Patient Falls
Preventing Patient Falls

The primary goal of every hospital and care facility is the health and safety of their patients. hile some problems, such as illness cannot be avoided, compounding illness with injuries can and should be avoided. Risks such as slipping, tripping, and falling while in the hospital are an increasing problem for hospitals. The purpose of this paper is to identify a preventable patient injury and suggest a corrective policy for the hospital to reduce the amount of incidence.

Identification of Problem

Patient falls are a growing problem in hospitals. In fact, according to the Centers for Disease Control and Prevention, "In 2004, 14,900 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized." (National Center for Injury Prevention and Control, 2007). These…...

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Works Cited

Hitcho EB, et al. (2004). Characteristics and circumstances of falls in a hospital setting: a prospective analysis. J Gen Intern Med;19(7):732-9.

Landro L. (2005). The informed patient: hospitals aim to curb injuries from falling; risk for young patients. Wall Street Journal: Mar 23;D1, D7.

National Center for Injury Prevention and Control. Division of Unintentional Injury Prevention. Falls among older adults: an overview. Centers for Disease Control and Prevention. 2008. Available at  http://www.cdc.gov/ncipc/factsheets/adultfalls.htm .

U.S. Department of Veteran's Affairs. Morse Fall Scale. Available at http://www.patientsafety.gov/CogAids/FallPrevention/index.html#page=page-4

patient falls in U.S. healthcare institutions is staggering. They increase insurance costs, staff pressure, and even more accidental injuries other than falls. esearch has shown that there are a number of ways patient falls may be mitigated: more nursing rounds, patient exercise, and body awareness conditioning. Tai Chi is a Chinese martial art that is practices for both defense training and health benefits, as well as longevity. The overall theory is to allow the individual to become more flexible, increase strength in certain muscle groups that are not always used in modern life, and to become more aware and attuned to the individual's own body. A 2012 study looked at the effectiveness of tai chi and low-level exercise in reducing falls in older adults, but concluded that there was no difference between the control group and the experimental group over a 1.5-year period. In fact, the study shows that…...

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REFERENCES

Suda, M., et al. (2008). Emotional Responses to Music: Towards Scientific Perspectives on Music Therapy. Neuroreport. 19 (1): 75-8.

Taylor, D., et al. (2011). Effectiveness of Tai-Chi as a Community-Based Falls prevention Intervention. Journal of the American Geriatric Society. 60 (5): 841-8.

Tomkins, C. And Orwat, J. (2010). A randomized trial of telemonitoring heart failure patients. Journal of Healthcare Management. 55 (5): 312-22.

Clinical/Organizational Problem According to the United States Department of Health and Human Services Agency for Healthcare Research and Quality (2018), between 700,000 and one million patients in the United States fall while in hospital each year, and about one third of these falls could have been easily prevented with effective administrative procedures and best practice protocols. Yet many organizations lack the quality and safety initiatives they need to prevent patient falls in hospital. As a result of negligence to prevent falls, patients experience a number of injuries that could even lead to higher mortality rates. Hospitals like this, which do not have fall preventing strategies in place, risk malpractice suits and fail to fulfill their ethical responsibilities to patients. Therefore, the organizational problem is related to insufficient—even nonexistent--fall prevention strategies.
Description of Problem
Falls occur at a rate of three to five per every 1000 bed stays, and are more prevalent in long-term…...

Bed Alarms and Chair Alarms to educe Patients' Falls in A Short-Term Care Facility
Importance of bed alarms and chair alarms

Bed alarms have been taunted as not useful in the modern day healthcare deliveries. Nonetheless, the significance of these facilities always strikes much admiration from different healthcare facilities. Alarms are important as warning gadgets that every section of an organization should consider in its ranks. Hazard preparedness requires that all possible strategies adopted to ensure that there is safety for all the people, and even the property being used within a healthcare facility (Vincent, 2010). Thus, the bed and chair alarms are just material things that have been used to provide avenues for the protection of human health, minimizing and eventually stopping the occurrences of cases like patient fall and strain at the health facilities. In the modern hospitals, communication within and without the healthcare facilities between the patients and the…...

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References

Vernikos, J. (2011). Sitting Kills, Moving Heals: How Simple Everyday Movement Will Prevent Pain, Illness, And Early Death-- And Exercise Alone Won't. Fresno, Calif: Quill Driver Books

Vincent, C. (2010). Patient Safety. Chichester, West Sussex: Wiley-Blackwell.

