Patient falls are expensive, time-consuming and injurious.
According to the Agency for Healthcare Research and Quality, approximately 700,000 to 1 million hospitalized patients — about 3% of all hospitalized Americans — fall each year. More than one-third of those falls result in injury, and those injuries frequently lead to prolonged hospitalization. The average cost for a fall with injury is about $14,000, according to The Joint Commission.
Yet despite the fact that fall prevention has been a National Patient Safety Goal for years, patient falls continue to be a problem in hospitals throughout the United States. Part of the problem is that patients today are typically older and sicker than patients of years past, and both age and illness increase the risk of falling. The hospital environment also contributes to the risk; people who function well within their own homes may stumble when maneuvering in unfamiliar surroundings.
It is virtually impossible to eliminate fall risk. However, fall prevention strategies can preserve patient health while saving staff time and increasing patient satisfaction. Consider these four evidence-based strategies:
1. Tailor fall prevention interventions to the individual.
The Joint Commission recommends using a standardized, validated tool such as the Morse Fall Scale to identify an individual’s fall risk. Ideally, the tool will be used to assess all hospitalized patients, as patients of all ages and abilities are vulnerable to falls. Factors that commonly increase the risk of falling include impaired mobility (such as that resulting from stroke, arthritis or neuromuscular disease), use of assistive devices (including walker and canes), visual problems, and dementia and delirium.
Obviously, each of these factors requires different interventions. A patient who lives alone, has poor vision and uses a walker to steady herself may not want to wait for someone to help her to the bathroom and may try to get there on her own, despite repeated encouragement to call for assistance. Keeping her glasses and walker within reach and maintaining a clear path between the bed and bathroom may decrease her risk of falling.
2. Provide safety companions.
Patients who are disoriented fall into the high-risk category, as they may not remember fall prevention instructions or even their current location. It may well be cost-effective to provide safety companions, such as certified nursing assistants, to stay with confused patients. According to a 2014 Pennsylvania Patient Safety Advisory, data from 75 Pennsylvania hospitals indicated a statistically significant correlation between lower rates of falls with harm and the use of sitter programs.
The medical-surgical unit at Mercy Health-Anderson Hospital in Cincinnati also saw a decrease in its fall rate after it began assigning safety companions to disoriented patients. According to a 2013 article in Becker’s Hospital Review, the unit’s fall rate dropped from 10 falls per 1000 patient days to 2 falls per 1000 patient days over a three-year period. The unit also instituted hourly rounds and used bed alarms.
3. Use bed alarms judiciously.
Do bed alarms prevent falls? Some studies say no; others say yes. As a 2016 article in Frontiers in Public Health noted, “the effectiveness of the bed-exit monitor in preventing falls rely on numerous factors, including the design of the alarm sensors, the likelihood of healthcare workers responding to the alarms, as well as the selection of patients.”
Cincinnati’s Mercy Health-Anderson Hospital found it helpful to adjust the delay time on bed alarms. At the start of their fall prevention efforts, the alarms were set to ring 10 seconds after a patient left the bed. Collectively, they decreased the delay time to 1-2 seconds, giving staff eight extra seconds to respond and assist patients.
Of course, bed and chair alarms can exacerbate the confusion of already disoriented patients. As Dr. David Oliver wrote an a 2018 BMJ article, “the routine use of sensors isn’t recommended in good practice guidance.” Instead, assess each patient’s needs and only use a bed or chair alarm if it makes sense.
4. Institute hourly rounds.
One of the best
ways to prevent patient falls is purposeful hourly rounding, a best practice in
fall prevention according to the Agency for Healthcare Research and Quality.
The idea is to ensure that a staff member (nurse, nursing assistant or unit
manager) visits each patient at least once an hour to attend to the patient’s
During hourly rounds, staff should assess the patient’s pain, position, possessions and need to use the restroom, and help patients as needed. Staff should also ensure that the bed is in its lowest position, the environment is uncluttered, and eyeglasses, assistive devices and appropriate footwear are within reach.
Research on hourly rounding in 14 different hospitals revealed that the practice led to a 52% reduction in patient falls and a 12% increase in patient satisfaction scores. Additionally, staff walked less than they did before because intentional hourly rounding prevented a lot of inefficient running around. It is anticipated that improving clinician workflow is going to continue to be a major area of focus given the financial pressure and growing burden of provider burnout.
Despite the numerous clinical and financial benefits of improving clinical rounding, nearly every hospital in the country struggles with these types of interventions because they don’t have access to actionable data. Clean Hands – Safe Hands has partnered with several hospitals to provide insights that would have otherwise been invisible.
The Clean Hands
– Safe Hands sensors placed on alcohol and soap dispensers in patient rooms
automatically record whenever a badged staff member enters the room. Managers
and staff can review data to see how often staff are visiting patient rooms,
and have access to real-time data interventions to address any issues that may be
keeping staff from checking on patients regularly.
Nationwide data from Clean Hands – Safe Hands users has revealed that providers, on average, visit patients in regular hospital rooms 3.3 times more than patients in isolation rooms. Not only can Clean Hands – Safe Hands measure the problem, they can provide targeted interventions and real-time predictive analytics that allow hospitals to identify a potential risk before the fall occurs.
These four evidence-based fall prevention strategies can decrease falls and improve patient safety, which can reduce costs and increase patient satisfaction. The Clean Hands Safe Hands system can help you easily identify gaps in rounding and get a handle on this costly problem.
Contact Clean Hands – Safe Hands to learn more about how you can utilize the system to reduce fall risk in your facility.