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Falls by orthopaedic patients may lead to negative outcomes such as injury, prolonged hospitalization, delayed rehabilitation, and increased costs.
We examined the impact of a multidisciplinary Falls-prevention Program (FPP) on the incidence of inpatient falls and fall-related injuries in an orthopaedic hospital during a 6-year period.
Patient data...
Context in source publication
Context 1
... February 2008, a multidisciplinary task force was established to develop a FPP with the aim of creating a safe environment for inpatients and to reduce the inci- dence of falls and consequent injuries. The various elements of the plan were introduced in stages during a 6-month period and the FPP was fully operational by July 1, 2008 (Table 1). ...
Citations
... Fall is one of the most common health threats encountered in the aged population [1]. Falls occurring in the hospital are quite common with rates ranging from 2.3 to 17.1 falls per 1,000 patient-days [2,3]. It is reported that approximately 23% to 42% of inpatient falls result in injury, and 4% to 8% result in serious injury [2,4,5]. ...
Objectives:
Few studies have evaluated the mechanism of serious injury in acute hospitalization. Thus, the association between fall-related serious injury and activity during falls in acute care hospital remains unclear. Herein, we investigated the relationship between serious injury caused by fall and activity at the time of the fall in an acute care hospital.
Methods:
This retrospective cohort study was conducted at Asa Citizens Hospital. All inpatients aged 65 years and older were eligible for the study, which was conducted from April 1, 2021, through March 31, 2022. The magnitude of the association between injury severity and activity during the fall was quantified using odds ratio.
Results:
Among the 318 patients with reported falls, 268 (84.3%) had no related injury, 40 (12.6%) experienced minor injury, 3 (0.9%) experienced moderate injury, 7 (2.2%) experienced major injury. Moderate or major injuries caused by a fall was associated with the activity during the fall (odds ratio: 5.20; confidence intervals: 1.43-18.9, p = 0.013).
Conclusion:
This study recognizes that falling during ambulation caused moderate or major injuries in an acute care hospital. Our study suggests that falls while ambulating in an acute care hospital were associated not only with fractures, but also with lacerations requiring sutures and brain injuries. Among the patients with moderate or major injuries, more falls occurred outside the patient's bedroom as compared with patients with minor or no injuries. Therefore, it is important to prevent moderate or major injuries related to falls that occur while the patient is walking outside their bedroom in an acute care hospital.
... The education brochure was prepared by the researcher in line with the literature. (Clarke et al., 2012;Galbraith et al., 2011;Johnson et al., 2014;Schwendimann et al., 2006). The content of the education brochure; it includes osteoarthritis, total knee replacement surgery, pre-and post-operative care (wound care, exercises to be done, initial mobilization, etc.), definition of falling, determination of risk factors and precautions to be taken. ...
The aim of this study is to determine the effect of fall prevention education given to patients with scheduled total knee arthroplasty (TKA) on their fear of falling in the postoperative period. The study had a quasi-experimental design. The study sample included 70 patients. Data were gathered with a patient characteristics form and the Falls Efficacy Scale-International (FES-I) at face to face interviews. The intervention group was given a brochure and face-to-face education about fall prevention before surgery. Activities such as the first mobilization, assisted walking, climbing stairs, getting out of bed and sitting in bed after the surgery were demonstrated and performed. Patients were followed up to 16 weeks after surgery. The mean age of the control and intervention groups, respectively; 62.26 ± 6.38 and 59.46 ± 7.33. The fear of falling scores before the operation and in the postoperative 6th-8th weeks were high in the intervention group (40.17 ± 8.32 and 31.71 ± 7.83 respectively) and the control group (44.14 ± 8.86 and 40.91 ± 8.43 respectively). The fear of falling scores in the postoperative 14th-16th weeks were high in the control group (37.2 ± 9.03) and moderate in the intervention group (26.42 ± 5.59). The scores for FES-I in the 6th-8th weeks and 14th-16th weeks after surgery were very significantly lower in the intervention group than in the control group(p <.001). The results of the study showed that the patients experienced a great fear of falling before and after surgery. It can be said that the education given reduces the fear of falling significantly and in the early period.
... 1 3 4 An in-hospital fall resulting in an injury can add 6 days to a hospital stay and an additional $14 000 USD in healthcare spending. [5][6][7] Researchers have identified patient-level (eg, age and frailty) and organisational-level (eg, lack of leadership and staff training) factors associated with in-hospital falls and falls with injury. 4 8 To address these risk factors, numerous fall prevention interventions have been implemented (eg, risk assessments and enhanced vigilance) but with mixed success. ...
