Reducing the Risk of Falls in the Hospital – Apollo Hospitals Leads the Way

Overview

Falls are the most common problem faced by the elderly population. These falls can result in serious injury. As per a study published in the Indian Journal of Public Health in 2019*, falls (especially among the elderly) are the most frequently reported incidents in critical care hospitals accounting for 14 – 53 per cent in India.

Multiple research studies on risk assessment of falls have documented well-established fall risk factors in a hospital setting. However, assessments alone does not prevent patient falls. If you or your loved ones is admitted in a hospital, you should take some common measures like staying in bed or staying seated to reduce your risk of falling during your hospital stay. Nurses or other caregivers can ensure that you have easy access to things you may need like food, water, phone, etc.

Apollo Hospitals conducted an audit on knowledge and practice of nurses concerning prevention and management of patient falls.

Definition of fall

A patient fall is defined as an event that results in a sudden, unplanned descent (fall) of a patient to the floor with or without injury.

Falls may be at different levels – i.e., from one level to ground level e.g. from beds, wheelchairs or down stairs on the same level as a result of slipping, tripping, or stumbling, or from a collision, pushing, or shoving, by or with another person below ground level, i.e. into a hole or other opening in surface.

Not all patient falls are predictable or preventable in acute care hospitals. Some falls are simply the result of individual physiological responses to illness or treatment in care settings in which patient ambulation is essential to recovery.

Types of fall

1. Accidental falls– Occur when patients fall unintentionally because of an environmental hazard or equipment failure (14% of all falls).
2. Anticipated Physiological Falls– Occur in patients with known risk factors for tripping related to the patient’s underlying medical condition (78% of all falls)
3. Unanticipated Physiological Fall– Falls which occur in patients who do not have identified risk factors until the fall occurs – e.g. faints, seizures. (8% of all falls)

Fall Risk Assessment

IPSG6 (International patient Safety Goals 6), a part of evidence-based fall safety initiative, was developed to prevent patients from falling. For any fall prevention program, the characteristics and activities of patient linked to an increased risk of falling should be the main focus. While there’s some form of assessment for risk of falling among patients that is likely to help determine when special prevention interventions are needed, there is currently very little evidence to support the use of fall risk assessment tools.

There is nothing to suggest that the use of a generic assessment tool (identified from the literature) offers greater accuracy than tools developed by institutions based on local patient characteristics.

No interventions have, currently, been proven to be effective in fall prevention in the acute care setting. Expert opinion, however suggests that institutions should have a falls prevention program consisting of multiple interventions aimed at minimizing the individual patient’s risk of falling. While the use of multiple fall prevention interventions was the most common approach, results of their effectiveness are contradictory.

How Hospitals Can Prevent Patient Falls

Our bench mark is 0.5 rate per 1000 inpatients; Apollo Hospitals has taken more measures to reduce the fall

The measures as follows:

1. Identifying the vulnerable groups
2. Assessment of Vulnerable patient within 2 hrs.
3. Applying yellow band.
4. Applying side railings.
5. Applying brakes for all the cots.
6. Patient First card at the edge of the cot.
7. Education to the relative on fall risk prevention.
8. Education of the staff of fall risk assessment.
9. Uses of grab bars and call bells.
10. Importance of using safety belts on stretcher and wheel chairs.
11. Conducting training classes regularly.

High risk assessment through Modified Morse Fall Risk Scale and following Preventive Measures

Do’s and Don’ts For Patients to Prevent/Reduce the Risk for Falling

If you are a patient, your nurse will talk about to you about your risk for falling while you are in the hospital. Based on your risk, an individualized fall prevention plan will be developed to keep you safe. A daily mobility plan will keep the patient active and moving. Following are some general do’s and don’ts created for your safety.

Do’s

1. Always sit for some time before standing up and walking to avoid giddiness and falls.
2. Keep the washroom floor dry
3. At home shower mats can be used to prevent falls in bathrooms for persons having difficulty in walking on wet floor or tiled flooring
4. Seek assistance as and when required to go to the washroom especially in the night and early morning
5. Ask the doctor if any of the prescribed medications can cause giddiness, examples antihypertensive, pain killers like Tramadol so that required precautions can be taken to avoid falls
6. Exercise regularly
7. Wear footwear that do not skid
8. Ensure entryways and staircase areas are well lit
9. Education to the patient and relative on fall risk prevention.

Don’ts

1. Never put the side rails down
2. Never forget to call for help 
3. Never make your room dark 
4. Never move about or walk (ambulate) without assistance of a health care personnel 
5. Do not forget to inform your nurse while change of attendants
6. For attendant/Caregiver/Nurse
7. Never leave the patient unattended 
8. Never allow the patient alone to washrooms especially during night

Conclusion

Patient fall may result in lacerations, fractures or internal bleeding, resulting in increased health care utilization. Research studies show that close to one-third of falls can be prevented. Fall prevention involves managing a patient’s underlying fall risk factors and optimizing the hospital’s physical design and environment. Therefore, educational module, rounds by night supervisors, fall campaign in the hospital, posters across the hospital on fall prevention, knowing your fall risk will help the organization to overcoming the challenges associated with sustaining a fall prevention program.

Authors’ contributions:
Department of Quality Systems
Apollo Health City, Hyderabad