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We are all painfully aware that falls are not uncommon in hospitalized patients, but I was shocked and appalled to learn that there are approximately 11,000 falls that are ultimately fatal in U.S. hospitals each year, according to the Joint Commission Center for Transforming Healthcare.
Fortunately, there appear to be some very viable solutions at hand.
Hospitals that use the center’s new measuring systems and solution have been able to slash the number of patients who fall by 35%, as well cutting the percentage of patients injured when they fall by 62%. Extrapolating these results to an average 200-bed hospital, an estimated $1 million could be saved each year through fall prevention efforts.
Hospitals participating in this study ranged from small community-based hospitals with fewer than 200 beds to large medical centers with more than 1,700 beds. All used a data-driven, Lean Six Sigma–inspired "Robust Process Improvement" methodology to determine the causes of falls and create solutions to prevent them. One solution was simply providing hourly rounding which included proactive toileting. When you think about it, this makes perfect sense. Patients with an immediate need may not be able to hold it until it is "their turn" for the nurse to assist them. In their haste to avoid soiling their clothes, a mechanical fall is very understandable, especially if they are impaired due to weakness or medication.
Other solutions included teaching patients how to actively participate in their own safety, engaging patients and family members in their fall safety program, using a validated fall risk assessment tool, and increasing awareness and participation among staff so that patients did not walk alone.
Most of us have received that dreaded call from the nurse about a patient who was injured from a fall. I once had a patient who slipped and fell, breaking a hip while in the hospital for a relatively minor issue. If she had been more stable on her feet, she probably could have caught herself prior to hitting the hard floor. Had a close relative not witnessed the incident, it would have been very difficult (and embarrassing) to explain to the family why their loved one experienced such a traumatic event while in a seemingly protected environment. Her son was very understanding, though the event was very disconcerting all the same.
Based on their staffing, resources, and creativity, different hospitals may develop different innovative solutions to prevent falls. There is room for a wide variety of options. Yes, early ambulation is crucial to help prevent unnecessary complications, such as pneumonia and blood clots, but we should be mindful of the individual patient’s circumstances. A simple order requesting the nurse to ambulate a patient in the room or down the hall two or three times a day may be adequate for some, while in other cases a formal physical therapy consultation may clearly be in order. If there are any concerns over the patient’s ability to ambulate safely and I am not sure if a physical therapy consult is really needed, I sometimes call the nurse into the room and the two of us walk with the patient. That way, I can get an immediate sense of the likelihood of falls, the need for dedicated strengthening exercises, and, on occasion, the impact that medications are having on gait. And for those difficult, unmotivated patients, family members can frequently provide invaluable encouragement, as well as the emotional, and sometimes physical safety net many patients desire.
With safety interventions and highly engaged care teams in place, even steady patients never walk truly alone.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected]
We are all painfully aware that falls are not uncommon in hospitalized patients, but I was shocked and appalled to learn that there are approximately 11,000 falls that are ultimately fatal in U.S. hospitals each year, according to the Joint Commission Center for Transforming Healthcare.
Fortunately, there appear to be some very viable solutions at hand.
Hospitals that use the center’s new measuring systems and solution have been able to slash the number of patients who fall by 35%, as well cutting the percentage of patients injured when they fall by 62%. Extrapolating these results to an average 200-bed hospital, an estimated $1 million could be saved each year through fall prevention efforts.
Hospitals participating in this study ranged from small community-based hospitals with fewer than 200 beds to large medical centers with more than 1,700 beds. All used a data-driven, Lean Six Sigma–inspired "Robust Process Improvement" methodology to determine the causes of falls and create solutions to prevent them. One solution was simply providing hourly rounding which included proactive toileting. When you think about it, this makes perfect sense. Patients with an immediate need may not be able to hold it until it is "their turn" for the nurse to assist them. In their haste to avoid soiling their clothes, a mechanical fall is very understandable, especially if they are impaired due to weakness or medication.
Other solutions included teaching patients how to actively participate in their own safety, engaging patients and family members in their fall safety program, using a validated fall risk assessment tool, and increasing awareness and participation among staff so that patients did not walk alone.
