Falls in Hospitals: Impact and Prevention Strategies

This article discusses the incidence of falls in hospitals among older adults, the contributing factors for falls, and the impact of falls on individuals and the healthcare system. It also explores the role of nurses in promoting physical activity and fall prevention in healthcare settings, including the need for effective teamwork, strategies for nurses, standardized risk assessment tools, modification of the environment, and fall prevention care strategies.

Running head: FALLS IN HOSPITALS
FALLS IN HOSPITALS
Name of the student:
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Introduction:
A fall can be defined as the event that results in individuals coming to rest inadvertently
on the ground or floor or other lower level. WHO have stated that fall related injuries might be
fatal as well as non-fatal and can result in associated burden physically, financially as well as
emotionally (Singh et al., 2015). Falls are mostly common among the aged people in the nation
that might be resulting from natural age-related musculoskeletal changes that are further
complicated by co-morbidities, chronic illness and insufficient physical mobility. This
assignment would show how falls taking place among hospital inpatients are affecting lives of
patients and health organizations and how nurses can reduce such incidences.
Incidence of falls related to functional decline and frailty in the older adult population 65
and older in hospitals:
Falls among the hospital inpatients are the most frequently reported safety incidents
almost in every nations of the world and Australia is not an exception. One of the data published
by Australian Burden of disease study in the year 2011 showed that falls are one of the leading
contributors of the total burden among the people who are aged 75 years and over and accounts
to about 2.8% above the age cohort of 95 years. The data published by AIHW (Australian
Institute of Health and Welfare) in 2018 had shown that one of the most common causes of
injury deaths were falls accounting or about 37% and the number was higher in case of females
where 535 of the cause of injury related deaths were because of falls only (Aihw, 2018). The
main causes of hospitalized injury were mainly falls accounting for about 41% followed by other
types of hospital acquired injuries. In the year 2015 to 2016, about 34000 hospitalizations
accounting for about 3.2 per 1000 hospitalizations had reported inpatient falls. The rate of falls in

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the public hospitals accounted for around 4.6 per 1000 hospitalizations. This number was much
higher in comparison to the inpatient falls in the private hospital that accounted for about 1.3 per
1000 inpatients. The differences in the rates in the public as well as private hospitals are seen to
reflect major differences both the in casemix as well as the recording practices.
Contributing factors for falls among older people in hospitals:
The most commonly identified risk factors for fall in the hospitalized patients have been
identified to be above the age of 85, a recent fall by the patient, gait instability, newly acquired
urinary incontinence of frequency as well as different types of adverse drug reactions and neuro-
cardiovascular instability. Many of the studies are also of the opinion that natural aging process
often places older adults at an increased risk of having a fall not only in hospitals but also in their
own homes and residing places (WHO, 2016). Three important reasons why older people are
more likely to have falls are the chronic health conditions like that of heart disorders, dementia
and low blood pressure which can cause dizziness in the patients. The other cause of falls among
the older people might be different impairments like that of poor vision as well as muscle
weakness. The other factor contributing to falls among people in the inpatient units is illness that
can affect balance like that of labyrinthitis which actually cause inflammation of the delicate
balance regulating different parts of the ear. The different types of chronic health conditions that
are listed above can sometimes lead to loss of balances as well as a brief loss of consciousness of
fainting as well as sudden feeling of dizziness (Health.wa.gov.au, 2016). All these might
contribute to falls in hospitals. Some of the other external factors in the hospitals that can
contribute to falls are wet or recently polished floors in the hospitals, dimly lighted rooms as well
as rugs and carpets that are not properly secured in the hospitals rooms. Falls can also occur in
patients when the nursing professionals do not keep the important things of the patient within

