Injuries from Falls and Immobility
In hospitals and other health care facilities patient and family falls are among the most frequently reported incidents. Unlike some other types of adverse events, many inpatient falls cause little or no harm, but the high overall rate of falls means that they are a significant cause of hospital-acquired injury. Falls can sometimes lead to severe injuries, such as hip fractures and head trauma.
Immobility is a decrease in the amount of time spent up and moving (getting out of the bed or chair and walking, for example). Immobility causes loss of muscle strength along with changes in the cardiac response to exercise. Immobility in the hospital increases the chances of delirium, pressure ulcers, venous thromboembolism, falls, and functional decline. Functional decline is the loss of the ability to perform activities that ensure a person’s independence, such as walking, getting to the toilet, and dressing. Functional decline leads to increased lengths of hospitalization and readmission.
Goal: The Partnership for Patients estimates that 25% of fall injuries are preventable. The goal set for hospitals is to cut the number of preventable fall injuries in half while maintaining or increasing patients’ mobility by 2013. Over three years, this would prevent a total of 43,750 fall injuries, while maintaining or increasing mobility.
While agreed-upon and evidence-based strategies for fall injury prevention in the hospital setting have been challenging to establish, the goal is to reduce fall injuries by encouraging safe mobility (getting up and walking) of patients. Efforts to reduce falls and fall injuries while increasing safe mobility focus on risk assessment followed by interdisciplinary and multi-component responses. Examples include avoiding bed rest orders; instituting a toileting schedule to assure that a patient has help walking to and from the bathroom at regular intervals; frequent walks; frequent reorientation if confused; providing a safe environment including good lighting, a bed that lowers to the floor, appropriate assistive devices, and removing clutter; and reducing drugs that may cause dizziness, drowsiness, or confusion. Devices such as bed and chair alarms that alert staff to a patient’s movement should be used only in combination with interdisciplinary and multi-component responses to avoid the consequences of immobility.i