Background
To guide fall prevention efforts, United States organisations, such as the Joint Commission and the Agency for Healthcare Research and Quality, have recommended organisational-level implementation strategies: leadership support, interdisciplinary falls committees, electronic health record tools, and staff, family and patient education. It is unclear whether hospitals adhere to such strategies or how these strategies are operationalised.
Objective
To identify and describe the prevalence of specific hospital fall prevention implementation strategies.
Methods
In 2017, we surveyed 80 US hospitals participating in the National Database of Nursing Quality Indicators who volunteered for the study. We conducted descriptive statistics by calculating percentages for categorical variables and the median and IQR for count variables.
Results
A total of 60/80 (75%) of hospitals completed the survey. The majority of hospitals were not-for-profit (98%) and urban (90%); more than half were Magnet (53%), small (53%) and teaching (52%). Hospitals were more likely to use leadership strategies, such as updating fall policies in the past 3 years (98%) but less likely to reward staff (40%). Hospitals commonly used interdisciplinary falls committees (83%) but membership rarely included physicians. Hospitals lacked access to electronic health record tools, such as high-risk medication warnings (27%). Education strategies were commonly used; 100% of hospitals provided fall education at staff orientation, but only 22% educated all employees (not just nursing staff).
Conclusions
Our study is the first to our knowledge to examine which expert-recommended implementation strategies are being used and how they are being operationalised in US hospitals. Future studies are needed to document fall prevention implementation strategies in detail and to test which implementation strategies are most effective at reducing falls. Additionally, research is needed to evaluate the quality of implementation (eg, fidelity) of fall prevention interventions.
... The Joint Commission (2015) considered falls as a top 10 Sentinel Event Alert, which is defined as "unexpected occurrence that involve death and serious physical and psychological injury" (2015, p.1). According to Galbraith, Butler, Memon, and Harty (2011) There is considerable evidence for effective fall prevention, and healthcare stakeholders are implementing quality improvement projects and evidence-based practices to protect patients from harm Dykes et al., 2017;Laulirn & Shorr, 2019). There is a wealth of literature on fall prevention, and systematic reviews have identified effective interventions. ...
Background: Every year in the United States, hundreds of thousands of patients fall in hospitals with 30 to 50 percent resulting in injury. In Texas, the fall rate in adult patients is 33.9 percent, and in one teaching hospital in South Texas, patient fall rates have been above the national benchmark for two years (2017-2019), despite increased use of sitters for patient safety and multiple fall prevention strategies. The annual direct care cost of all fall events in the United States for individuals more than 65 years old is about $34 billion. Practice problem: The objectives of the fall initiative program were increasing adherence to documentation of data from the Morse Fall Assessment and tailored interventions in the electronic health record. The goal of the project was to promote patient safety by decreasing the fall rate per 1000 patient days to below the national benchmark of 3.44/1000 patient days. Intervention: The project was piloted in two telemetry units over 12 weeks using the Iowa Model of Evidence-based Practice. Telemetry staff received one-on-one education from the educator in the unit using a tailored intervention poster. The Nurse Champion observed 58 rooms and conducted chart documentation to ensure universal fall precautions were carried out during every shift. Incidence of falls was tracked daily, and post fall huddles were conducted after any incidents. Outcome: The average monthly fall rate after implementation was 2.47/1000 patient days, which was below the national benchmark. Conclusion: The fall assessment documentation in two telemetry units at DHR Health can be adapted or implemented hospital-wide. The results showed a statistically significant correlation between the Morse fall score assessment on EHR and monthly fall events (p=0. 0078). Champions were able to identify interventions and areas that needed to be improved such as education, patient engagement and stakeholder buy-in.
... On average, the cost implication for a fall with injury is around $14,000. [7][8][9] Between 2009 and 2015, The Joint Commission's Sentinel Event database compiled a total of 465 severe falls occurring in hospitals. 63% of these severe falls resulted in death, while the remaining patients sustained serious injuries. ...
Patient falls during hospitalization can lead to severe injuries and remain one of the most vexing patient-safety problems facing hospitals. They lead to increased medical care costs, lengthened hospital stays, more litigation, and even death. Existing methods and technology to address this problem mostly focus on stratifying inpatients at risk, without predicting fall severity or injuries. Here, a retrospective cohort study was designed and performed to predict the severity of inpatient falls, based on a machine learning classifier integrating multi-view ensemble learning and model-based missing data imputation method. As input, over two thousand inpatient fall patients’ demographic characteristics, diagnoses, procedural data, and bone density measurements were retrieved from the HMH clinical data warehouse from two separate time periods. The predictive classifier developed based on multi-view ensemble learning with missing values (MELMV) outperformed other three baseline models; achieved a cross-validated AUC of 0.713 (95% CI, 0.701–0.725), an AUC of 0.808 (95% CI, 0.740–0.876) on the separate testing set. Our studies show the efficacy of integrative machine-learning based classifier model in dealing with multi-source patient data, which in this case delivers robust predictive performance on the severity of patient falls. The severe fall index provided by the MELMV classifier is calculated to identify inpatients who are at risk of having severe injuries if they fall, thus triggering additional steps of intervention to prevent a harmful fall, beyond the standard-of-care procedure for all high-risk fall patients.
