Inpatient falls and subsequent injuries Discussion
Inpatient falls and subsequent injuries Discussion
Inpatient falls and subsequent injuries are among the most common hospital-acquired conditions with few effective prevention methods. Objective To evaluate the effectiveness of patient education videos and fall prevention visual signalling icons when added to bed exit alarms in improving acutely hospitalised medical-surgical inpatient fall and injury rates. Design Performance improvement study with historic control. Setting Four medical-surgical units in one US public acute care hospital. Study participants Adult medical-surgical inpatients units. Interventions A 4 min video was shown to patients by trained volunteers. Icons of individual patient risk factors and interventions were placed at patients’ bedsides. Beds with integrated three-mode sensitivity exit alarms were activated for confused patients at risk of falling. Main outcome measures The main outcome measure is the incident rate per 1000 patient days (PDs) for patient falls, falls with any injury and falls with serious injury. The incident rate ratio (IRR) for each measure compared January 2009–September 2010 (baseline) with the follow- up period of January 2015–December 2015 (intervention). Results Falls decreased 20% from 4.78 to 3.80 per 1000 PDs (IRR 0.80, 95% CI 0.66 to 0.96); falls with any injury decreased 40% from 1.01 to 0.61 per 1000 PDs (IRR 0.60, 95% CI 0.38 to 0.94); and falls with serious injury 85% from 0.159 to 0.023 per 1000 PDs (IRR 0.15, 95% CI 0.01 to 0.85). Icons were not fully implemented. Conclusion The first known significant reduction of falls, falls with injury and falls with serious injury among medical-surgical inpatients was achieved. Patient education and continued use of bed exit alarms were associated with large decreases in injury. Icons require further testing. Multicentre randomised controlled trials are needed to confirm the effectiveness of icons and video interventions and exit alarms.
IntroductIon Falling is a major public health problem with sequelae that range from minor bruises and abrasions to more serious consequences such as lacerations, fractures, head injuries and even death.1 Age-adjusted fall mortality rates have increased in recent years.1 Compli- cations from falls while hospitalised are included on the Centers for Medicare and
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Medicaid Services’ list of non-reimbursable events.2 More than one million patients fall in US hospitals annually, accounting for 85% of all hospital-acquired conditions.3
Inpatient fall and injury incidence varies according to unit characteristics,4 with medi- cal-surgical patients at higher risk than inten- sive care patients. Medical-surgical units in the USA report between 3.67 and 6.26 falls per 1000 patient days (PDs).4 Twenty per cent of medical-surgical unit falls result in some injury, while 2% result in serious injuries.4 The acute care patient may be at increased risk of falling due to newly altered mobility, medication side effects, history of previous falls, frequent toileting and altered mental status all in an unfamiliar environment.
As part of the 2010 US Patient Protection and Affordable Care Act, acute care hospi- tals were encouraged by the Partnership for Patients to test interventions to decrease patient falls and resultant injuries by 40%.5 By the end of 2014, the Agency for Healthcare Research and Quality reported that hospital falls were essentially unchanged from 2010 levels.6 The lack of significant injury reduc- tion despite years of effort and the finding that fall prevention efforts may not be cost-ef- fective7 have contributed to frustration among researchers, healthcare workers and patients at risk. To improve patient and hospital staff satisfaction and prevent needless suffering, this study examines the efforts of one hospi- tal’s medical-surgical units to educate patients and staff via video, icons and alarms.
Background An urban public safety net hospital with a linguistically diverse patient population found that patient fall and injury rates were trending upwards. From 2009 through September 2010, fall prevention measures varied widely throughout the hospital. A ‘falling star’ magnet was placed on the door to the patient’s room. This was meant to communicate to staff that the patient is at
Reducing medical-surgical inpatient falls and injuries with videos, icons and alarms
Sasha J Cuttler,1,2 Jill Barr-Walker,3 Lauren Cuttler4
Inpatient falls and subsequent injuries Discussion