By Don Sadler
Despite efforts to reduce their frequency in hospitals and in the OR specifically, patient falls remain a serious problem for health care facilities. It’s estimated that somewhere between 700,000 and one million patients in the U.S. experience a fall in the hospital each year.
Patient falls are obviously dangerous for patients, potentially leading to bruises, fractures, skin lacerations and other forms of trauma, as well as extended lengths of hospital stay for patients. The financial impact of patient falls is also significant – the cost of these falls averages $30,000 per hospital stay or $50 billion total per year.
And as of 2008, the Centers for Medicare & Medicaid Services (CMS) no longer reimburses hospitals for certain types of traumatic injuries that occur while a patient is in the hospital — many of which could result from a fall.
According to David Taylor, MSN, RN, CNOR, the president of Resolute Advisory Group LLC, while falls in the operating room are relatively rare, they do occur. “OR staff can prevent harm to their patients if they understand how these incidents occur and implement safety precautions to prevent them before they happen,” he says.
Taylor cites a 2018 study published in the AORN Journal that reviewed 22 OR patient falls between 2010 and 2016 within the Veterans Health Administration. The majority of the incidents (68 percent) involved patients falling from the OR bed while 27 percent happened during the transfer of the patient to or from the OR bed, according to the study.
Meanwhile, a review of The Joint Commission’s Sentinel Event database indicates that the main causes of patient falls are inadequate assessment, miscommunication, protocol deviations and deficiencies in the physical environment.
“There are any number of reasons why a fall could occur in the OR,” says Taylor. “These include tilting or malfunctioning of the OR bed, problems with safety restraints or locks on the gurney wheels, inadequate patient sedation and poor communication among OR staff.”
According to Holly Wirth, MSN, RN, SCRN, clinical director, neurosciences on the Inova Fairfax Medical Campus in Falls Church, Virginia, having a surgical procedure typically increases a patient’s risk of falling. “Medications, anesthesia and being connected to equipment are all factors that can lead to a patient falling down,” she says.
“Patients may walk into our facilities independently, but after having a procedure, they may feel unsteady, dizziness or weak,” Wirth adds. “Educating patients and their care companions on what to expect post-procedure or during their hospital stay helps create a safe environment for recovery.”
Being Proactive About Fall Prevention
Darla Ceppi, who is the clinical director of the orthopaedic/spine unit on the Inova Fairfax Medical Campus in Falls Church, Virginia, says that her facility is very proactive when it comes to falls prevention. “We ambulate our patients on the day of surgery,” she says. “And we’re aggressive with mobilization – all staff are trained on how to move the patients.”
When patients are admitted to the unit, Ceppi and her team discuss the falls contract with them, which encourages patients to call for assistance every time they want to get up.
“We also have fall mats by the bed in every room in case there is a fall to hopefully decrease injury,” says Ceppi. “And at shift change, every high-falls patient is discussed so all staff are aware and can help as needed.”
Taylor stresses the importance of eliminating distractions in the OR that can lead to patient falls. “Noise and loud music, for example, can keep the team from being focused on the patient,” he says.
“Also avoid irrelevant conversations that can keep team members from anticipating next steps,” Taylor adds. “Using electronic devices for patient care is expected but using your phone to text someone during a procedure is not. Neither is surfing the Internet during a surgical procedure.”
Taylor was once asked to review a medical malpractice suit in which various aspects of a patient fall were being evaluated to determine who was liable for the patient’s injuries.
“The phone records of the anesthesia provider and circulating nurse were subpoenaed,” Taylor says. “And the records revealed that they were both using their phones throughout the case, sending and receiving text messages, searching the Internet and playing games.”
Getting More Engaged
Brian Arndt, MBA, BSN, RN, CNML, who is the director for heart and vascular service for University Health, San Antonio, says that he has noticed an increase in fall prevention measures and stratification of fall risks in hospitals.
“The alarms are getting more sophisticated and the health care teams are more engaged in preventing falls,” says Arndt. “Although we are a long way from the goal of zero patient falls, I honestly believe we’re heading the right way.”
Arndt believes that not enough consideration has been given to the emotional and behavioral impacts of patient falls. “After a fall, I have observed that patients often demonstrate deceased self-confidence in gait and a reluctance to release railings or support devices,” he says.
“Or worse, I’ve seen patients frantically grasp at anything to hold on to, becoming unstable and falling again,” Arndt adds. “The fear of a repeat fall can represent a true barrier to recovery and mobility.”
Wirth concurs: “Psychologically, patients who fall may feel scared and anxious,” she says. “They may lose their sense of feeling safe, which may have a lasting impact on them.”
Taylor believes that training and education are among the biggest keys to preventing patient falls, along with fall risk screening tools. “So is an assessment of your OR and hospital equipment,” he says. “Adequate safety equipment, proper positioning equipment and technology can be simple solutions to patient safety and fall prevention.”
In addition, Taylor stresses the importance of never underestimating the size of patients who are being transferred. “I have seen near misses with every patient type, from infants to morbidly obese patients,” he says. “Be sure you have the right people in place for patient transfers, and never try to transfer a patient by yourself. There’s safety in numbers.”
“Awareness of the effects of sedation and blocks is critical in the perioperative environment, especially in an elderly population,” adds Arndt. “It’s vital to be familiar with all of the equipment in the OR and vigilant when positioning and transferring patients to and from the operating table.”
A Comprehensive Fall Prevention Program
The Inova Fairfax Medical facility has implemented a comprehensive, evidence-based patient fall prevention program in which nurses assess patients regularly using the Johns Hopkins Fall Risk Assessment Scale to determine their level of falling risk during their stay. “Interventions are then tailored to each patient’s individual needs and risk factors,” says Wirth
Nurses and care providers on the Inova Fairfax Medical Campus support fall prevention through a multi-faceted approach that consists of the following:
- Patient and family education;
- Purposeful rounding on patients to anticipate needs;
- Creating a safe patient care environment; and
- Embracing fall prevention technology such as bed exit alarms and remote video monitoring.
“We use AVASYS, which is a remote form of monitoring,” says Ceppi. “A small camera is placed in the patient’s room that sounds an alarm when the patient attempts to get up. For patients who are non-directable with AVASYS, we put a sitter in the room.”
“Our goal is to send each patient home better than when they arrive at our facilities,” says Wirth. “Preventing harm to patients while they’re on our campus – including patient falls – is a key component of our organization’s mission, vision and values.”
“All health care providers play a pivotal role in preventing patient falls and the injuries that can be caused by them,” adds Taylor.