By Marlene Icenhower, BSN, JD, CPHRM, and Heidi McCoy, MSN, BSN, RN, CPHRM, CPPS
Every year, hundreds of thousands of patients suffer a fall in a hospital, long-term care center, or rehabilitation facility. Many of these mostly preventable falls result in serious injury or death. Medical costs associated with fall-related injuries are expected to reach a staggering $100 billion per year by 2030. Because the Centers for Medicare & Medicaid Services does not reimburse hospitals for injuries related to inpatient falls, these events can significantly deplete the ever-shrinking revenue stream of healthcare organizations. Organizational fall prevention efforts require leadership, cultural commitment, thoughtful planning, and, most of all, active engagement of the nursing staff—the “eyes and ears” of the healthcare team.
While developing fall prevention policies and programs is a multidisciplinary effort, the task of implementing these programs lands squarely on the shoulders of a dwindling number of staff nurses. The Bureau of Labor Statistics estimates that over the next decade, 194,500 nursing job openings will be created annually. Concern over the ability to fill these jobs is so great that the American Nurses Association has urged the U.S. Department of Health and Human Services to declare the nursing shortage a national crisis. As the number of nurses in the workforce shrinks, staffing shortages will likely diminish the ability of healthcare organizations to deliver consistent, quality care to the patients they serve. One key vulnerability that the nursing shortage may impact is the area of patient falls—a risk that is directly correlated to nursing observation, monitoring, and quality of care.
Coverys has analyzed closed claims data to better understand the factors contributing to patient fall claims and the impact those falls have on our policyholders. This data provides valuable “signals” that can lend insight into existing vulnerabilities and allow policyholders to implement proactive risk strategies. For this report, Coverys evaluated 4,634 events that closed between 2018 and 2021 and identified 850 specific events where nurses (RN, LPN, or student nurse) were directly involved in the alleged event. There were 210 nursing-related events that involved falls. Below are some key insights gleaned from that data.
Organizations can prevent most falls by implementing and consistently adhering to a fall reduction program. A well-designed fall reduction program involves rigorous risk factor abatement, continuous patient assessment, and consistent performance improvement initiatives. Consider the following when implementing or reviewing such a program at your organization:
- Enlist champions. A successful fall prevention program is an interdisciplinary team effort that requires leadership support. Identify key individuals from each department/discipline to champion fall prevention program implementation and maintenance efforts. Patients and their families can be fall prevention champions as well. Educate patients and family members about fall prevention measures using written and verbal instruction. Have the patient repeat back and demonstrate key interventions, such as using the call light and calling for assistance. Ensure that patients and families understand the necessity of following the fall prevention plan.
- Incorporate universal fall precautions. Patient falls often relate to modifiable environmental factors. Careful assessment of patient care areas is essential to recognizing and rectifying safety issues before they result in harm. Universal precautions that apply to all patients regardless of fall risk include simple environmental modifications to ensure that:
- Patients’ personal items are within reach.
- Pathways are dry and clear of debris.
- Beds are in low and locked position.
- Wheelchairs, walkers, and other personal assistance devices are in locked position when stationary.
- Patients are provided non-skid footwear.
- Call lights are positioned within reach.
- Patients know when and how to call for assistance.
- Round to assess and address the “4 P’s.” Many falls occur when patients try to go to the bathroom or reach for something they need. Proactive, regular rounding to assess and address the following items can prevent falls before they occur:
- Pain: Is the patient in pain? If so, provide pain medication.
- Position: Is the patient uncomfortable or immobile? If so, reposition.
- Placement: Are essential items (call light, tissues, phone, etc.) within reach? If not, reposition essential items.
- Personal needs: Does the patient need to drink, eat, or use the toilet? If so, offer to help.
- Evaluate fall risks early and often. According to Coverys claims data, 83% of all fall claims involve a patient with one or more comorbidities such as diabetes, dementia, or cardiovascular disease. Early identification of these fall risks can fine-tune fall prevention efforts. Use validated and reliable standardized fall risk assessment tools to identify high-risk patients. Assess for fall risk upon admission to establish a baseline and complete continuously during hospitalization. Incorporate these findings into the patient’s individualized care plan.
- Don’t rely on equipment. Bedrails, restraints, and bed alarms are often used to prevent falls in patients who are frail, elderly, or confused. In some cases, these devices can increase the risk of harm from a fall. Between 1985 and 2013, the Food and Drug Administration received 901 reports of patients who were caught, trapped, entangled, or strangled in beds with rails. Similarly, improper restraint use can cause serious injury or death, and improper bed alarm use can cause injury as well. While fall prevention equipment such as bed alarms and video monitoring are essential parts of an organizationwide fall prevention program, they should never be substitutes for patient observation.
- Educate and train staff on the fall prevention program. Include documentation expectations related to falls, such as fall-related circumstances and risk factors and interventions to address them, in policies and procedures. Make training a part of initial onboarding/orientation and when implementing any significant changes, and include in the annual training and competency program.
- Communicate effectively. Involve all care team members − including the practitioner, the direct care team, and transportation personnel − in fall risk communication. Include any change in condition, fall risk assessment, or medications in care planning sessions and in handoff communications during shift change, transfers, and other points of care transition. Document the date, time, information provided, and to whom it was given.
- Centralize reporting and monitoring of falls. Centralize the monitoring, analyzing, and reporting of patient falls to committees with patient safety, quality improvement, and risk management responsibilities. Complete periodic audits to assess fall prevention program compliance. Fall and fall-related injury rates will indicate areas of success and opportunities for improvement.
Fall injuries affect not only the physical well-being of the fallen patient, but also the fiscal well-being of the organization. Successful fall prevention efforts depend on organizational commitment, continuous risk assessment, and consistent adherence to a carefully crafted fall prevention program.
Copyrighted. No legal or medical advice intended. This post includes general risk management guidelines. Such materials are for informational purposes only and may not reflect the most current legal or medical developments. These informational materials are not intended, and must not be taken, as legal or medical advice on any particular set of facts or circumstances.