Most of us have received that dreaded call from the nurse about a patient who was injured from a fall. I once had a patient who slipped and fell, breaking a hip while in the hospital for a relatively minor issue. If she had been more stable on her feet, she probably could have caught herself prior to hitting the hard floor. Had a close relative not witnessed the incident, it would have been very difficult (and embarrassing) to explain to the family why their loved one experienced such a traumatic event while in a seemingly protected environment. Her son was very understanding, though the event was very disconcerting all the same.
Based on their staffing, resources, and creativity, different hospitals may develop different innovative solutions to prevent falls. There is room for a wide variety of options. Yes, early ambulation is crucial to help prevent unnecessary complications, such as pneumonia and blood clots, but we should be mindful of the individual patient’s circumstances. A simple order requesting the nurse to ambulate a patient in the room or down the hall two or three times a day may be adequate for some, while in other cases a formal physical therapy consultation may clearly be in order. If there are any concerns over the patient’s ability to ambulate safely and I am not sure if a physical therapy consult is really needed, I sometimes call the nurse into the room and the two of us walk with the patient. That way, I can get an immediate sense of the likelihood of falls, the need for dedicated strengthening exercises, and, on occasion, the impact that medications are having on gait. And for those difficult, unmotivated patients, family members can frequently provide invaluable encouragement, as well as the emotional, and sometimes physical safety net many patients desire.
With safety interventions and highly engaged care teams in place, even steady patients never walk truly alone.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected]
We are all painfully aware that falls are not uncommon in hospitalized patients, but I was shocked and appalled to learn that there are approximately 11,000 falls that are ultimately fatal in U.S. hospitals each year, according to the Joint Commission Center for Transforming Healthcare.
Fortunately, there appear to be some very viable solutions at hand.
Hospitals that use the center’s new measuring systems and solution have been able to slash the number of patients who fall by 35%, as well cutting the percentage of patients injured when they fall by 62%. Extrapolating these results to an average 200-bed hospital, an estimated $1 million could be saved each year through fall prevention efforts.
Hospitals participating in this study ranged from small community-based hospitals with fewer than 200 beds to large medical centers with more than 1,700 beds. All used a data-driven, Lean Six Sigma–inspired "Robust Process Improvement" methodology to determine the causes of falls and create solutions to prevent them. One solution was simply providing hourly rounding which included proactive toileting. When you think about it, this makes perfect sense. Patients with an immediate need may not be able to hold it until it is "their turn" for the nurse to assist them. In their haste to avoid soiling their clothes, a mechanical fall is very understandable, especially if they are impaired due to weakness or medication.
Other solutions included teaching patients how to actively participate in their own safety, engaging patients and family members in their fall safety program, using a validated fall risk assessment tool, and increasing awareness and participation among staff so that patients did not walk alone.
Most of us have received that dreaded call from the nurse about a patient who was injured from a fall. I once had a patient who slipped and fell, breaking a hip while in the hospital for a relatively minor issue. If she had been more stable on her feet, she probably could have caught herself prior to hitting the hard floor. Had a close relative not witnessed the incident, it would have been very difficult (and embarrassing) to explain to the family why their loved one experienced such a traumatic event while in a seemingly protected environment. Her son was very understanding, though the event was very disconcerting all the same.
Based on their staffing, resources, and creativity, different hospitals may develop different innovative solutions to prevent falls. There is room for a wide variety of options. Yes, early ambulation is crucial to help prevent unnecessary complications, such as pneumonia and blood clots, but we should be mindful of the individual patient’s circumstances. A simple order requesting the nurse to ambulate a patient in the room or down the hall two or three times a day may be adequate for some, while in other cases a formal physical therapy consultation may clearly be in order. If there are any concerns over the patient’s ability to ambulate safely and I am not sure if a physical therapy consult is really needed, I sometimes call the nurse into the room and the two of us walk with the patient. That way, I can get an immediate sense of the likelihood of falls, the need for dedicated strengthening exercises, and, on occasion, the impact that medications are having on gait. And for those difficult, unmotivated patients, family members can frequently provide invaluable encouragement, as well as the emotional, and sometimes physical safety net many patients desire.
With safety interventions and highly engaged care teams in place, even steady patients never walk truly alone.
Dr. Hester is a hospitalist with Baltimore-Washington Medical Center who has a passion for empowering patients to partner in their health care. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected]
