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Running Head: THERAPEUTIC NURSING INTERVENTIONS

Therapeutic Nursing Interventions-Falls

Teresia Isiaho
Old Dominion University
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Running Head: THERAPEUTIC NURSING INTERVENTIONS

Therapeutic Nursing Interventions-Falls

Patient falls in acute care setting are a vital clinical concern. The Joint Commission

estimates that in the United States, hundreds of thousands of patients fall in hospitals/ year, with

30-50 percent resulting in injury (Joint Commission, 2015). Providing quality care and patient

safety is a top priority in acute care hospital settings. Different hospitals have protocols and

policies to follow to prevent falls. Nurses must maintain patient safety, screening patient for fall

risk during admission, and reassessing according to a hospital fall protocol. Even after following

these intrusions patient falls are still occurring and continue to be a massive problem during

patients hospitalization.

Clinical Problem

I currently worked on the medical-surgical/ diabetic floor. Each nurse assigned to five to

seven patients during the day shift. In this unit, even after utilizing nursing care plans, call light

/alarm, and fall bundles, injuries from this type continued to arise. In hospital setting patients are

at higher risk for falls than home because of their acute illness, medications, treatments, and

strange environment. Patient fall incidences are familiar in this floor. According to Ambutas

patient falls one of the most commonly reported incidents, often resulting insignificant injury,

death, loss of independence, prolonged hospital length of stay, and increased hospital costs

(2017, pg. 1 para 1). Per this study in a year 700,000 and 1,000,000 patient falls in the United

States during their hospitalization (Ambutas,2017). Most patients in this unit have diabetes. Also,

patients in this population are mostly in pain; they require frequent use of pain medicines (orally

and IV) which can alter their alertness and orientation levels or cognition hence creating a

considerable risk for falls. It also includes many patients with impaired gait due to age and

disability, diabetic vacuum wounds, attached medical equipment (IV tubing), and small, crowded
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Running Head: THERAPEUTIC NURSING INTERVENTIONS

patient rooms. These factors create the risk for falling at a prominent level until they return to

pre-hospital status. On a medical-surgical unit collaboration is the key toward positive patient

outcomes. In addition to nurses, patients are assisted by certified nursing assistants (CNAs)

occupational/ physical therapists and doctors. It is essential that all staffs be aware of fall

prevention implementations and goals. Nurses sometimes are faced with an enormous load of

patients making it unsafe to provide the maximum safety care required but with outstanding

protocols in place fall prevention are achievable.

Current Clinical Practice

Our floor use evidence-based practices and formal interventions such as Morse screening

and Fall Bundle tool. A patient that score forty-four or higher is at fall risk level. The floor

nurses use formal intervention to reduce falls by establishing hourly rounding, locking the

hospital bed and keeping it in the lowest position, non-skid socks on each patient. Also sticking

fall risk signs at the door, having at least one side rails up, having the bed /chair alarms on

correctly, call light within reach, yellow bracelet, and assisting patients to and from the bed.

After twelve hours another reassessment is done to reestablish changes or increase of numbers.

Even after Morse screening and Fall Bundle are set in place, there are still incidences of patient

falls in our unit. Patient load and nurse burn out issues might contribute due to lack of enough

time to establish Fall Bundle. Also, lack of collaboration with other healthcare teams such as

doctors when they come to assess the patient may forget to lower the bed and leaving the side

rail down. On the other hand, relatives might try to assist a high-risk patient unknowingly of their

fall status. Other patients want to maintain their independence and to prove to their caregivers

that they can ambulate without assistance.

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Running Head: THERAPEUTIC NURSING INTERVENTIONS

Nursing Interventions

There is plenty of literature regarding fall prevention interventions in acute care settings.

This was done initially to identify why in medical-surgical unit fall accidents continued to

increase even after the use of Fall Bundle, yellow bracelet, call light /alarm in place, hourly

rounding, signs, and fall video. The project task revealed even after all these measures fall rates

continued to occur. According to Ambutas study, an initiation to identify what preceded the falls

and detect patterns was important. The results demystified that classifying the patient as high or

low risk on numbers of falls is irrelevant because it takes one risk factor to lead to a fall (Silva,

2017). This classification method regarding high or low risk is one intervention that our unit use.

After this study, if a patient has four numbers of falls and is regarded as high risk, then it is

essential to assess and evaluate what caused those numbers to increase. The intrinsic and

extrinsic factors, age, and environment changes need to be checked and implemented to create

positive outcomes. Identifying the causes will be of immense help to better our fall prevention

program. Woodall (2014) found out that of 65 and older experience falls/year while one out of

five falls results in severe injury. Another nursing intervention was illustrated in a meta-analysis

and was carried in a medical-surgical unit for ten years. This was done to identify and give

solutions regarding fall risk and injuries. The study identified medication review, environmental

aids, fall teams, and technology as factors to consider decreasing falls injuries (Ambutas 2017).

