Keeping patients safe is crucial in today’s health care structure. Hospitals and healthcare facilities work hard to prioritize patient care and safety by implementing rules and policies that protect patients from accidents, infections, and injuries. However, events that violate patient safety are rapidly increasing. In addition, deaths that occur due to medical errors are slowly exceeding deaths caused by other events such as road traffic accidents, cancer, HIV infections, and mental health disorders. Canada’s health care policy agenda is already crowded, and improving patient safety has become a significant issue. According to the World Health Organization, one in every ten patients in developed countries suffers from harm during their stay in hospitals (Flott et al., 2019). Despite hospitals and other stakeholders in the health care sector continuing to make changes to improve patient care and decrease accidents in hospitals, practice errors such as inpatient falls are still being reported in large numbers.
Nurses play an essential role in ensuring optimum patient wellbeing in hospitals, and their contribution to patient safety cannot be underestimated. Despite nurses trying their best to prevent harm to their patients, events such as falls, administration of wrong medication to patients, or failure of types of equipment are still prevalent in present-day Canada. One out of seventeen hospital stays in Canada involves at least one harmful event to the patient. According to the Canadian Institute for Health Information, forty-six percent of the events were due to healthcare and medication issues, such as getting the wrong medication, while thirty percent were due to surgical site infections (Allin et al., 2019). Also, twenty percent were related to procedures such as bleeding after surgery, and four percent were due to patient accidents like falls.
During one of the clinical rotations as a student nurse, an incidence of an older cognitively impaired patient fall occurred in one of Canada’s independent hospitals. Ms. Oliver is an eighty-six-year-old female under the separate living wing of the facility. Before the fall, the patient had activated her medical alarm around ten minutes earlier. When asked what happened, she stated that she was trying to use the bathroom when she suddenly felt lightheaded and dizzy and fell. When asked questions about the event, the patient, who was fully oriented to time and place, responded appropriately by reporting swelling and pain in her left hip. The patient is a known hypertensive patient under treatment with beta-blocker and has a history of diet-controlled diabetes—she also reports poor feeding habits and low intake of fluids in the past days. Ms. Oliver’s case is not isolated because slips and falls among hospitalized patients are common. According to the Canadian Patient Safety Institute, between forty and sixty percent of all hospitalized patients in medical facilities suffer from falls yearly (Lee et al., 2022). In addition, the cases of elderly falls are more common in cognitively impaired patients than in others.
Both intrinsic and extrinsic factors cause inpatient falls. The Intrinsic factors involve the patient, which include a history of previous falls, unstable gait, old age, reduced vision, chronic and chronic illnesses, deficiency in the musculoskeletal system, and dangerous mental health status. On the other hand, extrinsic factors include the patients’ environments, such as furniture, poor lighting, improper use of assistive devices, small ward rooms, and medications. Concerning Ms. Oliver’s case, why did the patient fall during her hospital stay? The patient had reported poor feeding habits and low intake of fluids, use of better blockers, having a history of diet-controlled diabetes, and abrupt change in position. Why would these be the cause of the patient’s fall? First, Ms. Oliver was using beta blockers, lowering her blood pressure and decreasing her heart rate. Why would poor oral intake be the cause? Because inadequate oral fluids intake could lead to dehydration, reducing the overall circulation in the body.
Moreover, why would a sudden change in position cause the fall? A sudden change from a supine position to standing interferes with the body’s demand to maintain homeostasis against gravity. Also, why would poor feeding cause a fall? Because a recent illness with insufficient intake of nutrients would cause general body weakness and dizziness. Lastly, why would the patient suffer from a fall? Due to the patient’s advanced age, she most likely suffered from an unstable gait. From all the potential causes and examinations, the root cause was concluded that the fall was due to poor feeding, low fluid intake, and abrupt position change.
Concerning Ms. Oliver’s fall scenario, it is worth acknowledging that patient wellbeing has become a global concern, and the overall welfare of the patient is at risk. Patient safety is achieved through collaboration between physicians, pharmacists, nurses, and other staff of the healthcare team. However, nurses play a major role in providing excellent care and preventing the patient from harm. Nurses spend a considerable amount of time with patients compared to other health care providers and bear many responsibilities that, when executed effectively, help ensure proper patient care. Since most inpatient falls are preventable, the first nursing recommendation would be screening and assessing patients for risk of falls. The process helps plan a fall prevention care plan for the patient. For example, patients with unsteady gait require assistive devices, assistance getting out of bed, physical therapy, and nonskid footwear. At the same time, patients with mental instability require continuous virtual monitoring, frequent rounding from the nurses, and bed or chair alarms. Also, toileting schedule and incontinence briefs are recommended for patients with urinary incontinence or frequency.
Moreover, nurses can work closely with safety companions for high-risk patients to ensure optimum patient safety. Cognitively impaired patients have difficulties following instructions and require safety companions to prevent accidental falls. Another way nurses reduce hospital falls is by carrying out regular safety rounds on all high-risk patients. During these rounds, the nurse checks all safety measures to prevent falls, including armbands, patient fall signs, and bed alarms. From a patient safety perspective, nurses can also help prevent hospital falls by detecting clinical errors, communicating patients’ conditions, understanding care processes, monitoring patients for clinical deterioration, and identifying patient needs.
Most nurses do a recommendable job by assisting the needy and incapacitated patients in daily activities such as using the restrooms and making their beds. Also, patient safety can be maintained by placing essential items close to the patient, which reduces accidental patient falls. On the other hand, nurse leaders should implement proper staffing policies and management of nursing staff, which significantly influences patient safety outcomes. According to the World Health Organization, as the ratio of patients per nurse increases, there is an increased risk of mortality and morbidity (Sharma et al., 2020). Hence, nurses should ensure that their ratio to that of the patients is manageable.
In conclusion, patient safety is one of the primary concerns in the healthcare system, and significant changes should be made to prevent frequent cases of harm to the patient. The necessary hospital rules and policies on fall prevention measures should be followed to ensure quality care is provided to the patient. Nurses should emphasize these measures, which can be used universally regardless of the patient’s condition. Namely, constantly familiarizing the patient with the hospital room, teaching patients to use call lights, always leaving patients’ personal belongings in close reach, immediately answering patients’ call lights, and keeping all floors clean and dry. The nurses can also ensure they frequently assess and monitor their patient’s condition during their shifts. Lastly, due to these frequencies of falls, nurses, as patient advocates, have a role in providing all patients with safe and quality care at all times.
Allin, S., & Rudoler, D. (2019). The Canadian health care system. International Profiles of Health Care Systems, 27-35. https://nightingale.instructure.com/users/11895300/files/215834362/download?download_frd=1&verifier=wmsEEQggVgjvqzjQ0ixeuFZoYKEFPG3DQhCOB4hK#page=25
Flott, K., Fontana, G., & Darzi, A. (2019). The global state of patient safety. London: Imperial College London. https://www.imperial.ac.uk/media/imperial-college/institute-of-global-health-innovation/GlobalStateofPS_DIGITAL_16Sep19.pdf
Lee, S. E., Morse, B. L., & Kim, N. W. (2022). Patient safety educational interventions: a systematic review with recommendations for nurse educators. Nursing open, 9(4), 1967-1979.https://onlinelibrary.wiley.com/doi/abs/10.1002/nop2.955
Sharma, S. K., & Rani, R. (2020). Nurse-to-patient ratio and nurse staffing norms for hospitals in India: a critical analysis of national benchmarks. Journal of family medicine and primary care, 9(6), 2631. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491754/