Falls among patients hospitalized for various medical problems is a persistent problem in healthcare facilities. Despite stakeholders’ efforts to address the phenomena, hospitals continue to report patient falls within the care environment. The growing focus on the nursing profession’s role in facilitating safe and reliable care underscores the need for better care practices and coordination to reduce in-hospital falls. Nurse leaders are integral to creating and maintaining safe practices and conducive conditions for providing quality nursing care for good patient outcomes (Labrague et al., 2021). Exploring how nursing leadership can help resolve patient falls presents an opportunity to learn how leaders can leverage their strategic influence to protect hospitalized patients from falls. Reviewing the regulatory agencies and policies helps reveal lessons for nurse leaders and other professionals on effective fall prevention. Additionally, analyzing the impact of patient falls on organizational budgets provides a solid basis for scaling up fall prevention initiatives to maintain hospitals’ financial viability.
Patient falls in hospitals are a common safety issue that impacts patient outcomes. Falls are adverse events involving a patient’s accidental contact with the ground or floor that may or not cause injuries to the patient. The Agency for Healthcare Research and Quality (AHRQ) statistics on the incidence of in-hospital falls show that an estimated 700,000 to 1 million hospitalized patients fall each year (AHRQ, 2019). The complications associated with in-hospital falls include fractures, lacerations, hematoma, and death in severe injury cases. Injuries and complications stemming from in-hospital falls increase patients’ length of hospital stay and need for care to remediate the impact of falls on their health. Patients may get disabilities from the fractures and injuries associated with falls, particularly older clients with frailty. In addition to physical injuries, falls can also cause long-term disability necessitating long-term care to facilitate rehabilitation, thus inadvertently increasing medical costs for affected patients.
Several factors increase hospitalized patients’ risk of falls and associated complications. Previous falls or injuries predispose patients to falls within the hospital environment. Gait instability and visual and cognitive impairment are some of the fall risk factors in older patients who face a greater risk of falling due to aging (LeLaurin & Shorr, 2019). Some medications that alter motor coordination can also trigger falls in patients. For instance, psychotropic drugs with adverse effects such as altered motor coordination, dizziness, and drowsiness contribute to falls, especially in older adults. The use of medical equipment such as intravenous (IV) line poles and in-dwelling catheters that can trip patients is linked to increased fall risk. A patient’s physical environment can also increase their risk of falling. For instance, certain flooring materials that cause patients to slip, unsecured rugs, and damaged carpets are safety hazards that cause falls. Fall prevention in hospitals mainly involves assessing patient fall risk and optimizing the physical care environment to enhance clients’ safety.
Analysis of the Role of the Nurse Leader
Addressing in-hospital falls requires a multi-faceted approach involving healthcare professionals, leaders, and administrators. At the hospital level, administrators must develop and implement guidelines and protocols to reduce patients’ fall risk. Nurse leadership is crucial in supporting the implementation of measures to improve safety standards within the care environment. By partnering with other healthcare professionals, nurse leaders can pivot an organization’s workforce toward developing and maintaining a safety culture. Nurse leaders can help subordinate nurses in various units to understand fall prevention strategies by assessing their knowledge and attitudes related to the issue. Based on the assessment, a nurse leader can determine and conduct the appropriate training to address knowledge, and attitudes gaps in the workforce (Lopez-Jeng & Eberth, 2020). For instance, educating nurses about the correct placement of tethered equipment such as indwelling urinary catheters, IV lines, and other medical devices help them reduce the risk of patients tripping. Continuous reporting and monitoring of the incidence of falls can help nurse leaders modify fall prevention measures accordingly.
Nurse leaders can facilitate additional in-house training to help nurses assess and identify at-risk patients. The involvement of nurse leaders in fall prevention initiatives also includes developing patient education programs to impart fall prevention strategies. Knowledge of fall prevention measures such as using call bells, wearing appropriate shoes, using steady objects to support their movement, and seeking assistance to go to the bathroom can help patients minimize their risk of falling (LeLaurin & Shorr, 2019). Developing patient education programs enables nurse leaders to compile and disseminate such information to hospitalized patients at risk of falls. Effective nursing leadership also addresses staffing shortages that can contribute to increased incidences of patient falls. Nurse leaders must ensure there is adequate nursing staff to help nurses promptly respond to call bells. Nurses’ prompt response to patients’ call alerts reduces the client’s likelihood of attempting to mobilize independently, particularly during emergencies. Therefore, nurse leaders must make concerted efforts to improve patient safety in the care environment.
Regulatory Agencies and Policies
The persistent occurrence of in-hospital falls has necessitated action from various agencies actively leading efforts to eradicate the patient care issue. Several agencies and organizations have developed guidelines that healthcare organizations use in implementing measures to reduce in-hospital falls. The Centers for Disease Control and Prevention (CDC) plays an integral role in reducing the incidence of patient falls. The CDC issues guidelines on fall prevention in hospitals that healthcare professionals are encouraged to follow. According to the CDC, assessing the risk of falls in patients, identifying the modifiable risk factors, and implementing personalized interventions to reduce in-hospital falls are core components of a fall prevention program. In addition to the guidelines, the CDC created the Stopping Elderly Accidents, Deaths, & Injuries (STEADI) initiative that includes practice guidelines related to in-hospital falls (CDC, 2020). Hospitals can also access training resources for their staff to promote continued learning, thus improving healthcare professionals’ readiness to reduce patient falls.
