Patient Safety and Quality

Fall prevention program yields benefits at first then wanes

Patient falls in hospitals can lead to injuries, longer stays, and higher costs. Further, as of October 2008, Medicare and many State Medicaid agencies halted reimbursements to hospitals for costs associated with treating injuries that patients incurred when they fell while hospitalized.

Researchers from the Washington University School of Medicine tested the effectiveness of a fall prevention program on four floors (two intervention, two control) of the Barnes-Jewish Hospital from April to December 2005. Control floors had 7.5 and 6.9 falls per 1,000 patient days, while intervention floors had 6.4 and 5.1 falls per 1,000 patient days. Prevention strategies for all floors included ones the hospital normally employed, such as daily assessment of a patient's risk of falling, a review of fall prevention strategies with the patient and family members, and use of fall prevention signs. Additionally, staff on the intervention floors received self-study modules and in-service training. They also communicated with each other on a patient's risk by using dry erase boards or patient armbands. They implemented a toileting schedule, requested physical therapy or occupational therapy consultations, and reviewed with the patient and family any medications that could put patients at risk for falls.

Intervention floors saw a 23 percent reduction in patient falls when compared with control floors (57 and 70 falls, respectively), but results were not statistically significant. An initial decrease in falls of 43 percent for the intervention floors held fast for 5 months, but rates then rose again.

The authors suggest that staff turnover, high patient volume and turnover, high patient-to-nurse ratios, lack of buy-in from providers, and demands on nursing staff may explain why compliance was less than optimal. For example, though a toileting schedule was implemented, staff found it difficult to carry out because many patients chose not to use the facilities at their scheduled times. This study was funded in part by the Agency for Healthcare Research and Quality (HS11898).

See "Intervention to prevent falls on the medical service in a teaching hospital," by Melissa J. Krauss, M.P.H., Nhial Tutlalm, M.P.H., Eileen Costantinou, M.S.N., R.N., and others in the June 2008 Infection Control and Epidemiology 29(6), pp. 539-545.

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