No one wants to fall. It can be painful. And embarrassing if you fall in public. But when you’re weak and ill, like many hospital patients, falls can lead to serious health problems. In order to reduce the frequency of falls, hospitals and other health care facilities have fall prevention programs. But do these hospital policies to prevent falls help or harm patients? Read on to find out what a delicate balancing act hospitals and other health care facilities face.
Millions of patients fall in health care facilities every year.
Falls in health care facilities are more common than you might expect. According to the Agency for Healthcare Research and Quality (AHRQ), every year, between 700,000 and 1,000,000 people fall in US hospitals. And the AHRQ estimates that about 1/2 of the 1.6 million nursing home residents in the US fall every year. Moreover, about 1/3 of those who fall in nursing homes will fall 2 or more times in a single year.
Falls have serious impact.
A fall can devastate a patient’s health and wellbeing.
Falls frequently cause serious injuries.
More than 1/3 of in-hospital falls cause injuries, including serious injuries such as broken bones, bad cuts, internal bleeding and head trauma. And 10% of nursing home residents who fall suffer a serious injury, with approximately 65,000 patients breaking a hip each year. These injuries can delay or hamper healing.
Falls can also kill.
In 2014, the Joint Commission estimated there are 11,000 fatal falls in US hospitals every year.
Falls can lead to extended hospital stays.
Patients injured in a fall often require additional treatment and may have to stay in the hospital longer than originally expected. In one study, a falls with injuries extended hospital stays by an average of 6.3 days.
Falls can worsen patients’ quality of life.
A fall-related injury can negatively impact a patient’s quality of life, including hampering the ability to function independently. And, even when patients don’t sustain an injury, they can develop a fear of falling which leads to self-imposed restrictions of activity. This self-imposed limit on physical activity can further lead to losses of strength and independence. These issues are especially a concern for elderly patients, but the quality of life for non-elderly patients who fall can suffer as well.
Hospital policies to reduce falls.
Everyone who works in a health care facility wants to prevent falls as sincerely as patients themselves want to avoid falls. Hospitals develop fall prevention programs, and staff do their best to keep patients safe.
Staff wants to avoid falls.
Of course, nurses and aides care about the safety and wellbeing of their patients. However, their concern about patients’ falling is reinforced by a fear of getting blamed or reprimanded if one of their patients falls under their supervision.
Financial incentives to prevent falls.
Clearly, hospitals and nursing homes want their patients to be as healthy as possible. But health care facilities also have financial reasons to reduce falls. Patient death or serious injury associated with a fall while patients are being cared for in a health care setting is considered a “never event”. As such, the Centers for Medicare and Medicaid Services does not reimburse hospitals and other health care facilities for any additional costs associated with patient falls.
The good and bad news.
Clearly, falls lead to patient harm. But, on the other hand, programs to avoid falls can lead to patient harm as well.
The good news.
Research shows that about 1/3 of falls can be prevented. Many facilities have fall prevention programs which manage each patient’s risk factors for falling while optimizing the health care facilities’ physical design and environment.
The bad news.
Fall prevention programs limit patients’ mobility, which can lead to health issues.
What’s the negative impact of fall prevention programs?
Decreased physical activity.
Fall prevention programs at many hospitals and long-term care facilities limit the mobility of patients who could benefit from physical activity. As a precaution, staff often tell patients to never get out of bed on their own. And to make sure patients stay put, bed alarms notify staff if a patient gets up without a staff member’s help. (Interestingly, one study found that these bed alarms had no significant impact on patient falls. Why? Overworked nurses cannot always get to the patient before he/she falls.)
Although it would be great if staff could help patients increase their physical activity, there isn’t enough staff to help patients get up throughout the day just for the benefit of physical activity.
Why is limited physical activity bad?
Staying in bed for prolonged periods of time is unhealthy for most people, but it is especially dangerous for seniors. When seniors spend just a few days in bed, muscles can deteriorate significantly enough to cause severe long-term consequences. One study found that 35% of patients 70+ years old were more disabled upon discharge than when they were admitted.
And staying in bed can increase the risk of blood clots, bed sores, and pneumonia.
Generally, hospital patients spend a lot of time in bed.
Limited activity is common in hospitals. Traditionally, patients enter the hospital, get in bed, and rarely get up until it’s time to leave. One study found that patients spent, on average, 83% of their hospital stay in bed. (This study evaluated patients 65+ (without dementia or delirium) who were able to walk in the 2 weeks before their hospital admission.)
Some patients choose to stay in bed.
Some patients prefer to stay in bed, even if the doctor or nurse encourage them to get up and walk a bit. Dr. Cynthia J. Brown identified common reasons older patients choose to stay in bed:
- Too much pain, fatigue or weakness.
- IV lines and/or catheters that make it more difficult to walk.
- Not enough staff to help them.
- Feeling like they’re burdening nurses if they ask for help.
- Embarrassment from walking the hallway in flimsy gowns with messy hair.
Just a little bit of walking can make a difference.
Research shows that even a little bit of walking benefits patients – older hospital patients who walk 275 steps each day have lower rates of readmission within 30 days of discharge.
Hospital programs can encourage movement.
Because the benefits of physical activity is clear, more and more hospitals across the country encourage patients to get out of bed and move. But, barriers such as a shortage of staff and a lack of walking equipment can make it hard for these programs to flourish.
What can you do?
Ask your hospital or long-term care facility about fall prevention programs and how they balance the concerns around falling with the need for physical activity. And although physical activity is important, patients should not walk alone without medical team approval. For information on why patients fall, read my blog post: Why are Hospital Patients at Risk for Falls?
All hospital stays involve risk. Read these blog posts to reduce your risk of problems:
- Germs in Hospitals and Doctor Offices – Watch Out!
- Why is Sepsis so Dangerous?
- Is C. Diff Dangerous for Patients?
- The Dangers of Missed Bedside Alarms.
- Why is Hand Washing in Healthcare So Important? What You Need to Do to Stay Safe.
- The Benefits of Participating in Hospital Rounds.
- How to Avoid Medication Errors in the Hospital and at Home.
- Tips for Hospital Discharges.
- What You Need to Know About Pressure Sores.
- Is Your Hospital Safe?