Fall prevention is a constant concern for hospitals and health systems, with great costs involved. It is important not to get stuck in the same old way of thinking when it comes to protecting patients. Take the time to re-evaluate your fall prevention program and look for new opportunities to improve this key aspect of patient safety.
The most progressive approach to fall prevention involves taking a holistic approach to the patient and focuses on an individual’s risk factors, says Daniel Devine, MD, board certified in internal and geriatric medicine, practicing with Devine Concierge Medicine in Wayne, PA.
“In geriatric medicine, we’re moving more toward environmental issues and physical activity as a way of preventing falls. We’re looking at the whole person, everything from the shoes they wear and their activities, trying to sign them up for things like tai chi if they are cognitively intact,” Devine says. “Vitamin D supplementation has been shown to help. We continue to look at the medications a patient is on.”
There is an emphasis on “de-prescribing” as a means of limiting the medications a patient is on, because falls often are tied to low blood pressure or low blood sugar caused by prescription drugs, Devine says.
“Particularly for risk managers, it can be useful to review the use of psychotropic medications monthly or bi-monthly. Psychotropic medications are very highly related to falls, pretty glaring red flags for increased fall risks,” he explains. “Make sure you know who is on these medications and that these patients are being properly assessed to see if they are still necessary. If you can, do a dose reduction.”
Devine also advises simply watching patients walk around and meet regularly with physical therapists to assess fall risks. There is no population-based intervention for reducing falls because falls are so multifactorial that it takes deep study into each patient to find solutions, he says.
“Part of the way we look at falls is seeing the actual incident as just the tip of the iceberg. We have to look underneath to see what actually caused the fall,” Devine says. “It can be easy to think of all patients at risk of falls as one category of patients and then apply the same fall prevention strategies to them across the board. It is much more effective to look at each patient and determine what makes that particular person at risk for falling and address those issues.”
Devine says there is a lot of room for improvement with how hospitals and health systems address fall prevention. Part of the problem is the time constraints of modern medicine. A good geriatric assessment and discussion with the patient and family members takes about half an hour, he says.
“The regular 15-minute office visit or a quick visit in a nursing home makes it difficult to get into that,” Devine says. “Time is the most valuable commodity, and giving a patient time to express what is happening to themselves and what may influence their risk of falling is a difficult thing for most healthcare professionals.”
- Daniel Devine, MD, Devine Concierge Medicine, Wayne, PA. Phone: (610) 486-5980.