EXECUTIVE SUMMARY

There has been progress in fall prevention, but there is much more room for improvement. Some organizations are finding success with innovative products that can help reduce falls.

  • Data collection should include clinical information.
  • Falls may be reduced at meal times.
  • Hip protectors can help prevent fractures from falls.

Fall prevention is a perennial concern for risk managers but it is important not to get complacent about the challenge. Look for new ideas and ways to improve fall prevention efforts, as well as fall investigations.

Good data collection is essential to the proper investigation of fall incidents and long-term prevention efforts, says Bette McNee, RN, NHA, clinical risk management consultant at insurance broker Graham Company in Philadelphia. Data collection should go beyond the basics of how the patient slipped on a wet floor, she says.

“We need to record the clinical circumstances, such as the patient’s blood pressure, any new meds they were on, the first time out of bed — the information that can be useful when the hospital is investigating fall trends and what can be done,” she says. “This can help with identifying the risks that are unique to your patient population, because the fall risks are going to be different for a patient population with a majority of patients over 80 vs. a postoperative general surgery population.”

Healthcare organizations also are using more environmental design and innovative devices to prevent falls, McNee says. For instance, some hospitals are avoiding the sudden overhead light when a patient goes to the bathroom at night by using motion-activated, underbed lighting to illuminate the floor area instead, she says.

“When they are already looking at renovating rooms, hospitals are starting to look more at innovative designs, especially with flooring and the bathrooms,” McNee says. “In many hospitals, the design of the bathroom is increasingly important, with more attention to how to contain splashing that will leave water on the floor, for example. They’re using poured floors with grit to improve the slip coefficient, many things like that.”

Cord management also is a big concern. Some bed manufacturers are responding with options such as retractable cords and cord lines that run along the underside of the bed, she adds.

Healthcare risk managers should encourage consideration of these innovative product designs to reduce falls, says Alan Abrams, MD, a geriatric clinical advisor and member of the board of directors for Senior Helpers, a company based in Towson, MD, that provides in-home services to seniors.

“There are a number of devices that can help support older adults to reduce the risk of falls and to alert to the risk of fall. Some of them need better proof points but people should be on the lookout for some of these,” he says. “There are some interesting, innovative products that are being developed, such as balance monitoring devices, but the mainstay of fall reduction is that it is multifactorial and it includes environmental issues.”

Those environmental issues include lighting for vision cues, assist bars, elevated toilets, reducing clutter, removing potential trip and slip obstacles, reducing fall-associated medications, using proper footwear, and proper use of assistive devices such as walkers and canes, he says.

Other new products can monitor the restlessness of patients, McNee says. Patients tend to get restless and move about before they attempt to get out of bed and risk a fall, so this new technology can monitor how active a patient is in bed and prompt a nurse intervention before a fall, she says.

Hospitals also can borrow risk management strategies from senior care facilities to reduce fall risks, McNee says. For example, facilities caring for older patients often serve several meals a day, and serve items in ways that require slower eating.

“A lot of times, hospitals will find that when they track their trends in falls, they will find that there are fewer falls during meal times. Why? It’s because we have something to do when we’re eating and so we’re not moving about,” she says. “Speech therapists and occupational therapists are good at finding ways to slow down consumption, and this can be useful even if there is no need to prevent choking or otherwise slow down that patient’s eating. If a community hospital is seeing a lot of older people at risk for falls, doing something like that can be an effective way to address falls.”

An Ongoing Challenge

There has been progress in addressing falls, partly because of campaigns like the one led by the National Council on Aging (NCOA), says Linda Rowett, BSN, RN, risk consultant with liability insurer Coverys in Morristown, NJ. (The NCOA offers evidence-based fall prevention programs online at: https://www.ncoa.org/healthy-aging/falls-prevention/falls-prevention-programs-for-older-adults-2/.)

Another promising fall prevention method was implemented by the Veterans Administration (VA), Rowett says. The VA is using external hip protector devices designed to decrease fractures. Manufacturers offer multiple types of hip protectors, some with soft shells designed to absorb the energy and redistribute the force of the fall, and others with a hard shell that distributes the energy of the impact.

Rowett notes the VA has developed a toolkit for providers to aid in the implementation of hip protectors. “Although the scientific evidence is mixed, some large, randomized, controlled trials have demonstrated their usefulness in nursing home settings for preventing hip fractures in older adults,” the VA’s National Center for Patient Safety reported. (The toolkit is available online at: https://bit.ly/38RHdyw.)

The need for fall prevention will not decrease even as progress is made, Rowett says. The number of falls is large enough, and the effect of falls on individuals and organizations is significant enough that fall prevention will always be a top priority for risk managers, she says.

“Falls in 2017 were the second highest category of sentinel events, according to The Joint Commission. In 2015, they were the No. 1 cause of root cause analysis, according to the National Center for Patient Safety,” Rowett notes. “One-fourth of Americans aged 65 or older fall each year, and falls cause 2.8 million injuries annually. I don’t believe there will be a reduction in falls significant enough to mean we can take our focus off of this problem.”

SOURCES

  • Alan Abrams, MD, Geriatric Clinical Advisor, Board of Directors, Senior Helpers, Towson, MD. Phone: (844) 743-4357.
  • Bette McNee, RN, NHA, Clinical Risk Management Consultant, Graham Company, Philadelphia. Email: bmcnee@grahamco.com.
  • Linda Rowett, BSN, RN, Risk Consultant, Coverys, Morristown, NJ. Phone: (888) 993-8580.