Postoperative Patient Falls
Hospitalized patient falls affect health in huge way as they directly affect safety of patients as well as the concern for the quality of healthcare public health facilities around the world provide to patients. While limited data and information is available concerning inpatient falls following patients going on surgery, falls among hospitalized patients have been extensively studies. Falls is one of the major causes of morbidity like lacerations, closed head injuries and fractures among patients (Vhurch et al., 2011).

It has been shown that fall measurements determine patient outcomes since falls are often reported as adverse events in hospitals among the adult patient population. Falls make up a big part of the problems plaguing the health sector globally. Of all the adverse events in a hospital setting, falls is one of the most significant with nearly 3-20% of inpatients experiencing a fall at least once over the time they…...

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Mandl, L.A., lyman, S., Quinlan, P., Bailey, T., Katz, J. & Magid, S.K. (2013). Falls Among Patients Who Had Elective Orthopaedic Surgery: A Decade of Experience from a Musculoskeletal Specialty Hospital. Journal of orthopaedic & sports physical therapy, 43(2), 91-96.

Quigley, P. & White, S. (May 31, 2013). Hospital-Based Fall Program Measurement and Improvement in High Reliability Organizations, OJIN: The Online Journal of Issues in Nursing Vol. 18, No. 2

Vitor, A.F., Moura, L.A., Fernandes, A.P., Botarelli, F.R., Araujo, J.N. & Vitorino, I.C. (2015). Risk for Falls in Patients in The Postoperative Period, Cogitare Enferm. 20(1):29-37.

Support for New NursesProblem: Patient falls are a common occurrence in the Emergency department, often resulting in injury and harm (Campbell et al., 2020). The problem is one that needs to be addressed particularly with new nurses, as falls tend to occur most frequently during shifts in which new nurses are working.Quality improvement project: The Watch area is a good start, but it could be further developed into a full-fledged patient fall prevention program, using the PDSA (Plan-Do-Study-Act) model.Plan: Develop a comprehensive patient fall prevention program for all new nurses in the Emergency department, using the Watch area as the starting point. This plan should include the following steps:1. Conduct a thorough analysis of the current patient fall data, to understand the causes and contributing factors.2. Develop evidence-based best practices and protocols for preventing patient falls, taking into account the results of the data analysis.3. Train all staff members, including…...

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ReferencesCampbell, A. R., Layne, D., Scott, E., & Wei, H. (2020). Interventions to promote teamwork, delegation and communication among registered nurses and nursing assistants: An integrative review. Journal of Nursing Management, 28(7), 1465-1472.Fridman, V. (2019). Redesigning a fall prevention program in acute care: building on evidence. Clinics in geriatric medicine, 35(2), 265-271.

The Importance of Informatics in Patient Fall PreventionIn order to improve anything, it must first be measured in some fashion to establish benchmarks and evaluate progress and this is certainly applicable to healthcare settings where there are multiple opportunities for tracking improvements in patient care such as reducing the number of preventable patient falls. Indeed, between 700,000 and 1,000,000 individuals in the United States experience falls while in the hospital each year. These incidents can result in fractures, lacerations, or internal bleeding, which in turn adversely affect patient care while increasing healthcare costs. Moreover, a growing body of research indicates that nearly one-third of these falls are preventable (Ganz et al., 2024). Some of the general information that would be needed for an electronic healthcare record (EH) database to track fall incidents includes time of fall risk assessment, fall incidents, patient outcomes and staff response time. To learn more, the…...

