Literature Review

When you think about safety hazards, what comes to mind? Falls, fires, medication errors? Falls are a major concern in and outside of the hospital. It is known that falls are the leading cause of fatal and nonfatal injuries of older adults. Studies show that 35% to 40% of adults 65 years or older experience a fall each year. (Eliopoulos, 2018, p. 187) When it comes to the elderly, what are some of the leading causes of falls? There are many factors that contribute to falls including age related changes, improper use of mobility aids, medications, unsafe clothing, disease related symptoms, and environmental hazards. ( Eliopoulos, 2019, p. 187-188) As a group we reviewed five different studies that studied fall prevention programs and ways to prevent falls.

Each year, more than one in four older adults aged 65 and older will fall. Among older Americans, falls are the number one cause of injuries and death from injury. This represents 29 million falls, 3 million emergency department (ED) visits, 800,000 hospitalizations, and 28,000 deaths (Staff, 2017) Nurses spend a lot of time with patients providing care and are an integral part keeping patients safe during their time in the hospital. Nurses play an essential role in implementation of fall prevention interventions (Wilson et al., 2016). Care that is individualized and patient-specific based on their fall risk factors, are more likely to reduce falls than general interventions, such as door signage and the use of armbands that identify patients that score certain numbers on a fall assessment. Study results that looked at nurses’s perception on implementing fall prevention interventions to mitigate patient-specific fall risk factors, shared that the project increased mindfulness of staff regarding fall prevention, increased collaboration among nurses and with other clinicians and was transformative (Wilson et al.,2016). The changes made during the study were the addition of change champions, outreach, implementation tools, coaching and positive reinforcement and staff education.

Change champions promoted the use of fall prevention practices and were instrumental in implementing patient-specific fall prevention practices (Wilson et al.,2016). These change champions were able to provide education to their peers so it was “less management and was more peer to peer”(Wilson et al.,2016). Outreach occurred during the implementation phase where the principal investigator completed rounds on the study units every 5 to 6 weeks for a total of seven visits. The purpose being to address staff questions, review progress in implementation of the fall prevention interventions, positive reinforcement for practice change, to promote use of fall prevention practices and to address any issues encountered during implementation (Wilson et al.,2016). The data gathered by the nurses and provided to the principal investigator was useful in showing real time data on risk factors and interventions. Implementation tools such as quick reference guides and posters about fall prevention fostered critical thinking about selection of fall prevention interventions to address patient-specific fall risks and contributed to ongoing education of staff (Wilson et al.,2016). Coaching and positive reinforcement came not only from the change champions but from nursing management as well. This was a team effort that showed they trickle down effect can work in healthcare. Coaching provided praise and acknowledgement to fellow nursing colleagues for their focused attention to patient falls as well as used a means of staff education on other nursing units. Coaching was deemed important during this study because it opened a dialogue about patient-specific fall prevention (Wilson et al.,2016).

The overall findings of this study revealed that prior to this study, nursing care in relation to fall prevention utilized general fall prevention interventions versus more patient-specific. The study revealed that with the use of targeted risk factor fall prevention bundle and TRIP implementation intervention, nurses reported increased engagement in fall prevention. (Wilson et al.;2016)

Weakness and balance issues have been known to cause falls. Implementing a fall prevention program that is designed to help improve gait and balance has been studied and proven to help decrease the number of falls. Fall prevention is not all about the physical aspect of a patient, but also taking a look at the patient's home environment and medication. Education is an important part of a fall prevention program. In a study performed by nurse practitioners, it was found that fall scores dropped after participants attended an eight week education program that met twice a week. Education topics included medications, blood pressure, and ways to prevent tripping hazards. (Frith, Hunter, Coffey, & Khan, 2019) Fall prevention strategies are not only for hospital stays, but should continue once the patient has been discharged. Ninety percent of healthcare providers have reported discussing fall prevention with their patients which is mostly consistent with home modifications. Is this enough to truly prevent falls? Medication reconciliation, environment modifications, exercise and referrals for specialists should also be discussed. (Frith, Hunter, Coffey, & Khan, 2019)

Many facilities utilize screening tools to determine a patient's fall risk. A continuous quality improvement study completed at Cedar-Sinai Medical Center found that screening tools alone should not be used for this purpose (Silva & Hain, 2017). A patient’s risk for falls is unique to their circumstances and a comprehensive health assessment should be completed in order to assess the patient's risk for falls. The patients fall prevention plan should be specific to the patients individual needs. One challenge identified during the study was that some patients and/or family members did not adhere to the patients fall prevention plan by deactivating bed alarms or failing to call a nurse to assist them with ambulation. The nurse should educate the patient and their family members to ensure patient adherence to the care plan. The study found that patients are more likely to adhere to the care plan if they understand their risk factors, why the care plan is important and the negative outcomes of a fall. As a part of the quality improvement process, the nurses at Cedar-Sinai would meet after each fall to assess what happened and what factors contributed to the patients fall. Their continuous data collection and review allowed them to identify patterns and implement changes which resulted in steady reduction of patient falls. If nurses have an understanding of the unique circumstances of the patients they serve and the demographics surrounding the falls in their unit, they can more easily identify patterns and root causes of falls, which will help drive change to their actions plans in order to reduce the incidence of falls (Silva & Hain, 2017).