Recent Research Findings Suggest Practice Recommendations for Preventing Falls in Hospitalized Patients
Patient falls are common in hospitals. Inpatient falls result in decreased mobility and loss of independence for patients, loss of time required to complete incident reports for hospital staff, and additional costs for payers. The Joint Commission requires that a fall risk assessment be conducted on every patient when admitted to a hospital and that a fall-prevention care plan be put in place. Despite these measures, fall rates have failed to significantly improve. A likely explanation is the wide variability in care plans across hospitals and inadequate communication between the care teams and their patients.
At the American Medical Informatics Association annual meeting in 2012, Dr. Patricia Dykes and her colleagues at the Brigham and Women’s Hospital Center for Education and Research on Therapeutics (CERT) presented findings from her team's most recent study used data mining and modeling techniques to identify the factors associated with falls among inpatients during the 6-month period that they were testing their fall-prevention toolkit Fall TIPS (Tailoring Interventions for Patient Safety; FTTK). "This study showed us that the main problem was not with the FTTK-generated recommendations but with adherence to the recommendations," explains Dr. Dykes. "We also learned from focus groups that the main reasons for patient nonadherence to recommendations, particularly among younger patients, were that they did not believe they were at risk for fall, or that the nurses seemed rushed when they were recommending assistance for the patient, or that they were embarrassed to get help. The most common reason for provider nonadherence to recommendations was that there was not enough staff on the floor to help."
Based on the study findings, Dr. Dykes identified several practice recommendations for health professionals who care for patients at risk for falls. She says that fall prevention is a three-step process:
- Assess the risk of a fall;
- Create a care plan that is personalized and based on the assessment; and
- Execute the plan every time.
Dr. Dykes notes, "To make sure that the interventions are always executed, we cannot depend on the clinical staff alone. We have to always perform a good fall risk assessment, make sure that the intervention plan we develop is based on areas of risk for the patients, and involve the patients in this process." She adds that involving the patients and their families in completing the fall risk assessment is likely to improve its accuracy. Similarly, partnering with patients and families in developing the care plan is likely to increase their acceptance and execution of the recommendations.
Read our feature article about the work that Dr. Dyke and her team are doing to reduce the gaps in fall-prevention care.
