inpatients falls project
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Patient Safety Project
Jordan University of Science and Technology
Faculty of Nursing
Inpatient Falls Prevention Project
Patient Safety Program in Al- yarmouk Hospital
Prepared by:
Ashraf Al-Smadi
Advised by:
Dr. Yaseen Hayajneh
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Patient Safety Project
Introduction and Significance:
Patient safety represents a primary principle of all health care institutions. It is
basically defined as “the prevention of harm to patients” [1]. Although simple in
definition, the path to ensuring patient safety presents considerable challenges for all
health care administrators, nursing managers, register nurses, physicians, pharmacists and
researchers, looking for accurately build up safe healthcare services in today’s highly
complex health care systems. Ensuring patient’s safety includes processes and
operational systems that decrease the chances of errors and increase the chances of
stopping them when they occur [1]. Moreover, safety requires a complex system,
including a wide scope of activities in environmental safety, performance improvement
and risk management, also including safe use of medicines, infection control, equipment
safety, safe environments of care and safe clinical practice. It holds mostly all healthcare
disciplines, regulations and performers. Thus, patient’s safty requires a wide-range
approach in recognizing and managing actual and potential risks in individual services
[2]. Related literatures revealed that adverse events such as nosocomial infections,
medication errors, and injuries including patient falls affect thousands of patients in
hospitals annually [1].
Improvement of healthcare patient’s safety and healthcare quality are very important
to nurses [3]. For example, the International Council of Nurses (ICN) recommended with
its international campaign “Safe staffing saves lives” the importance of the patient safety
movement, focusing on a different of care indicators such as falls, inappropriate
surgeries, drug errors and factors that increase the morbidity and mortality of patients [4].
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Patient Safety Project
However, the institute of medicine [IOM] emphasizes the critical need to invest in
patient’s safety to improve health care quality regarding patient’s falls [1].
Related to western literature the falls defined as “A fall is a sudden, unintentional
change in position causing an individual to land at a lower level, on an object, the floor or
the ground, other than a consequence of a sudden onset of paralysis, epileptic seizure, or
overwhelming external force” [5]. In addition inpatient falls is defined as “An event in
which a patient suddenly and involuntary comes to rest on the floor with or without
physical injury,” [6]. In recent times, the Prevention of Falls Network Europe
recommended defining a fall as “an unexpected event in which the participant come to
rest on the ground, floor or lower level” [7].
The healthcare facilities identified patient’s fall as a serious health problem and may
result in injuries and complications, which prolongs hospitalization, decreases patients’
functional capacities, and leads to increased health care costs [8]. There is an impact on a
patient’s perception of safety and well-being; it may diminish the patient’s capability and
willingness to participate in activities of daily living and rehabilitation due to fear of
falling again. Many features of inpatient falls such as conditions, patient characteristics
and fall risk factors as well as interventions to prevent patient falls during hospitalization
have been widely researched.
Inpatient falls, is an important adverse event in healthcare settings, have not
considered as other adverse events. In spite of, that it is one of the most important
inpatient accidents and associated with negative clinical consequences. Inpatient falls and
fall-related injuries continue to be a multifarious challenge that a health care institution
confronts. For example, in acute care settings, inpatient falls represent the largest group
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Patient Safety Project
of reported incidents [9]. It is costing approximately $20.2 million per-year in resulting
diagnostic tests, legal expenses, injury repair & rehabilitation costs, and patient and
family dissatisfaction [10].
Several risk factors for inpatients falls have been identified such as Gait
instability, agitated confusion, urinary incontinence or frequency, a fall history, and the
use of drugs (sedative or hypnotics), have been found to be consistent risk factors
associated with inpatient falls [11]. The risk for hip fractures due to falls increases
significantly as the number of fall risk factors increase [12]. Risk factors associated with
inpatient hip fractures among older patients include: confusion, assisted ambulation, low
body weight, use of psychotropic drugs and impaired vision. Approximately 2% to 17%
of patients experience a fall during their hospital stays [13]. And fall related injuries
occur in 15% to 50% of hospital falls, and serious injuries including lacerations, fractures
or contusions are seen in 1% to 10% of hospitalized patient who fall [14].
During my training in al-yarmouk hospital I faced five accidents of inpatient fall
(5%), those accidents aware me to search for the most risk factors that contributed to this
obstacle, and find an appropriate strategies to reduce and prevent inpatients falling among
Al-yarmouk hospital departments.
Project Aim:
To increase nursing awareness about strategies that manage
and prevent inpatient's falls by proposing inpatient falls prevention
program among Al-yarmouk hospital departments as a path to improve
quality of healthcare by more precisely identifying patients at risk.
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Patient Safety Project
Method:
1. Find a process to improve: there is an opportunity to decrease inpatients falls at
Al-yarmouk hospital in order to maintain patient safety.
2. Clarify the current situation by:
a) Assess and analyze patient falls that reported during 2007 by number of
incident per department and subgroup.
b) Review for prevention assessments that were documented through 2007.
c) Review available fall prevention and management policy.
d) Review causes of patients falls that were documented through 2007.