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ReferencesChristodoulakis, A., Karanikas, H., Billiris, A., Thireos, E., & Pelekis, N. (2019). “Big data” in health care. Archives of Hellenic Medicine, 33(4), 489–497.Ganz, D. A. (2024). Preventing falls in hospitals. Agency for Healthcare Research and Quality. Retrieved from   D., Mazzia, L., & Crane, G. (2017). Advanced Practice Nurse-Led Statewide Collaborative to Reduce Falls in Hospitals. Journal of Nursing Care Quality, 32(2), 120–125.Jain, S., Dempsey, K., Wilcox, S., Bradd, P., Travaglia, J., Debono, D., Justin, L., & Hor, S.-Y. (2023). Practice development amidst a pandemic: a pilot program to develop leadership in infection prevention and control professionals. Leadership in Health Services (Bradford, England), ahead-of-print.Kobayashi, K., Ando, K., Nakashima, H., Machino, M., Kanbara, S., Ito, S., Inoue, T., Yamaguchi, H., Ishiguro, N., & Imagama, S. (2021). Challenges for Joint Commission International accreditation: performance of orthopedic surgeons based on International Patient Safety Goals. Nagoya Journal of Medical Science, 83(1), 87–92.Lynch, A., Kachappilly, R., Steen, G., & Lannon, R. (2019). 25 The Post Fall Review- An Opportunity to Intervene for Bone Health. Age & Ageing, 48, iii17-iii65.Mohammadzadeh, Z., Shokri, M., Saeidnia, H. R., Kozak, M., Marengo, A., Lund, B. D., Ausloos, M., & Ghiasi, N. (2024). Principles of digital professionalism for the metaverse in healthcare. BMC Medical Informatics & Decision Making, 24(1), 1–9.Nguyen, D., Tupas, K. D., & Thammasitboon, S. (2024). Evolution of a Continuing Professional Development Program Based on a Community of Practice Model for Health Care Professionals in Resource-Limited Settings. Journal of Continuing Education in the Health Professions, 44(1), 58–63.Subramanian, M. P., Hu, Y., Puri, V., & Kozower, B. D. (2021). Administrative versus clinical databases. The Journal of Thoracic and Cardiovascular Surgery, 162(4), 1173–1176.Wulandari, H., & Raharjo, T. (2023). Systematic Literature and Expert Review of Agile Methodology Usage in Business Intelligence Projects. Journal of Information Systems Engineering & Business Intelligence, 9(2), 214–227.Zurynski, Y., Ludlow, K., Testa, L., Augustsson, H., Herkes-Deane, J., Hutchinson, K., Lamprell, G., McPherson, E., Carrigan, A., Ellis, L. A., Dharmayani, P. N. A., Smith, C. L., Richardson, L., Dammery, G., Singh, N., & Braithwaite, J. (2023). Built to last? Barriers and facilitators of healthcare program sustainability: a systematic integrative review. Implementation Science, 18(1), 1–21.https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/ .Gray-Miceli,

Falls
THE ISSUE OF ACCIDENTAL FALLS

At some point, anyone who had learned how to walk has had the experience of falling down -- it is a universal experience for infants as they gain ambulatory ability. In hospitals, however, the accidental fall is the most reported type of patient safety incident, with elderly patient populations displaying a particular vulnerability (Oliver 2007, p.173). Approximately one-third of adults over the age of sixty-five will experience an accidental fall this year (CDC 2012, n.p.) Fischer (2005) offers some clarification as to how these incidents should be defined -- the simplest basic definition is "a sudden, uncontrolled, unintentional, downward displacement of the body to the ground or other object" (p822). This definition takes into account the unpredictable nature of the incident, and the fact that it frequently involves a certain loss of control on the part of the patient; it also reminds us that the fact…...

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References

CDC (2012). Adult falls. Web. Accessed at: http:/ / www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.htm

Currie, LM. (2006). Fall and injury prevention. Annual Review of Nursing Research. 24(1):39-74.

Fischer ID; Krauss MJ; Dunagan WC et al. (2005). Patterns and predictors of inpatient falls and fall-related injuries in a large academic hospital. Infection Control and Hospital Epidemiology. 26(10):822-7.

Grubel, F. (1959) Falls: A principal patient incident. Hosp Manage. 88:37-8.

Falls
The authors attempted to find a new way of measuring falls -- they were dissatisfied with the previous measure used -- and they argued that all aspects can be measured by the number of events divided by the number of opportunities for that event to occur.

In regards to falls, they argued that if you wanted to know how many falls resulted in fractures you would use the numerator as the number of patient falls that resulted in fractures and the denominator would be the totality of falls. So for instance if there were 20 falls that resulted in fractures and 100 falls altogether it would be 20/100 otherwise read as 20%. The numerator tells you what you want to study / question or investigates, and this -- the authors say -- can be as general or as specific as possible.

The problem is how you define falls. The authors in questions,…...

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Measuring Health Care Chapter 2. Fundamentals of Data (Chap. 2)

K.R. Tremblay Jr., and C.E. Barber (2005) Preventing Falls in the Elderly

 http://www.ext.colostate.edu/pubs/consumer/10242.html

Patients in hospitals often complain of pain regardless of the diagnosis. Several activities in a patient's life contribute to pain. Some of the activities include amount of sleep, daily chores and quality of life (Alaloul, Williams, Myers, Jones, & Logdson, 2015). While health care expenses have increased significantly over the years, there have been great improvements in increasing both family and patient involvement in medical care. Hourly care is one of the strategies that have worked well in various healthcare settings. Hourly care has been a success in various areas but using it in urgent pediatric settings hasn't been well documented (Emerson, Chumra, & Walker, 2013). Opportunities still exist to look into pediatric family preferences and perspectives as pertains to the use of whiteboards (Cholli, et al., 2016). Several studies have been done in different setups and this paper references many of them. The research projects include in-patient surveys, quasi-experimental…...

