Between 700,000 and 1 million patients suffer a fall – an unplanned descent to the floor with or without injury – in U.S. hospitals each year, according to the Agency for Healthcare Research & Quality. Between 30 and 51 percent of falls result in injury.
Falls, especially those resulting in injury, are a significant problem in health care. Any patient, regardless of age or condition, is at an increased risk of falls in the health care setting due to a variety of factors, including medications, a medical condition that may cause changes in the patient’s physiology, surgery, or other procedures that may leave a patient more vulnerable to falls and the subsequent effects of falls (The Joint Commission, 2015). In the United States alone, there are hundreds of thousands of falls in health care facilities with injury occurring in up to 50 percent of circumstances, which may ultimately result in up to 6.3 additional hospital days with an average added cost of $14,000 (The Joint Commission, 2015).
Health care workers have the ultimate responsibility of doing their due diligence to prevent these falls and the injuries that may occur as a result of these falls. Falls with serious injury consistently rank in the top ten sentinel events reported to The Joint Commission every year and since 2009, there have been 465 results of falls with injury reported to The Joint Commission’s Sentinel Event database, with approximately 63 percent of these falls having the ultimate outcome of patient death (The Joint Commission, 2015). Even in falls that are not fatal, adverse outcomes could include disability, a decrease in function, or decreased quality of life. Although some of these falls are unpreventable, the health care worker needs to do their part in recognizing potential falls risk factors, correctly documenting falls risk assessments, and performing purposeful hourly rounding to reduce the possibility of their patient having a fall that may result in serious injury or death.
Although there are certain falls risk factors that may seem obvious, such as impaired mobility, traction, or altered mental status, there are other risk factors that may not be as easily identified. These may include inherent cardiovascular, neuromuscular, or sensory abnormalities such as hypotension, coordination issues, or impaired sensory function. The health care worker also needs to be aware of external risk factors that may impair physical ability such as medication or environmental issues.
It is also necessary that an accurate falls risk assessment is documented on each patient so that the health care worker is taking a moment to really assess factors that may increase their patient’s risk of falling as well as provide appropriate interventions based on their patient’s individualized risk. Additionally, patients identified of being at an increased risk for falls need to have a corresponding plan of care to further help the health care worker identify potential ways to decrease their patient’s risk of falling to prevent injury.
The most relevant intervention that a health care worker can perform to decrease their patient’s risk of falling is to consistently practice purposeful hourly rounding to assure that patients’ needs are being addressed in real time to prevent falls. Performing purposeful hourly rounding includes assessing the four P’s with each hourly assessment: Pain, Potty, Position, and Possessions. By assessing and addressing these four factors, the nurse or patient care assistant is decreasing the likelihood that the patient will fall resulting in potential serious injury or even death.