... The average cost for a fall with serious injury is $14 000 per patient. 53,54 The Centers for Medicare & Medicaid Services will no longer pay for inhospital falls with trauma. ...
Evidence indicates that chances for a successful patient mobility program, prevention of pressure injury and falls, and safe patient handling are enhanced when an organization possesses an appropriate culture for safety. Frequently, these improvement initiatives are managed within silos often creating a solution for one and a problem for the others. A model of prevention integrating early patient mobility, preventing pressure injuries and falls while ensuring caregiver safety, is introduced. The journey begins by understanding why early mobility and safe patient handling are critical to improving overall patient outcomes. Measuring current culture and understanding the gaps in practice as well as strategies for overcoming some of the major challenges for success in each of these areas will result in sustainable change.
... However, patient falls remain one of the major causes of death and severe morbidity in hospitals (Institute of Medicine (US) Committee on Quality of Health Care in America et al. 2000;Fields et al. 2015). Patient falls represent 69.3% of adverse medical events (Fagin and Vita 1965), with a rate of about 2.3 to 17.1 per 1,000 patient days (Hitcho et al. 2004;Galbraith et al. 2011). Patient falls also cause a considerable financial burden on the health care system (Institute of Medicine (US) Committee on Quality of Health Care in America et al. 2000;Fields et al. 2015). ...
Patient falls are common adverse medical events in hospitals. The objectives of this study were to clarify the factors of patient falls at hospitalization or transfer to another ward, which could be assumed that patients experience new environment. Patients who were hospitalized or transferred to another ward at a hospital in Japan, between January 14 and February 14, 2014 were included. We used a risk assessment sheet and applied stepwise regression analysis to identify factors of patient falls. We also investigated changes in patient conditions on the risk assessment sheet by the chi-square test. A total of 1,362 patients (53.2% female; mean age, 57.1 ± 18.0 years) were eligible for analysis, and 38 (2.8%) fell during the study period. The fallers were significantly older than the non-fallers (63.8 ± 18.0 vs. 56.9 ± 18.7 years, P = 0.03), but no significant difference was seen in sex (55.3% vs. 53.1% female). “History of falls”, “Tubes inserted”, “Need assistance/supervision for toileting” and “Excretion more than two times per night” were significantly related to patient falls (adjusted odds ratios [95% confidence interval]: 2.41 [1.05-5.53], 3.64 [1.57-8.43], 4.52 [2.00-10.23] and 3.92 [1.38-11.09]). Among 30 fallers, “Overestimation or non-understanding of own physical abilities” was significantly more frequent after falls (30.0%) than before falls (6.7%, P = 0.02). The factors found in this study might be useful for identifying patients at higher risk of falls.
... Two recent randomised controlled trials of patient fall reduction programmes failed to demonstrate a reduction in injuries, 14 23 and several quality improvement falls prevention studies fail to report injury rates 17 27 or demonstrate no change. 25 31 Weinberg et al 12 reported a 64% decrease in serious injury falls over a 12-month period; however, injury outcome data were missing and the patient care units were heterogeneous. Quigley et al 27 reported a 55% reduction in serious falls but stated 'no significant trends in any direction', and a recent multicentre evaluation by the same author reported no changes in injuries. ...
Background
Inpatient falls and subsequent injuries are among the most common hospital-acquired conditions with few effective prevention methods.
Objective
To evaluate the effectiveness of patient education videos and fall prevention visual signalling icons when added to bed exit alarms in improving acutely hospitalised medical-surgical inpatient fall and injury rates.
Design
Performance improvement study with historic control.
Setting
Four medical-surgical units in one US public acute care hospital.
Study participants
Adult medical-surgical inpatients units.
Interventions
A 4 min video was shown to patients by trained volunteers. Icons of individual patient risk factors and interventions were placed at patients’ bedsides. Beds with integrated three-mode sensitivity exit alarms were activated for confused patients at risk of falling.
Main outcome measures
The main outcome measure is the incident rate per 1000 patient days (PDs) for patient falls, falls with any injury and falls with serious injury. The incident rate ratio (IRR) for each measure compared January 2009–September 2010 (baseline) with the follow-up period of January 2015–December 2015 (intervention).
