Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

AHRQ Director Carolyn Clancy, M.D., has prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They will address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan. Check back regularly for new columns.

For older adults, falls are serious, whether they take place in the home or in a health care setting.

More than one-third of adults over age 65 fall each year. Falls can cause bone fractures, disability, and even death. Among people 75 and older, falls are far more likely to cause admissions into a long-term care facility than for adults 10 years younger, Federal data show.

An estimated 500,000 falls  happen each year in U.S. hospitals, causing 150,000 injuries. Patients have a higher risk of falls if they—

  • Have weak muscles or problems walking.
  • Take drugs or a combination of drugs that make them sleepy.
  • Use a cane or walker.
  • Have chronic conditions.
  • Need to use the bathroom frequently.

Health care providers have known for a long time that falls among patients are a serious problem. But they haven't always agreed on the best way to prevent them.

This is changing, which means you or your loved ones may be safer from falls in the future.

Today, many hospitals and long-term care settings use new programs based on scientific evidence of what works best. The goal is to make sure clinicians understand the risk of falls, identify which patients have the higher risk, and take steps to reduce patients' risk.

A new toolkit from the Agency for Healthcare Research and Quality (AHRQ) focuses on the challenges that hospitals face as they try to develop and sustain a fall-prevention program. In addition to helping hospitals gain support for this process, the toolkit describes the steps that organizations can take to put the best fall-prevention strategies into practice.

Another program is an AHRQ-funded project (PDF File, Plugin Software Help) from a Wisconsin health system, a health technology company, and a university-based school of nursing. They developed a computerized program with four individual care plans, based on patients' risk for a fall and their ability to follow instructions on how to prevent one.  

The program helps nurses develop fall-prevention plans that match patients' needs and that can go in patients' electronic health records.

For example, the program identifies patients who are usually at low risk for falls but who may have an injury or condition that increases their risk. 

For these patients, steps to reduce falls include—

  • Making sure they are carefully watched the first time they get out of bed after surgery or a procedure.
  • Making sure they or a family member understand the need to call and wait for help before doing something that could cause a fall.
  • Helping them identify hazards or behaviors that make a fall more likely.
  • Learning safer approaches before they leave the hospital.

Some patients are at a high risk of falling but can follow steps on how to prevent a fall.

For these patients, steps to reduce falls include— 

  • Making sure they understand why they should use a walker or other device to help them move safely.
  • Consulting with the pharmacist or physician to be careful about drugs that can increase the risk of falls.
  • Using an alert system, such as wristbands, signs, or other communication to warn of the risk of falls.

We know that communication and teamwork among health care providers are important to reduce errors and improve patient safety. In fact, up to 70 percent of medical errors, including falls, are due to breakdowns in communication among health care teams.

To address this need, AHRQ and the Department of Defense have developed a Known as TeamSTEPPS®, the system is based on more than 20 years of research into how teamwork improves safety. It is used in hundreds of hospitals across the United States.

Early results show that TeamSTEPPS improves safety and quality in long-term care settings. For example, staff using teamwork skills reduced the rate of serious pressure ulcers among nursing home residents by 48 percent.

Reducing the risk of falls in hospitals and long-term care settings is an important goal. New tools can help health providers—and their patients—attain it. 

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care (Overview)
http://www.ahrq.gov/professionals/systems/long-term-care/fallpxtoolkit/fallpxtkover.html

Using a Computerized Fall Risk Assessment Process to Tailor Interventions in Acute Care
http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/advances-in-patient-safety-2/vol1/Advances-Hook_25.pdf [Plugin Software Help]

TeamSTEPPS Long-Term Care Version

Centers for Disease Control and Prevention
Falls Among Older Adults: An Overview
http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html

National Patient Safety Foundation
Key Facts about Patient Safety
http://www.npsf.org/for-patients-consumers/patients-and-consumers-key-facts-about-patient-safety/#Fal  

Current as of February 2013
Internet Citation: New Tools Help Health Providers Reduce Patients' Risk of Falls. February 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/020513.html