3. Evaluate the risk factors that will contribute to increase inpatient falls
incidence.
a) Staff: insufficient educational background, incomplete nursing assessment,
incomplete medical assessment, and work overload.
b) Education and training department: lack of staff training and orientations
programs.
c) Overlapping of Documents forms and policies.
d) Patients' medications, education level, and treatment side effects.
4. Select of improvement process based on previous factors:
a) Staff:
To review staff fall assessment and management competency.
Monitor staff application of the fall prevention and management
policy.
b) Education and training:
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Patient Safety Project
Conduct education sessions for health care providers about fall
policies, and fall risk assessment in Al-yarmouk hospital.
Monitor staff performance related to safe handling and lifting of
patient.
Develop intensive training at area of high incidence rate of falling
down.
c) Documents:
Review fall prevention and management policy.
Review patient fall risk assessment form.
d) Patient:
Educate patients and their families about the prevention and
management of falls.
5. Plan:
Tasks Responsible person
Encourage reporting of patient falls All healthcare providers
Review fall prevention and management policy Nursing department
Analyze the causes of patients falls reports Nurse
Monitoring of falls prevention and management policy implementation
Nurse
Training and education of staff on falls prevention and management policy.
Education department
Check the staff competencies in patient falls prevention and management.
Educators in each unit
Educate patient and family about prevention and management of falls.
All health care providers
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Patient Safety Project
Application of inpatients falls prevention program:
Assessment of patient risk for falls including health history, physical
examination, vital signs, visual acuity, grip strength, range of motion,
cardiovascular, musculoskeletal, neurological, and skin assessed upon
admission, at the beginning of each shift, when patients condition
change and following a patient's falls or near fall.
Assessment of patients functioning in the following areas: balance
gait, precipitating behaviors, physical status, cognitive function,
functional status, psychosocial, environmental and risk behavior,
medication and alcohol use assess upon admission, at the beginning of
each shift when patients condition change and following a patient's
falls or near fall.
Monitor environmental and patient's safety on regular basis.
Encourage participation in functional activities and exercise at patient
high possible level and refer to physical therapy as appropriate.
Educate patients and their families regarding fall prevention and
management.
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Patient Safety Project
Conceptual model for falls in Al-yarmouk hospital setting
A conceptual model provides as helpful summary of the multifactorial nature of
inpatient falls in Al-yarmouk hospital setting. In order to conceptualize the complexity of
hospital falls, risk factors at the patient and environmental level, the clinical context and
the clinical and economic consequences are graphically represented in Figure 1.
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Patient safety project
References
1.IOM (ed.): Patient Safety - Achieving a new Standard for Care.
Washington, DC: The National Academies Press; 2004.
2.World Alliance for Patient Safety Forward Programme 2005
[www.who.int/patientsafety]
3.Doran TB, S. Mendez, P. Poe, S. S. Newhouse, R.: Patient Safety as a
Measure of Health-care Quality. In: Measuring Patient Safety. Edited
by Poe SSN, R. Sudbury, MA: Jones and Bartlett; 2005 .
4.ICN: Safe staffing saves lives - International Nurses Day
2006. Geneva: International Council of Nurses; 2006.
5.Gibson MA, RO. Isaacs, B. Radebaugh, T. Worm-Petersen, J.: The
prevention of falls in later life. A report of the Kellogg International
Work Group on the Prevention of Falls by the Elderly. Danish
Medical Bulletin 1987, 34 Suppl 4:1-24.
6.Gaebler S: Predicting which patient will fall again. and again. Journal
of Advance Nursing 1993, 18(12):1895-1902 .
7.Lamb SE, Jorstad-Stein EC, Hauer K, Becker C: Development of a
common outcome data set for fall injury prevention trials: the
prevention of falls network europe consensus. J Am Geriatr Soc 2005,
53(9):1618-1622.
8.Rene Schwendimann: patient falls, akey issue in patient safety in
hospital, 2006.
9.Gaebler S: Predicting which patient will fall again . . . and again.
Journal of Advance Nursing, 18:1895–1902, 1993.
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Patient safety project
10.Englander F, Hodson TJ, Terregrossa RA: Economic dimensions of
slip and fall injuries. J Forensic Sci 41:733–746, 1996.
11.Evans D, Hodgkinson B, Lambert L, Wood J: Falls risk factors in the
hospital setting: a systematic review. Journal Nursing Practice 2001,
7(1):38-45.
12.Lichtenstein MJ, Griffin MR, Cornell JE, Malcolm E, Ray WA: Risk
factors for hip fractures occurring in the hospital. American Journal of
Epidemiology 1994, 140(9):830-838.
13.Heinze CL, N. Dassen, T.: Sturzhäufigkeit in deutschen Kliniken.
Gesundheitswesen 2002, 64(11):598-601.
14.Goodwin MB, Westbrook JI: An analysis of patient accidents in
hospital. Australian Clinical Review 1993, 13(3):141-149.
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