Results
Falls decreased 20% from 4.78 to 3.80 per 1000 PDs (IRR 0.80, 95% CI 0.66 to 0.96); falls with any injury decreased 40% from 1.01 to 0.61 per 1000 PDs (IRR 0.60, 95% CI 0.38 to 0.94); and falls with serious injury 85% from 0.159 to 0.023 per 1000 PDs (IRR 0.15, 95% CI 0.01 to 0.85). Icons were not fully implemented.
Conclusion
The first known significant reduction of falls, falls with injury and falls with serious injury among medical-surgical inpatients was achieved. Patient education and continued use of bed exit alarms were associated with large decreases in injury. Icons require further testing. Multicentre randomised controlled trials are needed to confirm the effectiveness of icons and video interventions and exit alarms.
... Inpatient falls alone are quite common, ranging from 2.3 to 17.1 falls per 1,000 patient-days. 2,3 Approximately 30% of these falls result in morbidity and up to 6% of these injuries are serious, including fractures, subdural hematomas, significant bleeding, and even death. 2,4,5 Patients who sustain fall-related injuries are reported to have higher overall hospital charges than similar matched patients who did not fall during their hospitalization. ...
Objective
To quantify the type, prevalence, and cost of imaging following inpatient falls, identify factors associated with post-fall imaging, and determine correlates of positive versus negative imaging.
Design
Single-center retrospective cohort study of inpatient falls. Data were collected from the hospital’s adverse event reporting system, DrQuality. Age, sex, date, time, and location of fall, clinical service, Morse Fall Scale/fall protocol, admitting diagnosis, and fall-related imaging studies were reviewed. Cost included professional and facilities fees for each study.
Setting
Four hundred and fifteen bed urban academic hospital over 3 years (2008–2010).
Patients
All adult inpatient falls during the study period were included. Falls experienced by patients aged <18 years, outpatient and emergency patients, visitors to the hospital, and staff were excluded.
Measurements and main results
Five hundred and thirty inpatient falls occurred during the study period, average patient age 60.7 years (range 20–98). More than half of falls were men (55%) and patients considered at risk of falls (56%). Falls were evenly distributed across morning (33%), evening (34%), and night (33%) shifts. Of 530 falls, 178 (34%) patients were imaged with 262 studies. Twenty percent of patients imaged had at least one positive imaging study attributed to the fall and 82% of studies were negative. Total cost of imaging was $160,897, 63% ($100,700) from head computed tomography (CT).
Conclusion
Inpatient falls affect patients of both sexes, all ages, occur at any time of day and lead to expensive imaging, mainly from head CTs. Further study should be targeted toward clarifying the indications for head CT after inpatient falls and validating risk models for positive and negative imaging, in order to decrease unnecessary imaging and thereby limit unnecessary cost and radiation exposure.
... For acute-care fall reduction programs, the leadership and guidance provided by a multidisciplinary team has been associated with greater success in implementing interventions and reducing fall rates. 6,15,16 The participation of physicians, nurses, physiotherapists, social workers, and case managers provides a wide range of knowledge and experience, endorses a teamwork attitude, and facilitates identification of necessary interventions. Providers from each discipline can increase awareness about fall prevention within their respective groups, advocate for changes in clinical practices, and foster a culture of patient safety. ...
... In another prospective cohort study, a multidisciplinary fall prevention program in an orthopedic hospital resulted in a 30% relative risk reduction in falls. 15 There were 11 patient interventions that were selected in a tiered system consisting of universal interventions for all patients and specific interventions reserved for high-risk patients. Although the selected interventions were different from the aforementioned study, the latter study also resulted in a decreased fall rate. ...
... Education and training of care providers regarding their roles and responsibilities are critical before introducing the program. 15,28 Furthermore, a trial period to pilot interventions can provide valuable information about the program's feasibility and effectiveness. 34 Clearly delineating responsibilities, ensuring availability and accessibility of resources and tools, and receiving feedback from bedside providers can promote implementation of the program and facilitate the incorporation of new interventions into pre-existing clinical practices. ...
With the anticipated increase in the number of total joint arthroplasty surgeries and associated fall risks, a fall reduction program can provide greater safety for patients in the postoperative period. Although further prospective studies are needed among total joint arthroplasty patients, there is sufficient evidence to show that a successful fall reduction program can be implemented. Common components to date have included a multidisciplinary team, multicomponent interventions specific to the risks associated with total knee and hip arthroplasty patients, education of patients and staff, and strategies to promote adherence to the program.
Published by Elsevier Inc.
