When Connie Nightingale and her husband, R. Richard Roy, traveled from their home in Maine to Brigham and Women’s Hospital (BWH) for Roy to begin six weeks of leukemia treatment, the possibility of falling was not on their radar screen.
After being admitted, a nurse pointed out the color-coded poster at the foot of Roy’s bed, with images showing risks of falling on the left and how to prevent it on the right.
“She asked, ‘Do you have any questions,’ and we said, ‘No, these problems don’t look like us,’” Nightingale recalls. “The nurse said, ‘Well, with the medication we’re going to give you, this will be you.’ She pointed out his risk and circled what he should do to be safe. It was eye-opening.”
Help for the most vulnerable
Each year, nearly 1 million patients across the United States fall during hospital stays. Between 30 to 50 percent of those patients suffer an injury.
“Any patient who is hospitalized can be at risk of falling because of the unfamiliar environment, illness, surgery, and medications,” says Patricia Dykes, PhD, RN, FAAN, senior nurse scientist and program director in the Center for Nursing Excellence at BWH.
Several years ago, Dykes developed a fall prevention toolkit and tested its effectiveness through a clinical trial of 10,000 patients at four hospitals.
“We saw a 25 percent decrease in falls,” she says. “Fall T.I.P.S. [Tailoring Interventions for Patient Safety] became our standard at BWH, and we’re continuing to refine it. We learned we need to improve communication among the care team, and to involve patients so they understand why they’re at risk and what precautions to take. The poster makes it clear.”
Dykes and her colleagues also found patients like Roy, who are used to being self-sufficient, do not realize how fast they can lose muscle strength.
Nightingale says, “For someone who has never been sick, he thinks, ‘I can do this on my own,’ but I tell him, you have to ask for help.’”
Dykes adds, “Some patients don’t call the nurse because they want privacy, or they think the nurse is too busy helping other patients.”
Expanding the toolbox
Escel Stanghellini, MSN, RN, quality program director for BWH’s Department of Nursing, says, “The main idea is to individualize care, and Fall T.I.P.S. is one of several tools.”
Nurses may also use signs on patient doors indicating high risk, assign personal care assistants to sit in a patient’s room, or use continuous virtual monitoring (CVM), which uses video and audio to remotely observe and direct patients.
With Brett Glotzbecker, MD, a physician in medical oncology, Stanghellini co-chairs a hospital-wide falls taskforce, where representatives from 10 departments across the hospital discuss cases and best practices to refine fall prevention policies.
“This is not just a nursing responsibility,” Stanghellini says. “All care providers and support staff have a role in patient safety and fall prevention.”
Reducing fall injuries in the community
Outside the hospital, people aged 65 and older are most at risk for falls. Each year, 2.5 million older adults go to emergency rooms with injuries including broken bones and head wounds.
“Injuries from falls are the leading cause of preventable death in older people,” Dykes says. “One fall can lead to a downward spiral of reduced mobility and declining health.”
Barbara Holder, a BWH primary care patient, is an avid walker and wants to maintain her independent lifestyle. She signed up for the nationwide study, STRIDE (Strategies to Reduce Injuries and Develop Confidence in Elders), aimed at preventing falls for people aged 75 and older in the community. Ten healthcare systems are participating in the study, including Partners HealthCare, founded in 1994 by BWH and Massachusetts General Hospital. Dykes is one of the study’s principal investigators for the Partners Healthcare site.
Holder enrolled in the study because, “I began drifting to one side when I walked, and it concerned me. About a month ago, I had cataract surgery, and now I’m walking a straight line.”
Vision problems are among the most common fall risk factors, as well as tripping hazards in the home, medication side effects, and lack of strength or balance. Through the study, a specially trained nurse evaluated Holder’s mobility and came to her home to advise on fall hazards.
“She also recommended a balance program through the local senior citizens’ facility, and I’m really grateful,” Holder says.
Dykes adds, “The good news is most falls are preventable. Our goal through all our work is to give patients the tools they need to avoid a fall based on their individual needs.”