Why patient falls are so hard to get ahead of

From shock-absorbing flooring to wearable technologies, hospitals have tried a litany of interventions to get to zero patient falls. But for years, falls have consistently landed on The Joint Commission's list of most common sentinel events. 

Oftentimes, patient falls take the top spot on the accrediting body's annual list of the 10 most frequently reported sentinel events, which the organization defines as a patient safety event that results in death, permanent harm, severe temporary harm or intervention required to sustain life. In the first six months of 2022, 199 falls were reported, making it the most common sentinel event so far this year. In 2021, they were also the most commonly reported sentinel event, with healthcare organizations reporting 485 patient falls. And these figures only include adverse events that were reported. 

"Every single hospital across the country focuses on falls because it's such a complex initiative," Kristin Ramsey, MSN, RN, chief nurse executive at Chicago-based Northwestern Medicine Memorial Hospital, told Becker's. She described patient falls as "one of the things that keeps me up at night" because "there's really two victims in a fall because the care provider also is traumatized anytime that a patient is injured underneath their care." 

Despite hospitals' prioritization and attention dedicated to these events, falls have proved to be an incredibly difficult challenge to get ahead of simply because of all the contributing factors tied to them. Hospitalized patients are often not feeling their best and in unfamiliar environments. Some may be disoriented and require medications that worsen those feelings. And even when patients are aware that they shouldn't try to get up from bed on their own, inevitably, there are times when it happens.

"At moments, for example, when you really need to get up and go to the restroom and feel like you could do it, or perhaps have a suspicion that if you ring the call bell, it won't work, people take it [upon] themselves to climb over the bed rails which almost always guarantees that they'll be higher off the ground … and succeed in falling," Albert Wu, MD, professor of health policy and management at Baltimore-based Johns Hopkins Medicine, told Becker's

While tech-powered interventions are exciting and certainly have a place, on their own, they're often too late at actually reducing falls since the patient is already moving around by the time an alert is provided, underscoring the need to pair them with other strategies. 

"There are reviews of rigorous studies — that is to say clinical trials — that in general have failed to find any effect of these interventions on reducing falls," Dr. Wu said. "I love a cool gadget as much as the next person, but the killer app would be some intervention that actually works [at reducing injurious falls]." 

While there's no single strategy to prevent all patient falls, one thing is clear: "We have to have different types of options," Ms. Ramsey said. That means having a combination of interventions individualized to the patient. Such combinations may include a bed exit alarm, rearranging furniture in a patient's room and lining the floor with fall mats.  

At Northwestern, once care teams are aware that a patient has a greater potential to fall — perhaps because of certain medications they're taking or a history of falling at home — and are alerted of the interventions put in place, the next step is to clear communication with the patient and their family. 

"We say, 'OK, do you agree to this plan?'" Ms. Ramsey said. "You know to always use the call light. You know not to get up by yourself. If there's family in the room [we tell them] you know you're not to get the patient up without our assistance." 

The most important component is individualizing the care plan, she said. That includes an assessment of how many people are required to get a patient up and whether lift equipment is necessary.

"There's not a one size fits all in preventing falls," Ms. Ramsey said. "It [requires] an individualized care plan with many different types of interventions." 

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