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Fall prevention and mitigation of patient injury if a fall does occur is a critical part of a hospitalized patient’s plan of care. Having a comprehensive strategy in place to prevent in-hospital falls has grown challenging in recent years. Patients are getting older and sicker, the nursing workforce is aging, and of course, hospitals and caregivers are wrestling with the enormous pressures and limitations created by the pandemic. To work around these obstacles, the healthcare industry must become more aggressive in its approach to fall prevention and improving patient outcomes. 

Hospital bed technology can reduce patient falls.
ProCuity™, one of the new generation of “intelligent” hospital beds (click here to see it in action ).

Patient falls continue to be a common adverse event reported in hospitals. Every year, between 700,000 and 1 million people fall while being treated in the hospital. It is also estimated that up to 11,000 U.S. patients die annually due to injuries sustained from a fall during hospitalization.

Not only is the cost of these falls to the healthcare system enormous—$20 billion annually—but the Centers for Medicare and Medicaid Services (CMS) is no longer reimbursing providers for treating patient injuries resulting from falls in a hospital. 

For patients, the long-term effects of falls can be debilitating. Caregivers are also equally impacted. From a personal perspective, during my time working at the bedside on a MedSurg unit, I have personally experienced two patients falling during my watch. It is something I will never forget from an emotional perspective, and how draining it was on both the individual and team morale on the unit. My current clinical work today is in the hope that no other nurses or patients have to endure another patient fall.

Today, the criticality of patients is increasing. Nurses are seeing sicker patients than ever before. Patients are also living longer, with those 65 years and older representing nearly 40 percent of hospitalized adults. Nurse-to-patient ratios have also gotten out of balance, which can lead to fatigue, burn-out, and mistakes. In my experience, on any given night, a Med/Surg nurse could have up to eight patients at one time in his or her care. When you couple this with the fact that the nursing workforce is aging, a potential shortage could also pose big problems. The onset of COVID-19 has also presented its set of challenges.  

For nurses, the restrictions that caring for a patient in the COVID “bubble” has placed on them–from donning and taking off PPE to the limited interaction they can have with patients–is something very new and hard to navigate. These protocols can leave patients susceptible to falls. Additionally, there are concerning reports that many COVID patients experience delirium, which also elevates the risk level for falls.  

There are a number of ways hospitals can address these challenges to help improve patient outcomes. 

One of the most important is improving bed technology—including standardization and interoperability. One study showed that 79% percent of falls were unassisted. In addition, 85% of falls occurred in the patient’s room. The problem is many hospitals today use multiple generations of beds, all with varying degrees of technology and options. This makes training on beds much more challenging. Hospitals should consider standardizing their beds to one specific kind, as this helps support a nurse’s interaction with the bed becoming a hardwired process and promotes easier decision-making.  Thankfully, technology has arrived to help achieve these ends.

Stryker, for example, just came out with a new bed, the first of its kind, that can connect wirelessly to any nurse call system and can be used for all acuity levels. Called ProCuity™, this “intelligent” hospital bed not only helps alert nurses if a patient is out of position or has left the bed, it also eliminates difficult tasks like ensuring a nurse call cable is properly plugged in. By streamlining usability, training, and maintenance, technological advancements like this help hospitals make their beds work better for patients and staff.   

Updating your hospital beds with wireless technology can help reduce patient falls.
With wireless technology, hospital beds can be connected to any nurse call system.

Another important fall prevention strategy is data analysis. Numbers don’t lie and so one of the best ways to ensure a hospital’s fall prevention strategy is on track is to routinely monitor and analyze data around fall rates. By determining the cause and type of falls that occur, hospital administrators have a 360-degree view of the issue and can take forward-thinking action to prevent reoccurrence.

Communication is also paramount. When a fall occurs, all appropriate stakeholders in charge of a patient’s care should conduct post-fall huddles to assess all the factors that contributed to the accident and plan an appropriate mitigation strategy. Effective after-action review may also improve team performance by 20-25%. Likewise, nurses should communicate with their patients—what I call teach-back education. By asking open-ended questions about their well-being and state, nurses can help identify potential fall risk problems beyond just finding a shaky grab bar in the bathroom.   

When it comes to fall prevention, there is no one size-fits-all-plan. But as the pandemic and other healthcare challenges have shown us, we can no longer be reactive in our planning. With better technology, more data, and increased education and communication, we can more quickly reach our desired outcomes—improving the safety of our patients and caregivers.  

Sabrina Flavin, BSN, RN, CPPS
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