PRACTICE PROBLEM
According to the Centers for Disease Control and Prevention (2023), more than three million older adults in the emergency department are treated for fall injuries each year. Roughly one in four adults 65 and older in the United States has fallen, and most do not report it to their physician. In Georgia (GA), approximately 398,000 older adults reported falls.
Falls are preventable and can be very costly for everyone. Prevention measures need to be implemented to ensure patient safety. In 2015, Medicare and Medicaid paid 75% of fall-related medical costs out of more than 50 billion dollars. In GA, the cost of care for falls or fall-related injuries was 940 million dollars, with 155 million dollars paid out of pocket by consumers (CDC, 2023).
Falls may cause severe injuries like hip fractures, head injuries, or minor broken bones in the arms, leg, or wrist. No matter how serious the injury, it can disrupt routine patient care and cause clients to become less active or make it harder for them to care for themselves (CDC, 2023). Patients in the in-center dialysis facility tend to be noncompliant with treatment adherence when pain or imbalance occurs.
I practice in an outpatient hemodialysis center. Dialysis patients are at high risk for falls, and a marked risk reduction can be achieved by modifying risk factors in this outpatient setting (Heung, 2010). Patients may sometimes fall post-treatment related to fluid shifts, hypotension, imbalance, or other underlying conditions. Patients may have a fall at home that goes unreported until they return for treatment with a swollen limb, knot on the head, or visual bruising.
In recent months we have noticed an increase in incident reports related to patient falls. This safety problem is an area I would like to explore and seek initiatives to improve patient outcomes. In our quality improvement performance meeting, fall rates were discussed, and the physician, facility administrator, and charge nursing staff discussed the need for improvement. No extensive safety plan is currently in place, so this would be a perfect opportunity to research our fall rate data and address the safety issue. We assess patients quarterly via fall risk assessment forms, but there needs to be more follow-up.
My facility has recently changed its HR solution department, and with that came a new risk management evaluation for the workman’s compensation team. I ultimately selected falls to address in this practice exercise because while performing a walkthrough with the risk team, I noticed some changes that might be made to help decrease the number of patients and staff falls in the facility.
Adverse event reports and hospitalization logs are available for review in the facility, and patient satisfaction scores and access to local hospital databases are general resources to measure data on patient fall rates and injuries associated with the falls.
Reviewing what patient fall rates have been in my facility in the past will give me a clear picture of what implementations are needed to increase patient and staff safety in our facility now and in the future.
Reference:
Centers for Disease Control and Prevention. (2023). Facts about falls. Retrieved from, https://www.cdc.gov/falls/facts.htmlLinks to an external site.
Heung, M., Adamowski, T., Segal, J., & Malani, P. N. (2010). A Successful Approach to Fall Prevention in an Outpatient Hemodialysis Center. Clinical Journal of the American Society of Nephrology, 5(10), 1775–1779. https://doi.org/10.2215/cjn.01610210Links to an external site.