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References

Alaloul, F., Williams, K., Myers, J., Jones, K. D., & Logdson, C. (2015). Impact of a Script-based Communication Intervention on Patient Satisfaction with Pain Management. Pain Management Nursing, 321 - 327.

Brosey, L., & March, K. (2015). Effectiveness of structured hourly nurse rounding on patient satisfaction and clinical outcomes. Journal of Nursing Care Quality, 153.

Cholli, P., Meyer, E., David, M., Moonam, M., Mahoney, J., Hession-Laband, E., . . . Bell, S. (2016). Family Perspectives on Whiteboard Use and Recommendations for Improved Practices. Hospital Pediatrics, 426 - 430.

Emerson, B., Chumra, K., & Walker, D. (2013). Hourly rounding in the pediatric emergency department: patient and family safety and satisfaction rounds. J Emerg Med, 99 - 104.

Inpatient Whiteboards
This study is a theoretical framework exploring whiteboard use preferences and recommendations for patient-centered care and communication through whiteboard use.

This study is a theoretical framework exploring whiteboard use, script-based communication, and hourly rounding to evaluate effectiveness of care associated with pain management and patient satisfaction.

The study utilizes a conceptual framework.

This article uses a conceptual framework that provides a literature review

Conceptual framework

Conceptual Framework

Conceptual Framework

A 3-week pilot involving multidisciplinary whiteboard use

The setting is Stanford University Medical Center

Sample characteristics (# of patients) Patients available for the pilot were 104 patients: 56 from inpatient units with use of whiteboards and 48 from inpatient units with no use of white boards.

internal medical residents were also surveyed.

Design: The study involved a semi-structured interview.

Setting: The interview took place in a pediatric urban academic hospital inpatient surgical service

Sample characteristics (# of patients) The number of people interviewed were 29 families.

Design: The researchers used a prospective, quasi-experimental…...

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References

Alaloul, F., Williams, K., Myers, J., Jones, K. D., & Logsdon, M. C. (2015). Impact of a Script-based Communication Intervention on Patient Satisfaction with Pain Management. Pain Management Nursing, 16(3), 321-327. doi:10.1016/j.pmn.2014.08.008

Brosey, L. A., & March, K. S. (2015). Effectiveness of Structured Hourly Nurse Rounding on Patient Satisfaction and Clinical Outcomes. Journal of Nursing Care Quality, 30(2), 153-159. doi:10.1097/ncq.086

Cholli, P., Meyer, E. C., David, M., Moonan, M., Mahoney, J., Hession-Laband, E., . . . Bell, S. K. (2016). Family Perspectives on Whiteboard Use and Recommendations for Improved Practices. Hospital Pediatrics, 6(7), 426-430. doi:10.1542/hpeds.2015-0182

Emerson, B. L., Chmura, K. B., & Walker, D. (2014). Hourly Rounding in the Pediatric Emergency Department: Patient and Family Safety and Satisfaction Rounds. The Journal of Emergency Medicine, 47(1), 99-104. doi:10.1016/j.jemermed.2013.11.098

setting, definition Sample/Setting
Conclusions (Appraisal)

Level of Evidence

(Flagg, 2015)

Implementing patient-focused healthcare within settings burdened by the combined challenges of scarce support systems, huge patient loads and constantly-growing patient care responsibilities, especially chronically ill patients

A healthcare organization with nursing staff on twelve-hour schedules

Characteristics: Number of patients individual nursing professionals have to cater to, which ranges between 3 and 5.

Catheter care, blood extractions, surgical schedules planned, antibiotic drugs' presence in the hospital inventory, patients' medicine/treatment plans

Necessity of bedside reporting, patient satisfaction and all-inclusive care framework

A case study technique implies researchers cannot undertake a broad-scale research using the sample. Outcomes might be case-specific and non-generalizable.

This article contributes to clarifying nursing role by employing numerous kinds of patient-focused care elements for improving care quality safely and manageably.