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their easy rich making patients try out on their own resulting in increased chances of falls
(Takanokura et al., 2015).
Impact of a fall on the individual and the health care system:
Falls among patients admitted in the hospitals are found to be associated with huge
number of negative outcomes not only for patient and family but also for the healthcare
professionals and healthcare organizations. Falls result in increased suffering of the patient
where their physical well being is compromised due to severe injuries like bruises, head trauma
as well as hip fractures that initiate unbearable pain among the patients. The patients are also
seen to suffer emotionally where they get frustrated because of the additional harm and suffering
caused by falls in hospitals in addition to the already present disorders they wanted to cure in
hospitals (Trinh et al., 2017). This in turn results in increased disappointments as well as loss of
trust on the healthcare professionals as the other could not provide sage and quality acre to the
patients. Apart from the loss of trust that results in affecting the therapeutic relationships
between professionals and patients, it also leads to additional financial flow thereby creating
financial burden on patient and family members. The professionals who could not prevent the
fall incidents are seen to suffer from guilty as well as loss of confidence that impacts their
practice as well (Cameron et al., 2018). The healthcare organization also has to spend additional
resources and funds as falls in hospitals are found to be associated with increased length of stay
of patients in hospitals, higher readmission rates and more detailed care by the professionals.
Loss of reputation and trust of public are also seen to be associated with hospital related falls.
Hence, nurses have the duty of the nursing professionals is to ensure that proper strategies for
management of falls need to be taken so that such situations do not arise among the patients and
high quality care is provided to each of them.

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Role of the nurse in the promotion of physical activity and fall prevention in health care
environment of:
Requirement of effective teamwork:
Nurses need to be well aware of the challenges of fall prevention. Fall prevention mainly
requires interdisciplinary approaches to care. Some parts of the fall prevention are found to be
highly-routinized and apart from these, other aspects need to be tailored so that it aligns with the
specific risk profile of each of the patients. It has been found that no healthcare professionals,
working alone regardless of how much talented they are, can prevent any falls (Zecevic et al.,
2017). Rather than this, fall prevention is seen to require the active engagement of many
individuals that would include multiple disciplines and teams that are involved in the caring for
the patient. In order to accomplish this cooperation as well as coordination, high quality
prevention requires an organizational culture as well as operational practices that promote
communication as well as teamwork and even individual expertise (Gray et al., 20170.
Strategies to be taken by nurses:
Nurses need to make sure that the fall prevention strategies are multifaceted as well as
comprehensive. They should mainly prioritize researches as well as different public health
initiatives for further declining the burden and thereby exploring the risk factors and then
utilizing effective prevention strategies. Nurses need to advocate as well as participate in
developing policies that would commit in creating safer environments and reducing important
risk factors. The nurses should also promote engineering for removing the potential falls along
with effective training of all the healthcare professionals from time to time and application of

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other types of evidence based prevention strategies and education based programs to develop risk
awareness.
Standardized risk assessment tool and other tools:
An important component that needs to be included in the prevention strategies by the
healthcare professionals is called the standardized assessment of risk factors for falls by the
Standardized risk assessment tool. Studies are of the opinion that assessing the risk of the patient
for the fall risks gives the nurses a good amount of information by which they can prepare an
individualized care plan (Zhao et al., 2018). There might be multiple risk factors for falls and
different patients might have different combinations of the risk factor while these changes might
change over time when a patient is in the hospital. It is important for the professionals to identify
the risk factors that are most important for the patients on the unit or in the hospital and for this a
standardized assessment of falls risk factors need to be developed that can be applied to more or
less most of the patients covering their risk factors. The different risk factors analysis that needs
to be done are mainly the categories of history of falls, medications, mobility problems as well as
utilization of the different types of assistive devices. The nurses also need to analyze the issues
like the medications that the patients are taking and whether the medications would impact the
health of the patients making them risky of fall behaviors. Nurses should also try to assess the
mental health status of the people to find out whether they are vulnerable with delirium,
dementia, or psychosis may be agitated and confused as they also increase them at the risk of
falls (Chen et al., 2016). Continence issues as well as other patient risks also associated are
impairment in the vision exposing the patient towards an environmental hazards as well as
orthostatic hypotension causing the patient to become light-headed or pass out when standing.

