Falls Prevention in Hospitals-the Need for a New Approach an Integrative Article

Abstract

Among adults (65years and over), falls are the leading cause of injuries that cause pain, emotional distress and loss of independence, reduced quality of life, increased number of hospitalization days, morbidity and mortality.1 It is estimated that by 2025, this group of patients will constitute approximately 1.2billion of the world population, eighty percent of whom will live in developed countries. 2 The rate of falls among adult's increases with age, with the prospect of falls in people aged 65 and older at about 35%, increasing to about 42% for those over 75years of age. Fifteen percent (15%) of patients, who fall, have a history of falling twice or more a year. Falls are the second cause of death in the US (75% of them are elderly people) with the death rate in the United States reaching36.8 per 100,000 people.3 Fall rates in hospitals range from about 30% to 50% or a range of 3.3 to 11.5 falls per 1,000 hospitalization days, 4 and they are the most frequently reported adverse events. Fall-related morbidity and mortality rates in hospitals are significant. It is estimated that at least 3-20% of the falls have resulted in injury.5 About 30% of the hospitalized patients who fall suffer injuries due to the fall, of which 4-6% suffer from severe injuries, including fractures, brain hemorrhage, bleeding and mortality risks.6 Fall-related injury rate during hospitalization accounts for up to 533 per 1,000 person-years for all injuries, 20 per 1,000 person-years for hip fractures, 270 per 1,000 person-years for head injuries. 7A 'fall' is defined as "an unplanned descent to the floor with or without injury to the patient". 8 The National Database of Nursing Quality Indicators (NDNQI) is the largest national database of US data relating to quality of nursing care.9 Falls in hospitals is one of the quality indices measured by the NDNQI organization since 2003 as a proportion of all falls per 1,000 hospitalization days. The reported fall rates range from 1.3 to 8.9 falls/ 1,000 hospitalization days. 10,11The lowest rates of falls are reported in Intensive Care Units (1.3 per 1,000 hospitalization days), adult wards (3.92 per 1,000 hospitalization days), and the highest rates are reported in rehabilitation wards (7.3 per hospitalization 1,000 days).12 The main risk factors for falls in hospitalized patients are impaired gait, confusion, urinary incontinence, history of falls and psychotherapeutic medications. 13 Economical costsThe economic burden of falls in general hospitals is significant. Indeed, it was found that falls increased the cost of hospitalization per patients that have fallen to an average of $6,669, and if the injury was caused due to a fall, the extra cost is on average between $12,000 to $23,000.14 In 2013, the gross expenditure from falls in the U.S was AbstractCurrently, around the world, hospitals invest a considerable amount of effort into preventing patients' falls during hospitalization. Despite the intensive emphasis targeted in preventive intervention, reducing the prevalence of this phenome...

Comparison of Humpty Dumpty and Buch Scales For Assessment of Fall Risk Among Pediatric Patients

“…Hasta güvenliği kapsamında hastaların düşme riskinin tanılanması, koruyucu önlemlerin alınarak düşmelerin önlenmesi hemşirenin sorumluluğundadır (27) . Literatürde, çocuklarda kullanılan ölçüm araçlarının duyarlılıklarının yüksek olmakla birlikte, özgüllüklerinin düşük olduğu (28) ve düşen hastaların yalnızca %47'sinde düşme riskinin belirlenebildiği vurgulanırken (3,14) bazı yazarlar tarafından hiçbir düşme riskini değerlendirme aracının güvenilir olmadığı belirtilmektedir (29) . Bununla birlikte, Uluslararası Birleşik Komisyonu (Joint Commission International, JCI) hasta güvenliği hedefleri arasında düşme riskinin bir ölçekle tanılanmasını ve bakım planlarında yer almasını önermektedir (3) .…”