Hospital and Nursing Home Falls Are Common and Can Result in Devastating Injuries to the Elderly

Falls are a common devastating complication of hospital and nursing home care, particularly in elderly patients.

Although they are preventable, epidemiologic studies have found that falls occur at a rate of 3-5 per 1000 bed-days and the Agency for Healthcare Research and Quality estimates that 700,000 to 1 million hospitalized patients fall each year. Patients in long-term care facilities are also at very high risk of falls. Approximately half of the 1.6 million nursing home residents in the United States fall each year, and a 2014 report by the Office of the Inspector General found that nearly 10% of Medicare skilled nursing facility residents experienced a fall

resulting in significant injury.

More than one-third of hospital falls result in injury, including serious injuries such as fractures and head trauma. Death or serious injury resulting from a fall while being cared for in a health care facility is considered a never event, and the Centers for Medicare and Medicaid Services do not reimburse hospitals for additional costs associated with patient falls. Falls that do not result in injury can be serious as well. As noted in a PSNet perspective "even supposedly ‘no harm’ falls can cause distress and anxiety to patients, their family members, and health care staff, and may mark the beginning of a negative cycle where fear of falling leads an older person to restrict his movement.

Preventing Falls

What can a hospital or nursing home do to prevent needless falls? Any fall prevention program should explicitly tackle the underlying assumption held by many health care providers that falls are inevitable and not necessarily preventable. A successful fall prevention program includes the following interventions:

A standardized risk assessment tool to identify patients with risk factors for falls.

An individualized plan of care that identifies interventions for an individual's differing risk factors, needs, and preferences (there is no "one size fits all” method to preventing falls).

Education of staff on the plan of care and the importance of following the interventions in it.

Interventions such as ensuring patients are within nurses’ line of sight, chair alarms, bed alarms, bed rails, lowering bed height, floor mats, safe footwear, mobility aides, continence management (including routines of offering frequent assistance to use the toilet), and review and (where appropriate) discontinuation of “culprit” medications associated with increased risk of falls, especially psychotropic medication.

A focus on prevention, detection, and treatment of delirium.

Sufficient staffing to implement the plan of care’s interventions and provide proper supervision and assistance.

Current Context

Fall prevention is a National Patient Safety Goal for both hospitals and long-term care facilities. The Joint Commission highlighted the importance of preventing falls in a 2009 Sentinel Event Alert. As noted above, falls with injury are a serious reportable event for The Joint Commission and are considered a "never event" by CMS. The most recent data from AHRQ's National Scorecard on rates of Healthcare Associated Complications (HACs) indicates that fall rates at US hospitals declined by approximately 15% between 2010 and 2015. https: //psnet.ahrq.gov/primers/primer/40/Falls. Darren understands the special needs of elderly hospital patients and nursing home residents, and has vigorously fought to protect their rights against needless and devastating falls. If you know someone who has suffered a fall with serious injuries in a hospital or nursing home, contact us today for a free case evaluation.