Nurses' solutions to prevent inpatient falls in hospital patient rooms

Nursing Economics,  May-June, 2008  by Huey-Ming Tzeng,  Chang-Yi Yin

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IN THE NATIONAL PATIENT SAFETY Goals for 2007, the Joint Commission (2007) emphasized the need to reduce the risk of patient injuries from falls. Patient falls, defined as the rate at which patients fall during their hospital stays per 1,000 patient days, are a nursing-sensitive quality indicator in the delivery of inpatient services. Among the nursing quality indicators identified by the American Nurses Association (2002), patient fall rates are perceived as the indicator that could be most improved through nurse-led safety strategies or interventions. In other words, nurses assume the primary responsibility and are somewhat liable when a patient falls in the inpatient care unit.

Hospitals have devoted quality improvement and research efforts to prevent falls, but patient falls nonetheless consistently compose the largest single category of reported incidents in hospitals (The Joint Commission, 2005a). Fall prevention programs (e.g., using fall risk assessment tools to evaluate patients' risks for falls) apparently do not effectively reduce inpatient fall rates because of human factors and ergonomics in a hospital environment. A patient-centered facility design should promote patient safety. A safety-driven design with a goal to prevent inpatient fall-related injuries should be a hospital design principle.

According to the reports published by the Centers for Disease Control and Prevention Injury Center (2007), falls are the third most common cause of unintentional injury death across all age groups and the first leading cause among people 65 years and older; however, these national statistics did not differentiate between fails that happened at home and those that occurred at health care institutions. A hospital can be a dangerous and erratic place for inpatients because of its unfamiliar physical environment (different from their home settings) and because of changes in patients' medical conditions as related to their physical and psychological health and sensory systems (e.g., pain). A better physical facility design may lead to better health care outcomes, such as fewer patient falls in acute care hospitals. In the current cost-containment medical environment, developing cost-effective interventions to address the extrinsic risk factors that are external to the patient system and related to the physical environment is essential. The Joint Commission (2005a) also emphasized that the process of establishing a comprehensive fall-reduction program must involve much more than connecting causes to cures. We believe that any fall prevention interventions should be acknowledged and accepted by the nurses who work at the bedside to ensure successful implementation and improved outcomes.

Purpose of this Study

The purpose of this qualitative study was to promote understanding of and to prevent inpatient falls. The goal was to promote safe hospital stays. Researchers explored possible ways to eliminate the extrinsic risk factors that may contribute to inpatient falls from the perspectives of nurses. Researchers conducted analyses of the interview transcriptions of nurses who currently work in the study unit (an acute adult medical unit) of a Michigan medical center. The findings of this exploratory study may help in design interventions to minimize falls and fall-related injuries during hospital stays. To better understand the possible ways to mitigate the extrinsic risk factors for inpatient falls, the five major aspects of fall causes as identified by the Joint Commission (2005b) were used to elicit and analyze data.

Review of Studies Related to Inpatient Falls

Cost of falls: Burden to our society. Based on two previous studies (Bates, Pruess, Souney, & Platt, 1995; Granek et al., 1987), Boswell, Ramsey, Smith, and Wagers (2001) used the data collected during the period between July 1998 and March 2000 to estimate the cost of falls to hospitals. They derived that if an acute care hospital had a fall injury rate of 6.6%, these fall incidents with injury result in a median 7.5-day increase in total length of stay and a median $5,317 increase in total revenue loss (cost) to hospitals. The average cost per fall (including falls with and without injury) would be $351. We further used the inflation calculator provided by the U.S. Department of Labor Bureau of Labor Statistics (2007) to calculate the estimated cost of falls to hospitals in 2007. As given by the inflation calculator, $100 in 2000 has the same buying power as $121.07 in 2007. Consequently, it was estimated that the projected cost per fall with injury to hospitals in 2007 would be at least $6,437 and the average cost per fall would be $425.

Other than the cost of falls to hospitals, additional cost may arise to individual patients (e.g., lost working days and income). The cost of falls to our society should also be justified by taking into consideration the trends in the national health expenditures per capita that the expenditure per capita has been increased from $2,813 in 1990 to $7,498 (projected) in 2007 (16.2% of the U.S. gross domestic product) (The Henry J. Kaiser Family Foundation, 2007). As a matter of fact, the cost of falls is an important issue for government, business, and individuals with and without health insurance. The size of this problem should be emphasized, and solutions that will effectively lead to fewer inpatient falls are needed.