Falls are the leading cause of fatal and nonfatal injures in people 65-years-old and older in the United States. They can play a catastrophic role in this population.
A few ounces of prevention can go a long way in the causes of falls. Effective communication among the healthcare team, patients and their families impacts patient safety.
There are a variety of acceptable definitions of a fall. According to the National Database of Nursing Quality Indicators, a fall is “an unplanned descent to the floor – or extension of the floor such as a trash can with or without injury to the patient.”
Each healthcare facility accredited by The Joint Commission and receives Medicare or Medicaid reimbursements, is required to have a fall prevention program in effect with continuous monitoring of the effectiveness.
Fall risks
There are several causes of falls. These include ones cited in the Johns Hopkins Falls Risk Assessment Tool.
Intrinsic and extrinsic factors – Intrinsic fall risk factors are considered “person factors” which include changes in cognition or incontinence that might result from disease/illness. Extrinsic fall risk factors are also known as environmental factors and are external to the person such as tubes/drains.
Causes of falls in the hospital setting include:
- History of previous falls (In the past 3 months)
- Medications (benzodiazepines, antidepressants, antiarrhythmics)
- Incontinence (bowel of bladder)
- Leg weakness
- Unsteady gait
- Poor balance
- Mental status change (confusion, disorientation and altered level of consciousness)
- Orthostatic hypotension
Environmental causes of falls should be considered when assessing a fall risk in the hospital, such as the presence of objects that may tether the patient such as IV tubes and drains or wet or slippery floor surfaces.
There are financial implications of patient falls which result in injury. These may include fractures, dislocations, intracranial injuries and crushing injuries. Extended hospitalizations and surgery may be required.
If a fall occurs, the standard of care requires updating the plan of care. The nursing staff review the plan. These are some of the questions legal nurse consultants ask when evaluating falls:
- How often did the staff evaluate a patient’s fall risk?
- What types of preventative measures were incorporated into the plan of care?
- What facts were documented in the medical record and incident report?
