Change in Nursing Practice

As a nurse we want to ensure that our patients receive a high quality of care. Patients should feel safe and satisfied while hospitalized. Many hospitals are continually looking for answers and implementation to significantly reduce the inpatient fall incidents. According to Bechdel et al (2014), the top priority of health care organizations nationwide is to reduce and eliminate falls within the clinical care settings. One of the serious problems in acute care hospital is the patient’s fall. The unfamiliar environment, acute and co-morbid illnesses, prolonged bedrest, polypharmacy, and the placement of tubes and catheters are common challenges that place patients at risk of falling. Most of the falls that I have encountered while working involves

Problem: Patient falls have long been a common and serious problem in hospitals across the nation, causing

For the most part, hospitals are places where one comes for healing and it is place where our clients should feel safe and away from harm. Nurses have an important role as a patient advocate and are to provide all clients with safe, compassionate, and quality care at all times. Nonetheless, the hospital can also be a dangerous place for inpatients. It is a foreign environment to clients and there may be alterations in their medical condition in regards to their physical and/or mental status. With this said, there is a need to improve upon how we care for our clients, especially those who are at most risk for various incidents.

Capan, K., & Lynch, B. (2007). Reports from the field: patient safety. a hospital fall assessment and intervention project. Journal of Clinical Outcomes Management: JCOM, 14(3), 155-160.

In the healthcare facility there are many things that can benefit from change. Bedside rounding with the inclusion of the entire care team would be a beneficial change to any healthcare facility. By doing bedside rounding it promotes patient and family involvement in the exchange of information and planning of their care. This also allows for the interdisciplinary team to be completely involved rather than picking up bits and pieces of information throughout the day from multiple different people. This is also a great opportunity for the patient and their family to ask questions with the entire care team available for answers.

Elimination of patient falls is not an easy task otherwise they would have been eliminated by now. Patient falls unfortunately continue to be a challenge and occur within the hospital and nursing home settings at alarming and sometimes deadly rates. The Center for Disease Control estimates that 1,800 older adults living in nursing homes die each year from fall-related injuries. Survivors frequently sustain injuries resulting in permanent disability and reduced quality of life. Annually, a typical nursing home with 100 beds reports 100 to 200 falls and many falls go unreported (CDC, 2015). Falls occur more often in nursing homes because patients are generally weaker, have more chronic illnesses, have difficulty ambulating, memory issues, and difficulty with activities of daily living all of which are factors linked to falling. Contributing causes of nursing home falls include walking or gait issues, environmental hazards such as wet

Patient safety is one of the nation's most imperative health care issues. A 1999 article by the Institute of Medicine estimates that 44,000 to 98,000 people die in U.S. hospitals each year as the result of lack of in patient safety regulations. Inhibiting falls among patients and residents in acute and long term care healthcare settings requires a multifaceted method, and the recognition, evaluation and prevention of patient or resident falls are significant challenges for all who seek to provide a safe environment in any healthcare setting. Yearly, about 30% of the persons of 65 years and older falls at least once and 15% fall at least twice. Patient falls are some of the most common occurrences reported in hospitals and are a leading

A fall can make wide spread consequences on the health service or can be affected seriously by the increased health care utilization. Among the fallers approximately 30% of falls result in physical injury leading to extensive hospitalization with significant hospital expenses (Tzeng & Yin 2010). Preventive care phases can support health services to regulate the spare expenditure to a greater extend. A fall in hospital consequently affects the nursing staff, which lead to impaired job satisfaction, additional work load and startling time consume. As the front line of care, nurses can prevent falls and reduce fall injury rates in acute care unit with available resources (Dykes et al. 2013). This literature review aims to assess the efficiency of planned interventions to reduce the incidence of falls in acute medical units. The discussions of the main findings of the review as well as the recommendations for further research are revealed to conclude this study.

A patient fall is one of the unit-based nursing-sensitive indicators in 6 East, a 22-bed adult unit in a 594-bed tertiary hospital in downtown Charleston, SC. The majority of the patients’ population in this unit is pre and post liver transplant, renal transplant, pancreas transplant, nephrology, urology, and general medicine. The fall rates in 6 East were 6.09 total falls per 1,000 patient days during the 1st quarter of 2015 and 7.56 on the 2nd quarter. These statistics were tremendously beyond the 3.28 total falls per 1,000 patient days of the National Database of Nursing Quality Indicators (NDNQI) benchmark of hospitals of > 500 beds. The significant fall rates in the unit accounted about 35% of the total falls on the hospital during the first half of the year. Although the hospital has a fall prevention program and policy, there is a knowledge gap among nurses and patient care technicians (PCT) regarding fall prevention due to lack of proper education reinforcement. This has led to an increase of staff non-compliance with the policy and fall rates in the unit. Furthermore, with the unit having high staff turnover rates, the newly hired staff members are not getting a proper staff education on fall prevention. Therefore, these newly hired staff members are unable to implement the fall prevention strategies and procedures efficiently.

