Despite a large quantitative evidence base for guiding fall risk assessment and not needing highly technical, scarce, or expensive equipment to prevent falls, falls are serious problems in hospitals.

Despite a large quantitative evidence base for guiding fall risk assessment and not needing highly technical, scarce, or expensive equipment to prevent falls, falls are serious problems in hospitals.

Why Do Patients in Acute Care Hospitals Fall? Can Falls Be Prevented?

Why Do Patients in Acute Care Hospitals Fall? Can Falls Be Prevented?
Objective

Obtain the views of nurses and assistants as to why patients in acute care hospitals fall.

Background

Despite a large quantitative evidence base for guiding fall risk assessment and not needing highly technical, scarce, or expensive equipment to prevent falls, falls are serious problems in hospitals.

Methods

Basic content analysis methods were used to interpret descriptive data from 4 focus groups with nurses (n = 23) and 4 with assistants (n = 19). A 2-person consensus approach was used for analysis.

Results

Positive and negative components of 6 concepts—patient report, information access, signage, environment, teamwork, and involving patient/family—formed 2 core categories: knowledge/communication and capability/actions that are facilitators or barriers, respectively, to preventing falls.

Conclusion

Two conditions are required to reduce patient falls. A patient care plan including current and accurate fall risk status with associated tailored and feasible interventions needs to be easily and immediately accessible to all stakeholders (entire healthcare team, patients, and family). Second, stakeholders must use that information plus their own knowledge and skills and patient and hospital resources to carry out the plan.

Patient falls are serious problems in acute care hospitals and are used as a standard metric of nursing care quality.1 The unfamiliar environment, acute illness, surgery, bed rest, medications, treatments, and the placement of various tubes and catheters are common challenges that place patients at risk of falling. Falls are devastating to patients, family members, and providers. A single fall may result in a fear of falling that can begin a downward spiral of reduced mobility, leading to loss of function and further falls.2–4 There have been many published research studies regarding falls. Although there is a sense of urgency in hospitals to prevent falls to “do no harm” and because Medicare will not reimburse hospitalization costs due to fall related injuries,5 patient falls remain a serious problem in US hospitals.

A review of fall prevention literature was conducted of English-language publications found in MEDLINE (1966 to November 2008) and CINAHL (1982 to November 2008) databases following procedures suggested by a literature consult service6 and using the search terms accidental falls, qualitative research, risk assessment, accident prevention, nurses, nursing assistants, and hospitals. Abundant research on fall risk assessment has resulted in well-established fall risk factors,7–10 but assessment does not prevent falls; interventions are needed to prevent falls. Regrettably, the evidence regarding the effectiveness of fall prevention programs is inconclusive.11 Synthesis revealed that this may be the result of many barriers to studying fall prevention in hospitals.

Explanation & Answer

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