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Patient Safety Project

Jordan University of Science and Technology

Faculty of Nursing

Inpatient Falls Prevention Project

Patient Safety Program in Al- yarmouk Hospital

Prepared by:

Ashraf Al-Smadi

Advised by:

Dr. Yaseen Hayajneh

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Patient Safety Project

Introduction and Significance:

Patient safety represents a primary principle of all health care institutions. It is

basically defined as “the prevention of harm to patients” [1]. Although simple in

definition, the path to ensuring patient safety presents considerable challenges for all

health care administrators, nursing managers, register nurses, physicians, pharmacists and

researchers, looking for accurately build up safe healthcare services in today’s highly

complex health care systems. Ensuring patient’s safety includes processes and operational

systems that decrease the chances of errors and increase the chances of stopping them

when they occur [1]. Moreover, safety requires a complex system, including a wide scope

of activities in environmental safety, performance improvement and risk management,

also including safe use of medicines, infection control, equipment safety, safe

environments of care and safe clinical practice. It holds mostly all healthcare disciplines,

regulations and performers. Thus, patient’s safty requires a wide-range approach in

recognizing and managing actual and potential risks in individual services [2]. Related

literatures revealed that adverse events such as nosocomial infections, medication errors,

and injuries including patient falls affect thousands of patients in hospitals annually [1].

Improvement of healthcare patient’s safety and healthcare quality are very important

to nurses [3]. For example, the International Council of Nurses (ICN) recommended with

its international campaign “Safe staffing saves lives” the importance of the patient safety

movement, focusing on a different of care indicators such as falls, inappropriate

surgeries, drug errors and factors that increase the morbidity and mortality of patients [4].

However, the institute of medicine [IOM] emphasizes the critical need to invest in

patient’s safety to improve health care quality regarding patient’s falls [1].

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Patient Safety Project

Related to western literature the falls defined as “A fall is a sudden, unintentional

change in position causing an individual to land at a lower level, on an object, the floor or

the ground, other than a consequence of a sudden onset of paralysis, epileptic seizure, or

overwhelming external force” [5]. In addition inpatient falls is defined as “An event in

which a patient suddenly and involuntary comes to rest on the floor with or without

physical injury,” [6]. In recent times, the Prevention of Falls Network Europe

recommended defining a fall as “an unexpected event in which the participant come to

rest on the ground, floor or lower level” [7].

The healthcare facilities identified patient’s fall as a serious health problem and may

result in injuries and complications, which prolongs hospitalization, decreases patients’

functional capacities, and leads to increased health care costs [8]. There is an impact on a

patient’s perception of safety and well-being; it may diminish the patient’s capability and

willingness to participate in activities of daily living and rehabilitation due to fear of

falling again. Many features of inpatient falls such as conditions, patient characteristics

and fall risk factors as well as interventions to prevent patient falls during hospitalization

have been widely researched.

Inpatient falls, is an important adverse event in healthcare settings, have not

considered as other adverse events. In spite of, that it is one of the most important

inpatient accidents and associated with negative clinical consequences. Inpatient falls and

fall-related injuries continue to be a multifarious challenge that a health care institution

confronts. For example, in acute care settings, inpatient falls represent the largest group

of reported incidents [9]. It is costing approximately $20.2 million per-year in resulting

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Patient Safety Project

diagnostic tests, legal expenses, injury repair & rehabilitation costs, and patient and

family dissatisfaction [10].

Several risk factors for inpatients falls have been identified such as Gait

instability, agitated confusion, urinary incontinence or frequency, a fall history, and the

use of drugs (sedative or hypnotics), have been found to be consistent risk factors

associated with inpatient falls [11]. The risk for hip fractures due to falls increases

significantly as the number of fall risk factors increase [12]. Risk factors associated with

inpatient hip fractures among older patients include: confusion, assisted ambulation, low

body weight, use of psychotropic drugs and impaired vision. Approximately 2% to 17%

of patients experience a fall during their hospital stays [13]. And fall related injuries

occur in 15% to 50% of hospital falls, and serious injuries including lacerations, fractures

or contusions are seen in 1% to 10% of hospitalized patient who fall [14].

During my training in al-yarmouk hospital I faced five accidents of inpatient fall

(5%), those accidents aware me to search for the most risk factors that contributed to this

obstacle, and find an appropriate strategies to reduce and prevent inpatients falling among

Al-yarmouk hospital departments.

Project Aim:

To increase nursing awareness about strategies that manage

and prevent inpatient's falls by proposing inpatient falls prevention

program among Al-yarmouk hospital departments as a path to improve

quality of healthcare by more precisely identifying patients at risk.

Method:

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Patient Safety Project

1. Find a process to improve: there is an opportunity to decrease inpatients falls at

Al-yarmouk hospital in order to maintain patient safety.

2. Clarify the current situation by:

a) Assess and analyze patient falls that reported during 2007 by number of

incident per department and subgroup.

b) Review for prevention assessments that were documented through 2007.

c) Review available fall prevention and management policy.

d) Review causes of patients falls that were documented through 2007.

3. Evaluate the risk factors that will contribute to increase inpatient falls

incidence.

a) Staff: insufficient educational background, incomplete nursing assessment,

incomplete medical assessment, and work overload.

b) Education and training department: lack of staff training and orientations

programs.

c) Overlapping of Documents forms and policies.

d) Patients' medications, education level, and treatment side effects.

4. Select of improvement process based on previous factors:

a) Staff:

• To review staff fall assessment and management competency.

• Monitor staff application of the fall prevention and management

policy.

b) Education and training:

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Patient Safety Project

• Conduct education sessions for health care providers about fall

policies, and fall risk assessment in Al-yarmouk hospital.

• Monitor staff performance related to safe handling and lifting of

patient.

• Develop intensive training at area of high incidence rate of falling

down.

c) Documents:

• Review fall prevention and management policy.

• Review patient fall risk assessment form.

d) Patient:

• Educate patients and their families about the prevention and

management of falls.

5. Plan:

Tasks Responsible person

Encourage reporting of patient falls All healthcare providers

Review fall prevention and management policy Nursing department

Analyze the causes of patients falls reports Nurse

Monitoring of falls prevention and management Nurse


policy implementation
Training and education of staff on falls prevention Education department
and management policy.
Check the staff competencies in patient falls Educators in each unit
prevention and management.
Educate patient and family about prevention and All health care providers
management of falls.

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Application of inpatients falls prevention program:

• Assessment of patient risk for falls including health history, physical

examination, vital signs, visual acuity, grip strength, range of motion,

cardiovascular, musculoskeletal, neurological, and skin assessed upon

admission, at the beginning of each shift, when patients condition

change and following a patient's falls or near fall.

• Assessment of patients functioning in the following areas: balance

gait, precipitating behaviors, physical status, cognitive function,

functional status, psychosocial, environmental and risk behavior,

medication and alcohol use assess upon admission, at the beginning of

each shift when patients condition change and following a patient's

falls or near fall.

• Monitor environmental and patient's safety on regular basis.

• Encourage participation in functional activities and exercise at patient

high possible level and refer to physical therapy as appropriate.

• Educate patients and their families regarding fall prevention and

management.

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Patient Safety Project

Conceptual model for falls in Al-yarmouk hospital setting

A conceptual model provides as helpful summary of the multifactorial nature of

inpatient falls in Al-yarmouk hospital setting. In order to conceptualize the complexity of

hospital falls, risk factors at the patient and environmental level, the clinical context and

the clinical and economic consequences are graphically represented in Figure 1.

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References

IOM (ed.): