Preventing falls is a quality improvement process that my organization strives to improve daily. I discuss my organizational fall measures with our Safety Officer and a member of the Fall Champion Team. The Fall Committee team is one of my organization’s steps to decrease our current fall rate. Although we have improved over the last 5years, there is still room for improvement. The data shared by the organization was specific but not sharable with outside sources due to privacy reasons. My organization has a “need to know the policy,” which means only the person caring for that patient is allowed to enter that patients chart; therefore, patient charts were not accessible to collect data. The Fall review report for FY20 was provided for the organization FY19 fall data review. This report alone was detailed data on organization falls, and there were no gaps in the data.

We discussed the organization’s fall measures, such as risk assessment tools. ( Morse Fall Scale, Wilson Sim Fall Assessment, and Get Up and Go). Fall risk assessments are done upon admission, each shift, and discharge. Also, fall risk wrist bands are worn; apple signs are placed on the door to alert staff of high-risk fall patients. Environmental rounds are done to access fall risk hazards. Consultation to Pharmacy for review of high fall risk medications are ordered. Nutrition consults are ordered for patients who have fallen in the last 30 days. Physical Therapy Consults are requested to access mobility, gait training, and exercises. Other areas discussed were the proper used of assistance devices and flagging charts of high fall risk patients. Even with all of these measures, falls are still happening.

A 2012 Cochrane Systematic Review reported that clinical assessment by a health care provider combined with individualized treatment of identified risk factors, referral if needed, and follow-up reduced the rate of falls by 24%. Similarly, the U.S. Preventive Services Task Force found that multifactorial clinical assessment and management, combined with follow-up, was effective in reducing falls (Phelan et al.,2015)

Falls during a hospital stay are common. Across 1,200 hospitals in the United States, adults in medical and surgical units fall 3.56 times per 1,000 patient days, with 26.1% of falls resulting in patient injuries, such as lacerations, fractures, intracranial bleeding, and death. Compared to patients without falls, patients with fall-induced severe injuries stay 6.9 days longer and have hospitalization costs that are $13,806 higher (2009 dollars). The costs of falls are often absorbed by the hospital, particularly for patients insured under Medicare. (Walsh et al.,2018)

In a study called Comparisons of Interventions for Preventing Falls in Older Adults, it talked about how falls are a substantial burden for patients and the health care system. Falls in the elderly population is increasing. The goal of this study was to assess the effectiveness of interventions. Data from the National Institute on Aging showed that the 2-year prevalence of falls among individuals aged 65 years or older was 36% in 2010. In 2012, the cost of falls to Medicare was $31 billion. Falls not only can cause severe injury or death, but they could also cause anxiety and depression and reduced quality of life. The incidence of falls is expected to continue to rise with the aging of the population worldwide. That is was is so crucial to put in place measures and intervention to prevent falls in healthcare. (Batalden, September 2018)

The majority of falls result from a combination of factors, and a wide range of falls prevention methods have been reported. Accurate fall risk assessment is essential. Some hospital falls prevention interventions include intervention such as patient education, modification of the environment, and clinician training. Hospital systems, policies, and procedures for preventing falls can also influence the outcome by optimizing organizational practices. (Slade et al. 2017)

There are many fall prevention interventions developed for the hospital and clinic setting. Interventions as educating patients or staff, putting signs at the bedside or wristbands on high-risk patients, providing socks with treads, reviewing events that precede falls, scheduling toileting, reviewing medications, installing bed alarms, and checking bedrails, among others. (Walsh et al., 2018)

Falls are preventable with risk assessment and exercise. Exercise has been shown to reduce the incidence of falls by 13% to 40%, which has led to a broad consensus among experts that community‐dwelling older adults, especially those at risk of falling, should be offered exercises that incorporate elements of balance, gait, and strength training. Organizations including the American Geriatrics Society and British Geriatrics Society, Academy of Geriatric Physical Therapy of the American Physical Therapy Association, National Institute for Health and Care Excellence, U.S. Preventive Services Task Force, and National Council on Aging have issued guidelines, recommendations, and action plans to assist practitioners working with those at risk for falls. (Li et al., 2017)

Fall prevention measures must be individualized for each patient. These interventions must be included in the care plan. A successful program must consist of environmental measures such as nonslip floors or ensuring patients are within the nurses’ line of sight. Clinical interventions, such as minimizing deliriogenic medications; care process interventions using a standardized risk assessment tool; cultural interventions emphasize that fall prevention is a multidisciplinary responsibility. Technological/logistical interventions such as bed alarms or lowering the bed height. The program should explicitly tackle the underlying assumption held by many health care providers that fall are inevitable and not necessarily preventable.

Batalden, P. (2018, September 6). Getting more health from healthcare: Quality improvement must acknowledge patient coproduction—an essay by Paul Batalden. Retrieved October 14, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC61204…

Li, F., Eckstrom, E., Harmer, P., Fitzgerald, K., Voit, J., & Cameron, K. (2016, February). Exercise and Fall Prevention: Narrowing the Research-to-Practice Gap and Enhancing Integration of Clinical and Community Practice. Retrieved October 22, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC47608…

Phelan, E., Mahoney, J., Voit, J., & Stevens, J. (2015, March). Assessment and management of fall risk in primary care settings. Retrieved October 22, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4707663/

Ranji, S. (n.d.). Falls. Retrieved October 22, 2020, from https://psnet.ahrq.gov/primer/falls

Slade, S., Carey, D., Hill, A., & Morris, M. (2017, November 12). Effects of fall prevention interventions on fall outcomes for hospitalized adults: Protocol for a systematic review with meta-analysis. Retrieved October 22, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC56955…

Walsh, C., Liang, L., Grogan, T., Coles, C., McNair, N., & Nuckols, T. (2018, February). Temporal Trends in Fall Rates with the Implementation of a Multifaceted Fall Prevention Program: Persistence Pays Off. Retrieved October 22, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6736680/