in-hospital falls

Complications

• fear of falling
• injury
• increased length of stay
• hip fracture
  • in hospital hip fracture with greater risk of institutionalization & death vs hip fracture in the community

Management

• a fall risk assessment should incorporate intrinsic & extrinsic factors
• multicomponent nonpharmacological interventions are effective in reducing incidence of delirium & preventing falls in the elderly
• multicomponent nonpharmacologic measures to prevent delirium reduce in hospital falls & injuries from falls
  • measures include reorientation, early mobilization, therapeutic activities, clinical hydration, nutrition, sleep hygiene, & hearing & vision adaptations
• care planning by nursing staff may reduce risk of falls
• a fall prevention toolkit that produced bed posters composed of brief text with an accompanying icon, patient education handouts, & plans of care communicating patient-specific alerts to key stakeholders may reduce falls risk
  • education alone insufficient to reduce in-hospital falls in the elderly
  • no significant effect on falls-related injuries
• nurse-led fall-prevention intervention involving both patient & family throughout hospitalization associated with lower risk for falls & fall-related injuries
  • 15% reduction in risk for falls; 34% reduction in risk for injurious fall
• considerations
  • patients often with intravenous infusions
  • cognitively impaired patients not likely to use call button
  • fall prevention should not promote immobility
• scheduled toileting reduces risk of in-hospital falls
• bed alarms signal too late
  • patient is on floor or away from bed
• night lights may be useful, but clinical efficacy in unproven
• physical therapy
  • the most effective evidence-based strategy for reducing in hospital falls in the elderly
  • assisted ambulation around the hospital >= 3 times daily
  • helpful but not likely to be translated into reduced in-hospital fall risk (unless hospitalization is prolonged)
• Hospital Elder Life Program (HELP) reduces frailty at hospital discharge
• Fall TIPS (Tailoring Interventions for Patient Safety) program effective in preventing inpatient falls through formal risk assessment & tailored patient care plans
• little evidence to support a other particular interventions
  • non-slip socks*
  • wrist bands &/or room markers to identify patients at risk
  • in-hospital exercise programs
  • sitters to prevent falls in high-risk patients
  • education of nursing staff
• restraints may increase risk of falls
• patient education reduces risk of falls in cognitively intact elderly (RR= 0.6-0.65); NNT=20

* smart socks reduce in hospital falls among patients at risk of falls

More general terms

• falls in the elderly