The Centers for Medicare & Medicaid Services (CMS) is another government agency involved in efforts to reduce patient falls. The CMS’ rule on non-reimbursable medical costs for incurred treating serious injuries attaches financial disincentives to hospital-acquired falls. The policy is considered a deterrent crucial to inducing practice changes in hospitals seeking to achieve excellence and reduce costs related to preventable falls. The Agency for Healthcare Research and Quality (AHRQ) researches common patient care issues, including patient falls. The agency gathers data on patient falls and develops evidence-based fall prevention guidelines to help hospitals address the issue (AHRQ, 2021). The Joint Commission is another organization involved in reducing and eradicating patient falls. The commission provides resources and tools to help healthcare institutions develop solid fall prevention initiatives. The resources include strategies such as creating awareness about falls, forming interprofessional fall prevention teams, and assessing patients’ fall risk, which is crucial to addressing in-hospital falls.
Fall prevention in hospitals often requires the utilization of economic resources to enhance the care environment and guarantee patient safety. Dedicating the resources is critical to alleviating the economic costs of in-hospital falls. Adequate staffing helps create a safe care environment as optimal nurse-patient ratios ensure the availability of nurses to respond to clients, thus reducing patient falls (Cooke et al., 2022). Maintaining adequate staff levels impacts operational budgets to cater to nursing labor needs in hospitals. Facilities seeking to reduce patient falls by partly increasing their workforce must adjust their operational budgets to facilitate human resource acquisition to maintain optimal nurse-patient ratios. Maintaining adequate nursing staff levels helps reduce the number of labor hours lost when time is dedicated to managing injuries from falls amid inadequate staff. Therefore, nurse leaders must understand their facility’s budgeting process to influence budget decisions that promote fall prevention by supporting nurses’ role in care delivery.
An organization’s capital budget facilitates the acquisition and installation of critical infrastructure vital to quality healthcare delivery. Patient falls impact capital budgets as some fall prevention measures entail modifying the physical care environment, which involves capital expenditure. Handrails signage, nurse call system installations, lighting technology installation on hallways, and flooring adjustments are environmental modification measures that help reduce hospital falls (Morris et al., 2022). The measures involve capital expenses on hospital equipment to improve the physical care environment. Direct medical costs associated with treating injuries resulting from falls also impact operational budgets. In-hospital falls are categorized as never events by the Centers for Medicare & Medicaid Services (CMS), which attract reimbursement restrictions (AHRQ, 2019). The CMS does not reimburse hospitals for medical costs associated with severe injury or death stemming from falls, increasing the facilities’ non-reimbursable expenses. Litigation arising from in-patient falls also impacts cash budgets when hospitals settle litigation claims related to patient falls.
Falls in hospitalized patients is a persistent care problem in nursing and healthcare. The impact of patient falls on patient outcomes and the care environment underscores the need for increased efforts to address the issue. Nurse leaders must leverage their influence and position to marshal their colleagues in adopting better care practices that foster a safe environment with reduced patient falls. The regulatory agencies and policies related to patient falls are a solid basis for developing and improving patient safety measures. The measures must ensure that nurses actively involve themselves in efforts to reduce the incidence of patient falls to promote better patient outcomes. Understanding the financial and budgetary implications of patient falls can help nursing leaders recognize the value of promoting a safe environment for hospitalized patients.
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007
Lopez-Jeng, C., & Eberth, S. D. (2020). Improving Hospital Safety Culture for Falls Prevention Through Interdisciplinary Health Education. Health Promotion Practice, 21(6), 918–925. https://doi.org/10.1177/1524839919840337
Cooke, M., de la Fuente, M., Stringfield, C., Sullivan, K., Brassil, R., Thompson, J., Allen, D. H., Granger, B. B., & Reynolds, S. S. (2022). The impact of nurse staffing on falls performance within a health care system: A descriptive study. Journal of Nursing Management, 30(3), 750–757. https://doi.org/10.1111/jonm.13555
Morris, M. E., Webster, K., Jones, C., Hill, A. M., Haines, T., McPhail, S., Kiegaldie, D., Slade, S., Jazayeri, D., Heng, H., Shorr, R., Carey, L., Barker, A., & Cameron, I. (2022). Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing, 51(5), afac077. https://doi.org/10.1093/ageing/afac077
Agency for Healthcare Research and Quality [AHRQ]. (2019, September 7). Falls. PSNet. Retrieved January 28, 2023, from https://psnet.ahrq.gov/primer/falls
Centers for Disease Control and Prevention [CDC]. (2020, July 16). About STEADI. Retrieved January 29, 2023, from https://www.cdc.gov/steadi/about.html
Agency for Healthcare Research and Quality [AHRQ]. (2021, March). Preventing falls in hospitals. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html