Clinical Issue: Falls in Hospitalized Patients

Falls are a common and serious problem for hospitalized patients. According to the Centers for Disease Control and Prevention (CDC), one in three hospitalized patients falls at least once during their stay. Falls can lead to serious injuries, including fractures, head injuries, and internal bleeding. They can also lead to prolonged hospital stays, increased healthcare costs, and even death.

Rationale for the Need to Change the Status Quo

Falls in hospitalized patients are a preventable problem. There are a number of evidence-based practices that can be implemented to reduce the risk of falls. However, these practices are not always implemented consistently.

A 2019 study by the Agency for Healthcare Research and Quality (AHRQ) found that only 60% of hospitals were implementing all of the recommended fall prevention practices. The study also found that there was significant variation in the implementation of fall prevention practices from hospital to hospital.

This variation in implementation is likely contributing to the high rates of falls in hospitalized patients. In order to reduce the risk of falls, it is important to implement evidence-based fall prevention practices consistently across all hospitals.

Best Practices from the Literature

The following are some of the best practices from the literature related to falls in hospitalized patients:

• Fall risk assessment:All hospitalized patients should be assessed for their risk of falling. This assessment should be conducted upon admission and at least once every 24 hours. The assessment should identify any factors that increase the patient’s risk of falling, such as age, impaired mobility, and certain medications.
• Care plan:Once a patient’s risk of falling has been assessed, a care plan should be developed to reduce that risk. The care plan should include interventions such as patient education, environmental modifications, and medication management.
• Patient education:Patients and their families should be educated about the risk of falls and how to prevent them. This education should be provided in a way that is culturally appropriate and understandable to the patient.
• Environmental modifications:The patient’s environment should be modified to reduce the risk of falls. This may include measures such as removing clutter from the floor, installing grab bars in the bathroom, and using non-slip mats.
• Medication management:Certain medications can increase a patient’s risk of falling. The patient’s medication regimen should be reviewed to identify any medications that may be increasing their risk of falling. If possible, these medications should be discontinued or replaced with alternative medications that do not increase the risk of falls.

Conclusion

Falls in hospitalized patients are a preventable problem. There are a number of evidence-based fall prevention practices that can be implemented to reduce the risk of falls. However, these practices are not always implemented consistently. In order to reduce the risk of falls, it is important to implement evidence-based fall prevention practices consistently across all hospitals.

Quality Improvement Project Plan

The following is a plan for a quality improvement project to reduce the rate of falls in hospitalized patients:

Goal: Reduce the rate of falls in hospitalized patients by 10% within one year.

Objectives:

• Implement a fall risk assessment tool for all hospitalized patients upon admission and at least once every 24 hours.
• Develop and implement a care plan for all patients at high risk of falling.
• Provide patient education on fall prevention to all patients and their families.
• Modify the patient environment to reduce the risk of falls.
• Review the medication regimen of all patients for medications that may be increasing their risk of falling.

Methods:

• The fall risk assessment tool will be implemented using a standardized form that has been validated for use in hospitalized patients.
• The care plan for patients at high risk of falling will be developed by a team of interdisciplinary healthcare professionals, including the patient’s nurse, physician, physical therapist, and occupational therapist.
• Patient education on fall prevention will be provided by the patient’s nurse using a standardized educational program.
• The patient environment will be modified to reduce the risk of falls by removing clutter from the floor, installing grab bars in the bathroom, and using non-slip mats.
• The patient’s medication regimen will be reviewed by the patient’s physician to identify any medications that may be increasing their risk of falling. If possible, these medications will be discontinued or replaced with alternative medications that do not increase the risk of falls.

Data Collection and Analysis:

The following data will be collected to track the progress of the quality improvement project:

• Number of falls per month
• Number of patients at high risk of falling who receive a fall risk assessment
• Number of patients at high risk of falling who have a care plan in place
• Number of patients who receive patient education on fall prevention
• Number of patient environments that are modified to reduce the risk of falls
• Number of patients whose medication