The evidence indicated that age, narcotic/sedative use, and overnight shift significantly and independently predicted the likelihood of a fall during the hospitalization (Cox et al., 2015). Moreover, cardiovascular comorbidities, neuro/musculoskeletal disease, evening shift, implementation of fall prevention strategies, and a higher RN-to-unlicensed assistive personnel (UAP) staffing ratio (RN/UAP) were significantly and independently associated with a decreased likelihood of a fall during the hospitalization. Additionally, the initiation of fall prevention strategies following a prescribed fall prevention protocol was found to decrease the likelihood of fall occurrence (Cox et al., 2015). From the evidence of the study, results can indicate that evidence-based fall prevention intervention can be effective modalities that can decrease fall occurrence for inpatients and the presence of RNs is indispensable to fall prevention setting (Cox et al., 2015).

Hospital falls are extremely common. In a study that was conducted to describe the epidemiological nature of hospital falls, they found that that about 183 of 1,300 patients fell during the period of study. Hospital falls are more common in the elderly where the average age of the patients who had fallen was found to be 63.4%. Many of the falls were unassisted (79%) and they had occurred while the patients were in their own rooms (85%). Generally, the number of falls in hospitals ranges from 2.3-7 falls per 1,000 patient-days and it was found that 30% of the falls that happen in hospitals result in injury with 4-6% leading to serious injuries ADDIN EN.CITE Hitcho20041043(Hitcho et al., 2004)1043104317Eileen B HitchoMelissa J KraussStanley BirgeWilliam Claiborne DunaganIrene FischerShirley JohnsonPatricia A NastEileen CostantinouVictoria J FraserCharacteristics and Circumstances of Falls in a Hospital Setting: A Prospective AnalysisJournal of General Internal MedicineJournal of General Internal Medicine732-7391972004( HYPERLINK l "_ENREF_2" o "Hitcho, 2004 #1043" Hitcho et al., 2004). Some of the serious injuries include subdural hematomas, fractures, excessive bleeding and in some extreme cases, death ADDIN EN.CITE Belechri20021044(Belechri, Petridou, & Trichopoulos, 2002)1044104417Belechri, M.Petridou, E.Trichopoulos, D.Bunk versus Conventional Beds: A Comparative Assessment of Fall Injury RiskJournal of Epidemiology and

This article’s main research problem was that most fall prevention programs depicted in hospitals were not as successful as desired. Despite implementation of the programs, hospitals still had a high rate of falls and/or injuries related to falls within their units. The purpose of this particular study was to solve this problem and examine the contribution of the response time to a patient’s call light and the fall related injuries in adult, in-patient facilities.

Falls are the leading cause of medical complications in health care facilities in the United States. Statistics from The Joint Commission shows that hundreds of thousands of patients fall in hospitals every year, with 30-50% of those falls resulting in injury (“Preventing falls and fall-related injuries,” 2015). Furthermore, the consequences of falls are that injured patients will require longer hospital stay leading to an increase in healthcare costs (“Preventing falls and fall-related injuries,” 2015). To prevent falls, health care facilities have implemented evidence-based intervention strategies such as fall risk assessment tools and faster call light response time.

Falling is a crucial issue among the hospitals. Even the hospitals make all the efforts to prevent falls, falls still occur frequently and some repeatedly. According to Currie (2008), approximately 700000 to 1000000 individuals fall in the United States hospitals each year. A fall in a health care organization is considered a never-event by Medicare and Medicaid services(CMS) (Cox et al., 2015). As the result, health care facilities are not reimbursed for hospitalized falls which increase the economic burden of hospitals.

Falls and fall related injuries are a common and significant health concern among inpatients, especially the elder population related to lack of fall prevention programs and lack of patient and nursing education. Patient falls contribute to unwanted hospital admissions, increase hospital stays, pain, severe injury or death (Demons & Duncan, 2014). Evidence suggests that falls contribute to functional decline, increased healthcare costs, and increase need for medical treatment including lengthy hospitalizations. Risk factors for falls range from environmental hazards to physical impairments and health diagnosis; therefore educating the nurse in appropriate falls prevention and interventions can considerably increase the health and safety of patients (Demons & Duncan, 2014).