Patient Safety Issue: Falls - Essay Example

Enhancing Quality and Safety

Laura Krozier

Capella University

Improving Quality of Care

And Patient Safety

July 5, 2020

Patient Safety Issue: Falls

Patient falls are largely preventable. Fall prevention is an initiative that is of the utmost importance when it comes to patient safety. Chu, 2017, states fall prevention requires a multidisciplinary approach to create a safe patient environment and reduce injuries related to falling. Falls often result in injuries, which may require extended hospital stays. Longer stays equal higher costs for both the patient and the facility.

Furthermore, falls often impact the quality of life. Some falls lead to sentinel events. Some factors that influence patient falls during hospitalization are patient age, polypharmacy, altered mentation, unsteady gait, the need to toilet, and previous fall history. Fall prevention starts with the nurse performing a fall risk assessment upon admission. A second method a nurse may incorporate for fall prevention is utilizing purposeful hourly rounding in their daily practice. The third intervention for fall prevention is participating in a bedside report with each patient care handoff. Hardwiring these three interventions is best practice and will result in improved patient outcomes.

Fall risk screening should be done at every patient admission and with each status change, which in acute-care settings may require screening every day or even every shift (Dykes, et al., 2018). Fall risk assessments include whether the patient ambulates with assistive devices, has a steady gait, or takes any medications that may cause dizziness. The assessment also covers whether the patient requires toileting assistance, is incontinent, or has a history of falls. Fall risk assessment begins when the patient first arrives at the department and ongoing throughout the shift. Patients are assigned a risk assessment score, and depending on the score, the appropriate interventions need to be applied. A care plan is formulated that is tailored to the individual patient's needs. Common interventions for fall prevention are yellow armbands, slip-resistant footwear, door signage, bed or chair alarms, and 1:1 staff sitters.

Further fall prevention measures include decluttering the room, ensuring that the call bell is in reach, and keeping a dim light on it. Fall prevention items such as slip-resistant footwear and fall identification bracelets are useful tools in identifying a patient at risk for falls. Patients at risk for falls are cared for by the entire disciplinary team, including nursing, nursing aides, physicians, radiology, housekeeping, dietary, case management, and physical therapy. All members of the interdisciplinary team need to be aware that the patient is at risk for falls. A patient with an altered mental status may require higher fall prevention measures such as a bed alarm or a 1:1 sitter at the bedside.

Purposeful hourly rounding is another tool that is known to prevent falls. Spano-Szekely, et al., 2018 states hourly rounds are an opportunity to ensure that universal fall precautions are implemented and that patients' needs are being met. Purposeful hourly rounds and anticipating the needs of the patient ahead of time helps to prevent falls. During purposeful hourly rounds, the nurse takes measures to provide a safe environment for the patient. These may include things such as a clutter-free environment, a well-lit room, and a call bell in reach. Utilizing a more focused hourly assessment is effective in addressing the most common reasons patients fall in the first place. According to Brown, 2016, the focused hourly assessment includes completing the evaluation of the "4P’s”: pain, positioning, potty, and proximity of personal items. Patients commonly fall when attempting to toilet themselves alone or when they cannot reach their belongings. When nurses perform hourly rounding with these intentions in mind, falls are prevented.

The third intervention for fall prevention is bedside handoff. Nurses can assess the patient together as they go to the bedside to give handoff. Bedside handoff should be utilized any time care is transferred to another nurse. It is at this time that nurses can assess the patient's fall risk status, address any changes, and ensure the environment is free of clutter. This would be the best opportunity to evaluate whether the patient has any pain, needs to use the toilet, feels comfortable in their position, and whether they have what they need, including the call bell and any personal items they desire. Bedside handoff also includes the patient and family members in the plan of care.

Fall prevention includes taking specific measures for the safety and well-being of the patient. Falls are preventable when tools are utilized appropriately. Performing a fall risk assessment upon admission or arrival, formulating a care plan based on the fall risk assessment, implementing purposeful hourly rounding, and implementing bedside handoff are all ways to prevent falls in the patient care setting. When fall prevention is a team effort, the result is fewer injuries, decreased costs, and better patient outcomes overall.

How nurses can help coordinate care to increase patient safety and reduce costs

In the healthcare setting, the nursing personnel are responsible for quality service delivery to the patents. Therefore, there are various routine practices that nurses in the healthcare sector can take up that will help in improving the co-ordination and increase patient safety while reducing cost.

• Routine patient checks up's during shifts- while nurses may be faced with numerous tasks at hand in the delivery of care services to patients, conducting routine checkups on patients could be an essential measure that would increase patient safety while reducing costs. This is because, through routine management practices, it is possible to identify any accidents such as falls immediately they occur. This will help to ensure that injuries are mitigated on time.
• Development of patient care centered programs- nurse could come up with patient-centered care initiatives that ensure that there is the delivery of better care services. Falls in patients may occur as a result of patients being left unsupervised. This could be a result of staff workers’ shortage, thus necessitating staffing to be another measure that needs to be accounted for in nursing-centered care.

Factors leading to a specific patient safety risk

Various factors may expose a patient and put them in the direct line of danger and their health safety at risk. These factors may include;

• Leaving a patient unsupervised for long periods- patient supervision is essential in preventing various instances of accidents such as falls and other injuries that the patient may sustain while under health care services.
• Patients with aggressive behavior are at a bigger safety risk- this is because the patient may exhibit signs of instability due to hyperactivity, which may result in the sustenance of injuries putting a patient’s safety at risk.
• Medication adherence difficulties- some patients have been identified to have difficulties in adhering to the specific medications which may put their health safety at risk. As a result, there is a need to ensure that nursing personnel can carry out supervisions and ensure that the patients follow the treatment procedures as outlined.

Communication

Communication is another critical aspect of the patient management aspects where the healthcare service provider is required to ensure that the most effective communication channel is used. In the hospital setting, direct verbal communication is utilized and is preferred because the patient can seek clarification of any unclear response. In the writing of prescriptions, healthcare officials and other personnel are advised to ensure that they use clear, legible, and concise writing that the patient can easily understand the message being passed across.