Falls are a public health problem and are common adverse events in hospitals, particularly among old and frail patients or those with mental illnesses. However, patients of all physical abilities and age may be at risk of falling in hospitals as a result of hospital procedures, surgeries, medications, a medical condition, and a diagnostic testing rendering patients confused or weakened. Moreover, falls which lead to serious injuries are a prevalent but preventable public safety problem that needs to be addressed. When a patient unintentionally comes to rest on a lower surface or the ground as a result of some untoward event, this is classified as a fall by the World Health Organization (WHO). A fall is also defined as any unplanned descent to the floor by a patient, whether or not it leads to an injury.
Falls are associated with or caused by a myriad of risk factors which make patients vulnerable to them. Some of these factors which contribute to falls include the physical environment deficiencies, inadequate assessment of the risk of falls, lack of proper leadership, inadequate adherence to safety practices and protocols or lack thereof, communication failures, and inadequate hospital staff supervision, orientation, skill mix, or staffing levels. Other risk factors surrounding falls include inability or failure to follow safety instructions by patients and nurses, incontinence, decreased mobility, poor lighting in healthcare facilities, disorientation, altered mental status, Alzheimer's disease, visual impairment, and confusion. At the same time, there are various barriers that work against the prevention or reduction of falls in hospitals, such as lack of sufficient resources, poor communication flows, limited knowledge on falls prevention among nurses, lack of reliable falls data, beliefs that patient falls cannot be prevented, and poor leadership.
Significance of Problem
The issue of falls in hospital settings is important and warrants further research or study for various reasons. First, given that patient falls is so prevalent and now considered a public health problem not only in the US but globally, it is a priority issue that has implications for people's quality of life. According to Gu, Balcaen, Ampe, and Goffin (2016), globally, between 700,000 and 1000,000 inpatient falls are reported annually. Hence, falls are common adverse events in most health facilities which need to be addressed. Furthermore, the problem of falls in hospitals is important because of its implications or effects on public health, nursing, nurses, and patients. As Gu, Balcaen, Ampe, and Goffin (2016) correctly observed falls in most cases develop into and cause other complications such as internal bleeding, lacerations, and fractures. In some serious cases, falls can result in death and as a matter of fact, falls is now considered to be one of the leading causes of deaths especially among the elderly population. Most importantly, falls significantly increase the length of hospital stay by patients due to the complications it causes, hence increasing the costs of care for patients, their families, and the healthcare system as a whole. Therefore, to ensure the delivery of quality and clinically cost effective care, the prevention of falls should be addressed since patient safety is part of the responsibility of hospitals and represents an important aspect of hospital care.
The current practice on hospital falls prevention is based on the recommendations made based on quality improvement and research initiatives by organizations such as the U.S. Department of Veterans Affairs National Center for Patient Safety, the Joint Commission Center for Transforming Healthcare, Institute for Healthcare Improvement, and the Agency for Healthcare Research and Quality. Some of the actions suggested by these organizations regarding falls prevention in healthcare facilities include incorporating safety precautions into the patient care and education practicum, communicating safety information to hospital staff raising awareness of the significance of falls prevention, and establishing interdisciplinary falls prevention teams to ensure facilities have the capacity and infrastructure to minimize falls.Other recommended current practice on falls prevention by hospitals include reporting and analyzing the contributing or risk factors for falls, developing an individualized plan of care for falls patients, conducting post-fall management such as transparency in reporting of falls, and a one-on-one education of patients on avoidance of falls. Additionally, the practice in some healthcare facilities entails the use of toolkits protocols, guidelines, and resources, such as VA National Center for Patient Safety: Implementation Guide for Fall Injury Reduction, the Joint Commission Center for Transforming Healthcare: Preventing Falls Targeted Solutions Tool (TST), IHI: Transforming Care at the Bedside How-to Guide: Reducing Patient Injuries from Falls, ICSI: Prevention of Falls (Acute Care), ECRI Institute: Falls, and AHRQ toolkit: Preventing Falls in Hospitals.
Impact on Background
The problem of patient falls impacts the organization (hospital) and the patient's cultural background in various ways. First, falls resulting in serious injuries or death of patients' and challenges hospitals' culture or value of patient safety. One of the most important responsibilities of hospitals is to promote the health and safety of patients. Falls undermine this value. Furthermore, the problem patient falls affects a patient's cultural background in that it interferes with and alters the health behavior of patients due to the pain and embarrassment that it occasions. Also, falls impact on patient and organizational cultural background in that it affects their preferences in terms of expectations of quality and standards of care.
