Hospital fall prevention doesn't work, study says

Despite nationwide efforts to prevent inpatient falls, new research disputes the assumption that hospital falls are really preventable, according to an article published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS).

As the leading cause of injuries (fatal and nonfatal) of older Americans, one in three senior citizens have a fall, totaling more than 11 million people over the age of 65, according to a JAAOS press release. In hospitals, about 3 to 20 percent of inpatients have a preventable fall. However, the literature review indicates that hospitals may not be able to prevent most falls.

Long-standing fall prevention strategies, such as patient education, vision assessment, and walking aids are not as effective in the hospital setting as they are in long-term care or home care settings, according to researchers.

"Of course, hospitals should educate patients and the families, use bed rails, keep beds low, keep floors dry and clear of clutter--all the common sense things that can reduce the risk of falls," said Terry A. Clyburn, MD, orthopaedic surgeon at the University of Texas Medical School in Houston and coauthor of the article, in a statement. "But we found no proof that falls in hospital are, in fact, preventable. And if not, they should not be categorized as a preventable occurrence and the burden shouldn't be borne by hospitals."

Other contributing factors to falls that may not be preventable (from a hospital perspective) are patient conditions, such as delirium, Parkinson's disease, osteoporosis or arthritis, history of stroke, vision or hearing problems, malnutrition, dizziness and vertigo, incontinence, and medications that might alter mental status.

"You have a patient who already needs hospital care for another condition, who may have recently undergone general anesthesia, who may be on strong pain medication," Clyburn said. "In the short time that the patient is admitted, it's difficult to also manage all the other risk factors that can contribute to a fall."

Hospitals are responsible for implementing fall prevention strategies, as required by the Deficit Reduction Act of 2005 and the Fiscal Year 2009 Inpatient Prospective Payment System Final Rule, outlined by the Centers for Medicare & Medicaid Services, according to the study. In addition, preventable inpatient falls are subject to nonreimbursement. Treatment for falls and complications costs the U.S. $20.2 billion each year, according to the press release.

For more:
- read the study abstract
- check out the press release

Related Articles:
NQF expands list of serious reportable events
Catch 22: Better reporting reveals more adverse events at hospitals
Patient falls challenged as no-pay events