Level 4.d -- Descriptive Observational Studies -- Case Study

(Fawaz, Williams, Myers, Jones, & Logsdon, 2015)

Assessing the efficacy of a combined intervention entailing script-based interaction, hourly rounding and whiteboard use…...

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References

Ann Rodney, P. (2015). The Design and Implementation of a Relationship-Based Care Delivery Model on a Medical- Surgical Unit. WALDEN DISSERTATIONS AND DOCTORAL STUDIES.

Ciaramella, J., Longworth, N., Larraz, L., & Murphy, S. (2014). Improving Efficiency, Consistency and Satisfaction on a Mother-Baby Unit With the Discharge Nurse Position. Wiley Online Library.

Dempsey, C., Wojciechowski, S., McConville, E., & Drain, M. (2014). Reducing Patient Suffering Through Compassionate Connected Care. Journal of Nursing Administration, 517 - 524.

Elena, A. (2015). Understanding the Culture of the Single Room Maternity Care Unit: Ethnographic Study. University of Calgary - Electronic Thesis.

Fall Prevention
All Staff

Falls in the Nursing Home

There has been an increase in falls in the nursing home. A number of things can cause residents to fall (Patient falls: How to prevent them). Illnesses, such as dementia among others, can cause residents to be confused. Confusion with residents requires continual monitoring in keeping the resident safe. Muscle weakness and instability cause falls when residents are confused, or when the resident insists on doing things themselves and maintaining their own independence in spite of the weakness or instability issues. Medications can also cause confusion. Sedatives and anti-anxiety medications are a particular concern in causing confusion. Medications can also cause drowsiness that can cause falls if patients are not put to bed when the medications are given.

Environmental factors also play a role in falls. Wet floors, poor lighting, incorrect bed height, improperly fitted shoes, unmaintained wheel chairs, or items on the floor that…...

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Bibliography

Falls in Nursing Homes. (n.d.). Retrieved from Centers for Disease Control and Prevention:  http://www.cdc.gov/HomeandRecreationSafety/Falls/nursing.html 

Patient falls: How to prevent them. (n.d.). Retrieved from patient Safety Partnership: http://www.patientsafetypartnership.org/Patient_Falls.html

Fall Reduction Project: An Evaluation of the Implementation Process Chapter 3: Implementation
In Brief
Blank hospital had a significant increase in falls in the inpatient acute care setting. For this reason, the need for an immutable and comprehensive fall strategy was identified at the hospital following an evaluation of the various costs (both financial and ethical) associated with falls deemed preventable. Towards this end, a fall prevention project was undertaken. I was responsive for overseeing the fall prevention project implementation.
1. Description of Steps
· Pre-implementation phase
· Implementation phase
· Sustainment phase
1.1. Pre-implementation Phase
The pre-implementation phase took a total of 2 months. In essence, pre-implementation phase was meant to prepare the entire facility for the actual phase of implementation. Towards this end, various steps were undertaken. These will be highlighted below.
1.1.1. Identification of Improvement Opportunities
This was founded on the collected fall data. There was an observed increase in the number of falls in the inpatient units.…...

Patient Access to Experimental Drugs
Experimental drugs are being used in treating cancer and other life-threatening diseases in the hopes that effective cures and treatments can be identified. There are however, ethical questions relating to the use of experimental drugs and this work seeks to answer the question that asks whether patients should have access to experimental drugs and to answer why or why they should not have this access.

Experimental Drugs

Experimental drugs have carved inroads to treating cancer patients and most recently; this has been reported in the form of a drug that serves to "neutralize two mechanisms cancers need to survive." (Coghlan, 2012) The new drug is Cabozantinib. This drug is reported by one individual interviewed in this study to have been used by a family member who died while taking the drug for non-small cell carcinoma in the form of lung cancer. When asked the question of how this…...

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Bibliography

Beauchamp, TL and Childress, JF (2001) Principles of Biomedical Ethics. Oxford University Press. 15 Feb 2001. Retrieved from:  http://books.google.com/books?id=_14H7MOw1o4C&source=gbs_navlinks_s 

Coghlan, A.K (2012) New Cancer Drug Sabotages Tumor's Escape Route. 24 Feb 2012. New Scientist. Retrieved from:  http://www.newscientist.com/article/dn21516-new-cancer-drug-sabotages-tumours-escape-route.html 

Beauchamp, TL and Childress, JF (2001) Principles of Biomedical Ethics. Oxford University Press. 15 Feb 2001. Retrieved from: