Fall prevention strategies for hospitals

One out of three older adults falls each year, making falls the leading cause of injuries for adults ages 65 years and older, according to the CDC. Combine those statistics with the aging of America-the number of adults 65 and older is projected to jump to 83.7 million by 2050, almost double the estimated 43.1 million in 2012, according to the U.S. Census Bureau-and a disaster is ready to happen.  

As many as 2.5 million older adults end up in hospital emergency departments for treatment every year, creating a financial burden of $34 million annually in direct medical costs, with hospitals assuming two-thirds of the total, according to the CDC. 

In response to the frequency and potentially dangerous repercussions in older adults, hospitals and other organizations have developed a variety of programs to address fall prevention.

Patient engagement makes big differences

In 2011, Sharp Memorial Hospital in San Diego started its STOP program targeting falls. As Verna Sitzer, manager, nursing innovation and performance excellence says, the hospital has been improving upon it ever since.

In 2010, the hospital experienced 95 falls with injuries, dropping to 36 in 2015. As reported by the CDC, the average hospital cost for a fall injury is $35,000 (2012 dollars), translating to cost avoidance for Sharp of $2.07 million.

SitzerWhat made the difference? Sharp formed a special team to tackle the falls problem, which developed patient assessments and recommendations to prevent falls, along with staff training. “Outcomes related to falls are nursing-sensitive indicators (depend on the quantity or quality of nursing care),” says Sitzer, “but falling is also an interdisciplinary problem so everyone needs to be trained.”

Sitzer says being in a new environment such as a hospital, where so much is happening at once, and taking new medications opens the door for more risk for falls. When patients are admitted to Sharp Memorial, they have to “unlock” televisions in their rooms. Once registered, they watch a video that introduces them to the hospital and also covers safety issues, including fall prevention.

Six hours after being admitted, patients take a fall risk survey and if any of the questions prompt a “yes” response, staff members urge patients to watch a more comprehensive video pointing out areas for potential falls during their stay.

Next: Specific areas to watch

Specific areas to watch

Since toileting is one of the major activities generating falls, nurses at Sharp pay attention to who is at risk and what mode of toileting-bedpans, bedside commode or a bathroom-should be used based on mobility, says Sitzer. “We make it easy to do the right thing.”

The hospital also conducts monthly debriefings on falls and has developed a variety of fall prevention protocols, such as lowering beds before patients try to get out of them.

Sharp takes advantage of special signage outside patient rooms to indicate certain conditions to staff members. A red maple leap signifies patients who are at risk for falling, as do a yellow armband and red, not-skid socks worn by patients.

Nurses also include risk information on the whiteboards in patient rooms. A stop sign in rooms reminds patients to ask for help if needed, while alarms notify nurses if patients are trying to get out of bed.

Sitzer says the hospital is exceeding benchmarks based on voluntary reports to organizations, such as the National Database of Nursing Quality Indicators, which measure nursing quality and satisfaction, monitor relationships between quality indicators and outcomes, assess staffing levels and improve reimbursement.

Adopting a broader focus

While older adults tend to have higher fall risks, patients of all ages are susceptible to falls. That’s why Holy Cross Hospital in Silver Spring, Maryland, implemented a fall prevention program that targets all ages of patients and starts with a fall assessment upon admission and upon transfer of each patient every shift.

“We believe that every patient that comes through our doors is at risk for falling regardless of their age,” says Kimberly Elliott, senior director, medical/surgical senior services for the hospital.

Holy Cross uses signage in every patient room that states, “Call Don't Fall,” along with a telesitter (someone who monitors patient activity remotely) to oversee patients who are at risk for falls; bed and chair alarms for those at higher risk; hourly rounding; floor mats; non-skid socks; and a self-release roll belt for impulse patients.

The program also ensures that someone stays within arms’ reach when patients are toileting and has initiated a toileting schedule as needed. Finally, the program promotes patient and family education.

Next: Modifying known risk factors

Modifying known risk factors

The John A. Hartford Foundation develops models of care to improve health outcomes for older adults. One if its initiatives is funding research on fall prevention that supports a program developed by Mary Tinetti, MD, professor of medicine and chief of geriatrics at Yale School of Medicine.

Tinetti’s early research studied 301 men and women who were at least 70 years old, living in the same community, and who had at least one of the following risk factors for falling: postural hypotension, a rapid drop in blood pressure when standing; taking four or more medications or psychoactive medications causing dizziness; or impairment in range of motion, balance or gait.

The control group of 148 had usual healthcare services and social visits, while the intervention group of 153 subjects received a combination of medication adjustment, behavioral instructions and exercise programs.

BermanAfter a year of observation, 35% of the intervention group fell, while 47% of the control group did. Of the research participants that had a particular risk factor at baseline, a smaller percentage of those in the intervention group than in the control group still had the risk at reassessment.

More recent outcomes indicate a risk reduction in falls of 25% to 35%, when older adults receive a combination of similar interventions as described above.

Amy Berman, a registered nurse and senior program manager with the John A. Hartford Foundation, says falls are preventable, which is why the program addresses the modification of known risk factors. She says the number one risk of falling is a previous fall. “When it happens, older adults stop becoming as active, lose their mobility and stay in bed more,” she says.

Mari Edlin is a frequent contributor to Managed Healthcare Executive. She is based in Sonoma, California.