Most of our patients are on controlled analgesics with symptoms such as dizziness or syncope

and muscle fatigue. Patient teaching is vital towards these types of patient, reminding them to

ask for help to ambulate is not enough because most patient will try to sneak out of bed. An

intervention to minimize narcotic fall such as one to one observation, call bell, and support to

ambulate should be in use. Staff knowledge about the effects of pain medication is also important
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Running Head: THERAPEUTIC NURSING INTERVENTIONS

to learn to prevent fall risk factors. The patient room should also be free from clutter, wet floor

spills, chords, good lighting, etc. Per Ambutas New practices included the use of an

Interprofessional fall team, floor mats and low beds, teach-back of families and patients, and

appropriate equipment with documentation of mobility on the communication board (2017, pg.

177). This study allows me to reflect on the benefits of a clean and safe environment. Also

including fall prevention program to teach the families and patients, on how to prevent falls.

Most of the time teaching is done to the patient only due to the time limit. Morris & Oroidin

echoes that a systematic review is important in preventing falls such as effective leadership,

multi-professional education and training, the continuation of learning and involving patients and

families members (2017). Additional a retrospective study and a hypothesis question were done

to find out whether there was a correlation between the nursing assessments and identification

of patients at risk for falls and nursing staff compliance with fall prevention program policy

(Urquhart,2013). In our medical-surgical unit, it is essential to integrate nursing assessment,

MORSE tool, and Fall Bundle. Doctors and nurses compliance to fall prevention protocols is

critical this will help lower patients fall injuries through teamwork and collaboration. Assessing

and providing interventions with rationales that are evidence-based practice will also decrease

the rates of falls in this unit. Per Votruba, Wisinski, & Syed (2016) suggest that remote video

monitoring is a safe intervention. The importance of video monitoring would not only improve

outcomes, but would also save money directly, lower legal costs, and improve patient

satisfaction (Votruba, Wisinski, & Syed (2016). This technology intervention lacks in my unit;

it can be implemented to lower hospital cost since Medicaid and Medicare do not pay for falls

that occur during patient hospitalization. This will also reduce the use of 1: 1 sitter during the

hospital stay. Patient safety will even be reestablished to an advanced level which will improve
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Running Head: THERAPEUTIC NURSING INTERVENTIONS

the patient satisfaction. These interventions continue to be implemented on our unit to prevent

falls. If I had to come up with a research study to avoid falls, I choose to test the efficacy of

causes of falls. Most falls might be credited to a delay of nurses on answering the call bells.

Nurses and nursing assistant need to respond promptly to assist both high /low-risk fall patient to

and from the bathroom. The research will also help to understand why nurses are not reacting

quickly. Is there any call bell fatigue, patient load, or beliefs regarding call bell? I theorize that if

nurses respond to all call bells within less than four minutes, then the figure of patient falls

would decline.

Summary

Patient safety is a top priority toward providing patients quality care; it is essential to prevent

falls during the hospital stay. Fall prevention is a global problem in acute care and in-home

health care setting. Falls cause patient death/ harm, dissatisfaction, and are costly to the hospital.

There is an abundance of literature trying to identify and give solutions to this clinical problem.

The use of innovation, formal, and informal intervention can curb and decrease fall issues. The

collaboration with the rest of health care workers is vital to implement this substantial clinical

concern. The studies above are just a select few that can be used to help achieve a superior fall

prevention.
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Running Head: THERAPEUTIC NURSING INTERVENTIONS

References

Ambutas, S. (2017). Continuous Quality Improvement. Fall Reduction and Injury Prevention

Toolkit: Implementation on Two Medical-Surgical Units. MEDSURG Nursing, 26(3),

175-197.

Morris, R., & O'Riordan, S. (2017). Prevention of falls in hospital. Clinical Medicine, 17(4),

360-362. Therapeutic Nursing Interventions Preventing Falls

Preventing falls and fall-related injuries in hospital settings (2015). The Joint Commission, 55.

Retrieved from: http://www.jointcommission.org/assets/1/18/SEA_55.pdf

Silva, K. B. (2017). Continuous Quality Improvement. Fall Prevention: Breaking Apart the

Cookie Cutter Approach. MEDSURG Nursing, 26(3), 198-213.

Urquhart Wilbert, W. (2013). The Effectiveness of a Fall Prevention/Management Program in

Reducing Patient Falls: A Retrospective Study. JOCEPS: The Journal of Chi Eta Phi

Sorority, 57(1), 24-27.

Votruba, L., Graham, B., Wisinski, J., & Syed, A. (2016). Video Monitoring to Reduce Falls and

Patient Companion Costs for Adult Inpatients. Nursing Economic$, 34(4), 185-189.

Old Dominion University Honor Pledge:

I Teresia Isiaho, pledge to support the Honor system of Old Dominion University. I will refrain
from any form of academic dishonesty or deception, such as cheating or plagiarism. I am aware
that as a member of the academic community, it is my responsibility to turn in all suspected
violators of the Honor Code. I will report to a hearing if summoned.
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Running Head: THERAPEUTIC NURSING INTERVENTIONS