P (patient/problem) Elderly/Frail Patients/ Falls/Injuries
I (intervention/indicator) A 6-PACK Program (use of a bed/chair alarm, use of a low-lo bed, a toileting regimen, ensuring patients' walking aids are within reach, supervision of patients in the bathroom, a "falls alert.")
C (comparison) No falls prevention/reduction program
O (outcome) Reduced incidents of patient falls
Does the implementation of the 6-PACK programme in hospitals help reduce and prevent falls among patients in hospitals?
The keywords used for the research include fall prevention, falls, clinical staff, hospitals, acute care settings, nurses, patients, 6-PACK program, prevent, reduce, and decrease.
Number and Types of Articles
Regarding the number of articles that were available for consideration, there were many articles that were considered for this paper.
Research and Non-Research Evidence
Research Evidence Articles
Stephenson, M., Mcarthur, A., Giles, K., Lockwood, C., Aromataris, E., & Pearson, A. (2015). Prevention of falls in acute hospital settings: a multi-site audit and best practiceimplementation project. International Journal for Quality in Health Care, 28 (1), 92-98
The researchers' main objective in this article is to conduct an assessment of falls prevention practices applied by selected hospitals in Australis and how interventions that promote best practice are implemented. The study also identified some of the barriers to the implementation of fall prevention programs in hospitals. The researchers utilized multi-component fall prevention interventions. Specifically, the study examined the extent to which interventions such as staff and patient education can help prevent or reduce falls in hospital settings. The authors' conclusion is that to ensure effective fall prevention and promote quality improvement in strategies preventing falls, hospitals should focus on clinical audits and feedback during implementation.
Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B. Shier, V.,... Ganz,D.A. (2013). Hospital fall prevention: A systemic review of implementation components, adherence, and effectiveness. Journal of the American Geriatric Society, 6(4), 483-494
In this study, the researchers primary objective was to investigate the implementation and effectiveness of major fall prevention approaches including the 6-PACK program and to determine the extent to which hospitals are adhering to these interventions. The study design used was a systemic review of previous studies by searching from electronic databases. The study's setting was US acute care hospitals. However, few studies presented data on the effectiveness of the different approaches to preventing falls. Furthermore, according to the authors, most acute care hospitals in the US lack the necessary tools and resources to effectively prevent falls. Additionally, this study examined the extent to which evidence-based practice regarding fall prevention is being utilized by healthcare facilities in coming up with successful fall prevention programs to enhance patient safety. The authors' conclusion from the review of the evidence was that even though there exist promising fall prevention interventions, the adherence, implementation, and reporting of outcomes is still poor and hence the need for more evidence on ways through which hospitals can effectively prevent hospitals.
None-Research Evidence Articles
Butcher, L. (2013). The No-fall zone: Nobody can prevent all patient falls, but hospitals aresignificantly reducing the ones they can. Hospital &Health Networks. Retrieved from https://www.hhnmag.com/articles/6404-Hospitals-work-to-prevent-patient-falls
In this article, the author uses the 12-bed cardiac telemetry unit at Essentia Health in Fargo, N.D as a case study of efforts being made by hospitals across the nation to reduce falls and enhance patient safety. According to Butcher (2013), in 2012, there was a reduction in fall rates at this hospital from seven falls for every 1000 patients to around 2 falls for the same population size. It is also the author's argument that even though it is not possible to completely eliminate the problem of falls in hospitals, patient falls may be significantly reduced through a combined emphasis on focus, care processes, and technology. The problem as identified by the author is that falls are still a serious threat to patient safety in hospitals and they affect the health care system in that they contribute to injuries or deaths to patients, prolonged length of hospital stay by patients, and additional costs of care. According to Butcher (2013), even though there are many interventions that have been proven to be effective in preventing falls in hospitals, multi-faceted fall prevention programs - such as the 6-PACK program - have the potential to significantly reduce the risk of falls. Some of the fall prevention measures suggested by the author include communicating with and educating staff and patients, assessing the risk of falling and injuries, and screening risks for falling when admitting patients.
Quigley, P., Beverly, L., Wexler, S.S., & Hester, A. (2015). Focus on... Falls prevention.American Nurse Today, 10(7), 28-38
In this article, the author focuses on the role of nurses in preventing falls in hospitals. The author argues that even though a lot of gains have been made regarding the problem of falls in healthcare facilities, more work still needs to be done. According to Quigley, Beverly, Wexler, and Hester (2015), successfully preventing falls requires teamwork and hence nurses must work together in ensuring the health and safety of their patients through the application of evidence-based fall prevention interventions. She argues that a systematic approach to fall prevention whereby...
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