Reducing In-Hospital Patient Falls
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Shorr is in the midst of a study, funded by the National Institutes of Health, to determine if a 2008 Medicare rule eliminating payment for the cost of treating preventable in-hospital falls will lower the rate of falls among hospital patients. He is the first to admit that additional study and research into falls is needed, although many seem to be "trying to find the magic bullet" to preventing falls, he says.
Over the years, for instance, items have been introduced such as bed and chair alarms, padded floor mats, and hip pads to prevent falls and injuries. Results generally have been mixed. "The fall rates have been remarkably stable over time, so it's not like there's a brilliant answer out there," he says. "Clearly, if it was easy, it would have been fixed."
A number of hospitals are trying to address the issue, including the 51-staffed-bed Bartlett Regional Hospital in Juneau, AK, which has seen falls drop from 6.5 per 1,000 patient bed days in 2007 to 6.1 in 2009. The nurses use electronic medical records to document the patient's status at least for every 12-hour shift, says William Gardner, RN, the nurse manager with the medical-surgical unit.
This opens up a "care plan of nursing intervention," Gardner says. Using the Situation Background Assessment Recommendation to hand off a communication report, "we make sure other nurses and other healthcare providers are aware of a patient's fall risks because those risks can go up or down with a new medication, even during a shift."
But it also has meant adding or reviewing other processes of care, such as ordering new slippers that patients can use to prevent falling when using a shower, implementing the use of bed alarms to alert nurses when a patient leaves the bed, and applying a floor cleaner with some additional tackiness.
"Our theory is we know we can't prevent every single fall, but we can prevent falls that are preventable by having those interventions identified by the organization," Gardner says.
Some hospitals are looking to tackle falls by joining collaboratives. For instance, 57 participants, along with 35 long-term care facilities and six home health agencies, began in 2008 to gather data as a part of the Maryland Patient Safety Center's Safe from Falls initiative.
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