Inpatient Falls - Contributing Factors, Outcomes, and Implications - Case Study Example

Student Name: Tutor: Title: Critical reflection on inpatient falls Course: Description of the incident Mr. Doe from bed 2 room 7 was found lying prostrate on the floor beside her bed. At the time he was clothed and had been preparing to go to the toilet I rang the emergency button for assistance, assessed the immediate environment for potential/actual hazards (non found), and then went to the aid of Mr. Doe. I checked Mr. Doe’s vital signs (pulse 100, respirations 22, skin pallor, cold and clammy) and level of consciousness (able to respond to verbal commands). I indicated to him that assistance was on the way. I covered him with a blanket and put a pillow off the bed under his head for comfort without changing her body alignment. I enquired as to whether he was in pain. Mr. Doe indicated that he had considerable pain as he hit his head when he fell (on the bedside table). At 3 pm the medical team arrived and conducted a full physical assessment and neurological examination. At 9.15am Mr. Doe was transported to x-ray for a CT scan for further investigations. At 9.30am Mr. Doe’s immediate family were notified of the incident. Documentation of the incident was completed by 4 pm. Contributing factors to inpatient falls Falling of patients during hospitalization is a persistent issue and is often brought about by a mixture of risk factors which are particular to patients as well as their conditions (intrinsic factors) and the environment of the hospital (extrinsic factors) (Dykes et al, 2009). Through understanding of these risk factors, it can be easy to identify suitable strategies of prevention (Aberg, Lundin-Olsson & Rosendahl, 2009). With regards to intrinsic factors, these are factors that relate to the physiology of the patient like age-related changes (reduced gait/mobility and vision issues), chronic illness, urinary incontinence, and confusion. Older patients have a higher possibility of falling while hospitalized. Polypharmacy, which is the use of several medications, considerably increases the risk of falling for older patients (Aberg et al, 2009). Other risk factors associated with inpatient falling include and not limited to fear of falling, falls’ history, and prolonged stay in the hospital. Extrinsic factors are factors that relate to the physical setting like poor state of the surfaces of the floor, absence of grab bars, improper or inadequate assistive devices’ use (Aberg et al, 2009). With respect to the case study, Mr. Doe’s fall could possibly be caused by lack of rails on the bed, inability of self toileting or as a result of polypharmacy leading to poor gait and balance. From Mr. Doe’s case, I learned that it is very imperative to consider the environment within which the patient is placed, physical status, and a review of nursing care and treatment plans to establish whether the patient is able to self-manage her physical care. Getting information from Mr. Doe is also very important since one is able to know if he has a history of falls. Through these considerations, effective monitoring and proper care can be provided to Mr. Doe hence prevent such incidences. Literature review According to Tzeng (2010) inpatient falls are actually considered a serious problem to patient safety as well as quality. Statistics show that falls of patient take place in nearly 1.9 to 3 percent of every acute care hospitalization with anywhere from two-fifteen percent of inpatients facing at least 1 fall. An approximated 30 percent of inpatient falling leads to serious injury (Tzeng, 2010). Since falls are amongst the serious adverse incidences experienced within hospitals, prevention of falls is a major element of any strategy of patient safety. Effective communication amongst patients, their families and staff promotes transfer of information, build relationships, and enhances capability for positive culture change in patient safety (Tiessen et al, 2010). It is stated that active participation of staff in the reporting system of fall incident as well as in the subsequent process of follow-up makes up an important element of a safety culture of fall prevention. Some authors established that hospitals might not be in a position to prevent various falls, since a lot of risk factors may not be under the direct control of the caregivers. For instance, one study, found that inclusive programs of fall prevention, including vision assessments, patient education, and walking devices did not decrease the occurrence of falls for the patients who underwent a usual inpatient hospital stay (Dacenko-Grawe & Holm, 2008). In long-term management, such strategies are considered to be more effective. Another study by Tzeng (2010), shows that there exist a strong association between delirium and falling that supports the necessity for early recognition and care of delirium within the hospital. This indicates that patients who receive intervention like pre- and postoperative reviews and care of delirium complications following an operation are less expected to get fewer major injurious falls, although it is not known whether this information is relevant to usual inpatient hospitalization (Tzeng, 2010). According to Tzeng et al (2008) who carried out a Before-After study (B-A) study in a setting involving two acute adult medical units within a hospital, nurses were involved as their target population. The intervention components vs. comparator in the study were the attendant assessment tool of the patient (assessment of patients’ needs for sitters), side rails and restraints. As reported, the falls results indicated the mean rate of fall per 1000 patient days reduced from 4.75 to 4.35 in 1 unit and from 5.13 to 4.15. Injuries from fallings per 1000 patient days raised from 0.25 mean to 0.59 and 0.49 to 0.58 within two units. Another randomized controlled trial (RCT) study was done by Ang et al (2011) in an acute care hospital, involving eight medical wards. Patients were their target. Patients’ number with high scores according to the screener of fall risk was 1812 (910 interventions, vs. 912 controls). The intervention components vs. comparator was the standard care together with patient education sessions grounded on risks recognized through the Hendrich II Falls Risk Model vs. standard care. Falls results from the study indicated that the incidence of fall rate was 0.4 percent in the intervention unlike 1.5 percent within the control group. According to the RCT study done by Cumming et al (2008), twenty four elderly care wards within twelve hospitals were involved. The patients as well as the staff were the target group. All patients within the ward were elderly. 