Characterization of the Adult Patients’ Falling Incidents
Da Silveira Barbosaa et al. (2019) conducted a descriptive cross-sectional retrospective study at a public university hospital in Brazil between 2011 and 2014. The study found the highest number of hospital falls in 2012 at 33.5%, with the highest incidence rate occurring among patients who are 60 to 69 years. Notably, the highest number of falls in 2012 is attributed to the change in hospital accreditation that initiated a series of initiatives that led to more reporting of fall cases in the hospital (Da Silveira Barbosaa, 2019). Female patients had the highest incidence of falls, with significant rates occurring during night shifts. Additionally, risk of fall was high in patient’s rooms and secondary to height. Concerning triggering factors for fall, the paper found patient-specific and environment-specific factors. The patient-specific factors included slipping, decreased strength and dizziness, with the slipping accounting for more than 25% of fall reports (Da Silveira Barbosaa, 2019). Secondly, equipment failures, wet floor and lack of grids in beds were critical environmental factors triggering falls, while equipment failures caused the highest 11.6 % (Da Silveira Barbosaa, 2019). Moreover, the study found the highest incidence of falls occurred among patients who were unaccompanied and had reduced mobility. As a result, the study recommended the periodic evaluation of hospitalized patients, the need for health providers to spend more time with patients, and instituting protective barriers to reduce falls among hospitalized patients (Da Silveira Barbosaa, 2019).
Patient Safety Incidents and Nursing Workload
Carlesi et al. (2017) evaluated the relationship between the occurrence of patient safety incidences and the nursing team workload in a public hospital in Chile. For that purpose, the authors conducted a quantitative cross-sectional analytical study by reviewing medical records in a high volume health facility located in Vina del Mar. The study defined workload as the ratio nurses compared to the number of hospitalized patients and used Therapeutic Intervention Scoring System in investigating patient safety incidences among patients in intensive care unit (Carlesi et al., 2017). As a result, the study found the highest nurses’ workload in medical-surgical specialties and lowest workload in pediatric and intensive care units. Moreover, fall incidence rates were higher in medical-surgical units and lower in pediatrics and oncology services. Out of the 625 patient safety incidences detected, patient fall was the least(1.92%) while medical errors were the highest, and accounted for 89.6% of reported cases (Carlesi et al., 2017). Despite the lower fall incidences, patient falls frequencies were strongly correlated to the nurses’ workload in the high volume facility due to reduced care and patient monitoring. The finding is consistent with results from other research settings and hence emphasizing the importance of addressing challenges faced by nurses in the hospital environment as a critical factor in addressing patient safety.
The Economics of Preventing Hospital Falls
Spetz demonstrated the economics of preventing falls in the hospital using a simple model (2015) . The authors noted that many hospitals had adopted fall prevention programs such as staff and patient educations, interdisciplinary committees and quality improvement techniques that aim at preventing falls in hospital environments (Spetz, Brown & Aydin, 2015). However, according to the author’s none of those strategies had been assessed to identify the most financial and clinical effective program. Therefore, the research examined the degree of improvement in patients fall rates from literature, and then calculated costs associated with falls, that included the reported value of the various prevention activities. The study recommends that nursing leadership ought to be cautious when implementing a fall-prevention program in hospitals since some of those programs are not cost-effective (Spetz, Brown & Aydin, 2015). There is also a need for identification of fall-specific factors and targeting program tailored towards patients at higher risks of fall to reduce the net cost of prevention, and yield positive returns. Lastly, there is a need for nurses to use best evidence-based practice, and implement data-tracking and benchmarking strategies to ensure compliance with fall prevention strategies.
The Challenges of Implementing Fall-Prevention Strategies
Several researchers have identified the complexity of nurses working environment as the most significant factor contributing to the incidences of fall and fall-related injuries in the hospital environment (Carlesi et al., 2017). Notably, factors such as night shifts, unaccompanied patients and nurses work-loads increase the risk of falls in the hospital environment (Da Silveira Barbosa, 2019). Despite the increasing awareness and advocacy on patient safety matters, there is still a gap in research on challenges faced by nurses in implementing fall-prevention programs. For instance, a primary barrier is the failure of policymakers and hospital leadership to evaluate the cost-effectiveness of fall-prevention programs (Spetz, Brown & Aydin, 2015).
Patient safety is a collective responsibility shared by the patient, caregivers and the health workers. Therefore, in high volume facilities such as medical units, all health providers should be responsible in prevention of falls to ease the burden on nurses. Furthermore, hospital policies on patent safety ought to be cascaded from the top leadership to health providers in hospital units. Such patient safety systems should introduce cost-effective measures such as the use of technology in fall-prevention, for instance, the use of detector among patient at higher risk of falling.
Carlesi, K., Padilha, K., Toffoletto, M., Henriquez-Roldán, C., & Juan, M. (2017). Patient Safety Incidents and Nursing Workload. Revista Latino-Americana de Enfermagem, 25(0). doi: 10.1590/1518-8345.1280.2841
Da Silveira Barbosaa, A., Chavesb, E. H. B., Ribeiroc, R. G., De Qadrosc, D. V., Suzukic, L. M., & De Magalhãesd, A. M. M. Characterization of the adult patients’ falling incidents in a university hospital.
Spetz, J., Brown, D., & Aydin, C. (2015). The Economics of Preventing Hospital Falls. JONA: The Journal of Nursing Administration, 45(1), 50-57. Doi: 10.1097/ nna. 0000000000000154