to consider reducing the incidence of falls in relation to the identified risk factors. Methodology Study Setting: This study will take place at a community hospital in Maryland. Research Design This study is a non-experimental, retrospective, descriptive case study (Polit & Beck, 2006). This design is selected since the paper will identify the risk factors that are present in the study setting without any manipulation of the variables. This study will try to investigate the fall incidences and the risk factors present retrospectively rather than prospectively (since prospective study design takes a longer span of time to complete. It is a case study since it will attempt to investigate in-depth the institution selected by the researcher to understand the issues underlying the risk factors and fall incidents in order to come up with fall prevention strategies in response to the risks identified. Sample and Sampling Procedure A convenience sampling of a community hospital in Maryland will be obtained, considering the limitations of student-level research (cost of travel, proximity to the University, etc.) Inclusion criteria are: (1) hospital-admitted patients from year 2006 to 2010 and (2) cases that present least one fall incident during the hospital stay. Data Collection Data will be obtained from personal visit to the hospital records section, gathering demographic information (hospital / case number, age, sex, educational attainment, socioeconomic status) and other valuable information (vital signs, medical and nursing diagnoses, medications, neurologic status, physical examination, mental examination, documentation of falling incident/s, visual and hearing acuity). Data Analysis The study will use descriptive statistical measures through the use of SPSS. This study will only identify the risk factors and use simple statistical tables in determination of the most frequently observed risk factors and to be place on a graph. Relationship of the variables (e.g. age vs. risk factor 1) will be assessed using the product-moment correlation coefficient or Pearson’s r. Strengths and Weaknesses This study has a major strength in data collection, which does not require experimental treatment and is convenience for the researcher to gather data using available records. However, weaknesses of this study is the sampling bias (though the convenience sample of the hospital selected), small sampling size (obtained in only one hospital) and poor generalizability of the findings. References Barrett-Connor, E., Weiss, T. W., McHorney, P. D. & Siris, E. S. (2008). Predictors of falls among postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA). Osteoporosis International, 20, 5, 715-722. Cameron, I.D., Murray, G.R., Gillespie, L.D., Robertson, M.C., Hill, K.D., Cumming, R.G., & Kerse, N. (2010). Interventions for preventing falls in older people in nursing care facilities and hospitals (Review), The Cochrane Library, 1. Hendriks, M., Bleijlevens, M., Van Haastregt, J. Crebolder, H., Diederiks, J., Evers, S., ...Van Eijk, J. T. (2008). Lack of Effectiveness of a Multidisciplinary Fall-Prevention Program in Elderly People at Risk: A Randomized, Controlled Trial. Journal of the American Geriatrics Society, 56, 8, 1390–1397. JCAHO (2005). Facts about the 2005 national patient safety goals. http://www.jcaho.org/accredited+organizations/patient+safety/05+npsg/npsg_facts.htm Faulkner, K. A. Cauley, J. A., Studenski, S. A., Landsittel, D. P., Cummings, S. R., Ensrud, K. E., Donaldson, M. G. Nevitt, M. C. & Study of Osteoporotic Fractures Research Group (2009). Lifestyle predicts falls independent of physical risk factors. Osteoporosis International, 20, 12, 2025-2034. Freeman, E., Muñoz, B., Rubin, G., & West, S. (2007). Visual field loss increase the risk of falls in older adults. Investigatve Opthalmology & Visual Science, 48, 10, 4445-4450. Gillespie, L. & Handoll, H. (2009). Prevention of falls and fall-related injuries in older people. Injury Prevention, 15, 354-355. Haines, T., Bennell, K., Osborne, R., & Hill, K. (2004). Effectiveness of targeted falls prevention programme in subacute hospital setting: randomised controlled trial. British Medical Journal, 328, 676 Healey, F., Scobie, S., Oliver, D., Pryce, A., Thomson, R., & Glampson, B. (2008). Falls in English and Welsh hospitals: a national observational study based on retrospective analysis of 12 months of patient safety incident reports. Quality and Safety in Health Care, 17, 424-430. Lamb, S.E., Jørstad-Stein, E.C., Hauer, K., & Becker, C. (2005). Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. Journal of the American Geriatric Society. 2005 Sep;53(9):1618-1622. Lee, J. E. & Stokic, D. (2008). Risk factors for falls during inpatient rehabilitation. American Hournal of Physical Medicine & Rehabilitation, 87, 5, 341-353. Oliver, D., Killick, S., Even, T., & Willmott, M. (2008). Do falls and falls-injuries in hospital indicate negligent care—and how big is the risk? A retrospective analysis of the NHS Litigation Authority Database of clinical negligence claims, resulting from falls in hospitals in England 1995 to 2006. Quality and Safety in Health Care, 17, 431-436. Polit, D. & Beck, C.T. (2006). Essentials of nursing research: methods, appraisal, and utilization, (6th ed.), Lipincott Williams & Wilkins. Rubenstein, L. (2006). Falls in older people: epidemiology, risk factors and strategiers for prevention. Age and Ageing, 35-S2, ii37-ii41. Shumway-Cook, A., Ciol, M.A., Hoffman. J., Dudgeon, B.J., Yorkston, K., Chan, L. (2009). Falls in the Medicare population: incidence, associated factors, and impact on health care. Physical Therapy, 89, 4, 324-32. Van der Valde, N. Stricker, B., Pols, H., & van der Cammen, T. (2007). Risk of falls after withdrawal of fall-risk-increasing drugs: a prospective cohort study. British Journal of Clinical Pharmacology, 63, 2, 232-237. Read More