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Studies have identified the importance of conducting the assessment risk factors
successfully. It mainly helps in making clinical decisions as the use of the standardized
assessments help the nurses in ensuring that the key risk factors are identified and therefore, this
can be acted upon. Secondly, it also allows the targeting of the preventive interventions to the
correct patients (Boyle et al., 2015). Resources always need to be targeted by the nursing
professionals to those patients who would have most benefits. Third, it also helps in facilitating
care planning where the nurses would be then developing care plans that can better focus on the
specific dimensions that places the patients at the greatest risks. Fourth, it also helps in
facilitating communication between healthcare workers as well as between the care settings.
The FRMT tool also called the Fall Risk Management Tool was developed and
introduced by WA Falls Prevention Community of Practice for hospital settings in the year 2010.
It is a 4 item fall risk screening tools that are used mainly for the sub acute as well as residential
care but can be also used extensively in hospitals. It has three sections - Part 1 - falls risk status;
Part 2 – risk factor checklist; and Part 3 – action plan. With the help of this tools, nurses can get
an idea about the risks of fall associated with patients and also develop action plan to protect
them from incidences of fall in hospitals.
Modification of the environment by nurses:
A number of initiatives need to be taken by the nurses to reduce the chance of risks of fall
associated with the patients. Nurses would need to familiarize the patients with the environment
and they should also help the patients in demonstrating call light use. The personal possessions
of the patient should be kept within the safe reach of the patient. Nurses need to arrange for
sturdy handrails in the bathrooms as well as in the rooms and the corridors of the hospitals. The

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hospital beds should be placed in the lower positions when a patient is resting in bed and should
also raise the bed to a comfortable height when the patient needs to be transferred out of the bed.
The hospital bed brakes should be kept locked along with the wheels of the wheelchair when
needs to be kept in the stationary position (Stubbs et al., 2015). The nurses need to keep non-slip
as well as comfortable and well-fitting footwear of the patient so that the patients do not slip
away. Using night lights or supplementary lighting, keeping floor surfaces clean and dry,
cleaning spills promptly as well as keeping patient care areas uncluttered are some of the ways
by which falls can be prevented. Every healthcare professional should be trained about the safe
handling practices of the patients so that they can undertake proper manual handling of the
patient and provide care services effectively.
Fall prevention care strategies:
Apart from risk assessment and modification of the environment and training procedures,
nurses should also try to develop fall prevention care planning process that enables them to
translate the risk assessment process into patient specific actions. The main rationale of applying
such care interventions is identification of specific acre services that would be implemented so
that the patient is less likely to fall during hospitalization (Gu et al., 2016). In case of patients
with altered mental status, nurses need to carry out delirium assessments and delirium prevention
protocols can be followed with medical providers evaluating the causes of delirium in the
patients like that of infection, electrolyte imbalance as well as medications. For patients who are
cognitively impaired and wants to wander or feel agitated, for the intense supervision should be
implemented. Medications should be reviewed for contributing to agitation as well as for
calming patients whose agitation are threat to others or themselves. Patients who have mobility
issues would require mobility assistance during their hospital status and therefore, assistive

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devices like canes and walkers should be provided in good repair by the bedside as well as
within safe reach. For people with toileting needs, they should be cared in ways by which they
would be taken to toilet on regular basis and this should be achieved through scheduled rounding
protocols (Zhao & Kim, 2015). Patients with visual impairments should be provided with
corrective lenses within easy rich. Moreover, falls may be also found to be associated with many
individuals who take specific medications and therefore medications of such patients should be
reviewed by a pharmacist with fall risk in mind. Accordingly, recommendations need to be made
to the treating provider for immediately available; the treating provider should carry out the
medication review.
Strategies by which nurses can promote physical activities:
Healthcare teams need to allocate physiotherapist to develop the gait and mobility of the
patients in order to help them walk safely and thereby improve their independence and
confidence. They can be helped and trained by ensuring mild to regular physical exercises where
they can gradually overcome their issues with walking and get the confidence to be independent
when they walk. Muscle strength training activities that involve major muscles groups need to be
done on twoo more days of the week, older adults should do ate least 150 minutes of moderate to
intense aerobic activities throughout weeks (Callis, 2016). Some of the aerobic activities that can
promote physical activities to prevent functional decline and falls are walking, dancing,
swimming, water aerobics, jogging, bicycle riding and others. Nurses need to engage the patients
in motivational interviewing and then advise them with strategies so that they can feel motivated
to become physically active.

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Conclusion:
From the above discussion, it can be seen that falls taking place in hospitals are
associated with huge burden on the nation. It also causes physical and emotional stress and
anxiety on the patients along with financial and emotion stress of family members. Nurses have
the responsibility of developing healthcare environment where patients can be kept safe from any
types of falls. Nurses can therefore undertake efficient standardized risk assessment procedure,
environmental modification as well as develop fall prevention care planning and strategies which
would ensure reduction in the prevalence of hospital related falls in the nation.

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