2047 patients were within twelve intervention wards and 1952 patients were within twelve control wards. The intervention components vs. comparator involved physiotherapist- and nurse-led interventions, assessment of risk, evaluation and adjustments (eyewear, walking aids, increased supervision, improvements of bedside environment), cooperation with other members of staff (confusion management, medication, foot problems’ management), physiotherapy, patient and staff education, supervised functional and balance exercises; vs. usual care. Results indicated that there were 9.26 falls for every 1000 bed days within the intervention wards vs. 9.20 falls for every 1000 bed days within the control wards. These results clearly indicate that when proper measures of intervention are put in place, prevention of falls can significantly reduce within hospital setting. Outcomes and implications The implications of inpatient fall can be quite extensive. In addition to physical injuries, falls can have unwanted effect on the psychosocial functioning level of an individual. For instance, Mr. Doe may possibly develop a fright of another fall or lose confidence in moving about safely leading to increased dependence and autonomy’s loss. It is argued that decreased mobility may possibly result in social isolation and to some extent depression (Tzeng, 2010). It is also contended that a fall may possibly induce an acute state of confusion and with dementia as a present diagnosis, the individual could be perceived as difficult (Dykes et al, 2009). This is the case when a patient refuses to walk or even stand because of being frightened of another fall. If Mr. Doe has a cognitive impairment and is not able to express this fear; such fear may possibly be indicated in agitated behaviors resulting in misunderstanding by healthcare providers. Once healthcare providers are busy or feel stressed, their level of patience may be overwhelmed to the limit point which in turn may possibly result in poor practices of care. Hospitals are obligated to ensure their patients’ safety. This is why litigation and complaints may imply an infringement within the duty of care and may possibly bring about negative publicity and members of the family may believe that their patient’s fall has taken place as a result of the staff’s negligence (Tzeng, 2010). On the other hand, in case a fall led to Mr. Doe being injured, the staff might experience distress or guilty feelings. Monitoring in addition to decreasing the possibility of falls as well as their outcomes within hospitals is the leading responsibility of hospital managers (Dykes et al, 2009). In order to decrease the possibility of falls as well as injuries, and enhance patients’ well being together with their quality of life (Qol), standards of quality ought to be set including effective policies of falls prevention, a harmless physical environment for patients and a workforce that is well trained (Dykes et al, 2009). Rush et al (2008) recommended that every health care professional who deals with patients that are identified to be vulnerable to falls should create and maintain required professional competence in assessment and prevention of falls. Through prioritizing of training staff and encouraging falls awareness within the facility, the quality of management and care provided by the hospital would be greatly improved. Even in situations where falls are not able to be prevented, fundamental steps which can improve the Qol and enhance the individual’s well being by reducing the risk ought to be considered always (Rush et al, 2008). In conclusion, as people get older one of their leading concerns is the capacity to preserve their independence and mobility. Illness, disability and injury, that lead to patient falls remains a leading issue in the independence loss in the older patient. It is important to consider an inclusive medical approach, which will treat situations and offer treatment programs that will classify and manage patients who are at risk of falling like Mr. Doe. Reference list Aberg, AC, Lundin-Olsson, L, & Rosendahl E, 2009, Implementation of Evidence-Based Prevention of Falls in Rehabilitation Units: A Staff’s Interactive Approach, J Rehabil Med, 41(13), 1034-40. Ang., E, Mordiffi, SZ, & Wong HB, 2011, Evaluating the use of a targeted multiple intervention strategy in reducing patient falls in an acute care hospital: a randomized controlled trial, J Adv Nurs, 21507049. Cumming, RG, Sherrington, C, Lord SR, et al, 2008, Cluster randomised trial of a targeted multifactorial intervention to prevent falls among older people in hospital, BMJ, 336 (7647), 758-60. Dacenko-Grawe, L., & Holm K, 2008, Evidence-based practice: A falls prevention program that continues to work, MEDSURG Nursing, 17(4), 223. Dykes, PC, Carroll, DL, Hurley, AC, Benoit, A, & Middleton B, 2009, Why Do Patients in Acute Care Hospitals Fall? Can Falls Be Prevented? J Nurs Adm, 39(6), 299-304. Tiessen, B, Deter, C, Snowdon, AW, & Kolga C, 2010, Continuing the Journey to a Culture of Patient Safety: From Falls Prevention to Falls Management, Healthc Q, 13(1), 79-83. Tzeng, HM, Yin, CY, & Grunawalt J, 2008, Effective Assessment of Use of Sitters by Nurses in Inpatient Care Settings, J Adv Nurs, 64(2), 176-83. Tzeng, HM, 2010, Inpatient Falls in Adult Acute Care Settings: Influence of Patients’ Mental Status, J Adv Nurs, 66(8), 1741-6. Tzeng, HM, 2010, Understanding the Prevalence of Inpatient Falls Associated With Toileting in Adult Acute Care Settings, J Nurs Care Qual, 25(1), 22-30. Rush, KL, Robey-Williams, C, Patton, L, Chamberlain, D, Bendyk, H, & Sparks T, 2008, Patient falls: Acute care nurses’ experiences, Journal of Clinical Nursing, 18, 357-365. Read More