Slips, trips and falls (STFs) can happen anywhere, and hospitals are no exception. Whether in a patient room or an operating room, STFs are a potentially costly and largely preventable risk to both patients and hospital staff alike.
Falls are of particular concern with patients over the age of 65, who make up the vast majority of hospitalized patients. According to the Centers for Disease Control and Prevention (CDC), falls among older adults are the leading cause of fatal and non-fatal injuries among people over 65. In 2014, 29 million older Americans experienced a fall, with around 800,000 requiring a hospital stay. There is also the risk of patients falling while they’re in the hospital. The Agency for Healthcare Research and Quality (AHRQ) estimates that between 700,000 and 1 million hospitalized patients fall each year.
When patients slip, trip or fall in the hospital, there are reimbursement implications. The Centers for Medicare and Medicaid Services (CMS) classifies death or serious injury from a fall while being cared for by a healthcare facility as a “never event,” meaning they do not reimburse additional costs related to falls. And the cost is not insignificant. According to the CDC, the average cost for a fall is more than $30,000, with total medical costs related to falls estimated at more than $50 billion. Research has also shown that falling once doubles the chances of a person experiencing another fall, so if a patient enters the hospital because of a fall, the odds of them falling while in the hospital are even higher, placing increased risk to the patient’s outcome and experience, as well as burden on the hospital staff caring for them.
Luckily, by combining a concerted effort to follow available guidelines and incorporating the right equipment and training for clinicians, it is possible to reduce the number of falls experienced by patients.
Reducing patient STFs
Hospitals are places where vulnerable patients come to receive the best, safest care possible. Patients enter for many reasons, and while there, everything must be done to ensure their needs and regulators’ expectations are met.
While the factors contributing to falls are unique to each patient, according to an analysis of the Joint Commission’s Sentinel Event database on falls with injury, the most common factors that contribute to STFs include:
- Inadequate assessment
- Communication failures
- Lack of adherence to protocols and safety practices
- Inadequate staff orientation, supervision, staffing levels or skill mix
- Deficiencies in the physical environment
- Lack of leadership
There is extensive research focused on quality improvement efforts aimed at reducing the number of falls in a hospital.
According to industry accreditors and research agencies, including the Joint Commission and AHRQ, best practices hospitals should follow to reduce falls and falls-related injuries include:
- Raise awareness broadly: The responsibility for identifying and monitoring fall risks in patients does not fall squarely on nurses. Hospitals should use a multidisciplinary approach for intervention that includes clinical and non-clinical staff at every level. Form an interdisciplinary falls prevention team, and consider appointing an executive sponsor who is empowered to ensure adequate equipment and resources are available to set hospital staff up for success.
- Use tools and a tailored approach: Not all patients, including ones identified as a fall risk, have the same needs. Therefore, an individualized care plan that’s responsive to differing risk factors, needs, and preferences, should be implemented. It’s important that someone perform a comprehensive, individualized assessment for falls and injury risk on a patient. It’s also a good idea to use a standardized tool to identify fall risk factors, such as the Morse Fall Scale, and have it integrated into your hospital’s electronic health record, if possible.
- Ensure proper training: The best approach to preventing falls starts with having the right information. To that end, make sure staff have undergone training and understand the best protocol to prevent STFs, and, if using a tool like the Morse Fall Scale, ensure they’re trained on it. If possible, be sure the training and patient education is structured and comes from health professionals rather than being provided ad hoc.
- Have the right equipment: Some STFs can take place because of fluid on the floor or a generally slippery floor surface. It’s not enough to give patients advice on safe footwear. Providing them with safe footwear that has grips can help when they are up and mobile, whether on their own or with the assistance of a hospital worker, can help. Equipment can also help with continence management, including offering frequent assistance with toilet routines. Having the right equipment, such as a commode, available can encourage more mobility.
- Look at prescriptions: Another way to reduce falls is through clinical interventions, which can include medication management. As part of an assessment, review and, if medically appropriate, consider discontinuing medications associated with increased risk of falls, especially psychotropic or deliriogenic medication.
- Help patients help themselves: By providing early access to medical advice on fall prevention, mobility aids such as canes or walkers, and, if medically cleared, exercise with a physiotherapist, hospital staff can boost a patient’s confidence and strength, which can help prevent future falls.
- Conduct post-fall management: A patient falling in a hospital can provide staff a valuable learning opportunity. To learn from the incident, assemble a huddle comprised of staff at all levels to discuss what, how and why the fall happened and what steps can be taken in the future to prevent it. Encourage a culture of open and honest reporting, so staff feel empowered to come forward with information. Analyze the falls data and look for trends that can be addressed proactively.
STFs and hospital staff
Patients are not the only people in hospitals at risk of experiencing a STF. While it is the job of healthcare workers to protect and care for their patients, they, too, are at risk. According to the Bureau of Labor and Statistics, the incidence rate of lost-workday injuries as a result of STFs in hospitals was 90% greater than the average rate for all other private industries combined. STFs are the second leading cause of lost-workday injuries in hospitals.
The leading cause of STFs for hospital staff is contaminants such as water, grease, bodily fluids or food being present on the floor. Whether in a patient room or an operating room, a slippery floor poses a significant risk. According to the CDC, steps hospitals can take to reduce STFs related to debris on the floor include:
- Have an established housekeeping program: Make the program available to all employees, and have it include information such as how to contact housekeeping staff, where wet floor signs are located and how to place them, and what cleaning methods are appropriate for different surfaces.
- Know your environment: Different areas of hospitals pose different STF risks. For example, ORs present unique challenges for preventing STFs as there is a lot of equipment, some of which has cords, space is limited and there is the presence of a variety of liquids including blood, saline and oils. STFs in the OR can cause patient harm, disrupt the procedure, contribute to surgical errors or delay a surgery, throwing off the surgical schedule for that OR.
- Map products to the environment: When developing an STF reduction program for your hospital, consider elements such as slip-resistant floor surfaces, slip-resistant footwear and contaminant control for liquid spills. In the OR specifically, consider products such as colored markings on equipment that pose a trip risk and slip-resistant mats. When choosing a slip-resistant mat, ensure that it’s highly absorbent with a wide range of materials. Additionally, aim for solutions that are easy to clean up and disposable, as that will help to mitigate the risk of cross contamination that is possible with a product that is laundered and reused.
A comprehensive STF program at a hospital is one that includes education, clarity, protocol, teamwork, the right equipment, and measures for continuous improvement. Adhering to the measures outlined in this article will help your hospital start or continue down the road to a safer space for both patients and those responsible for their care.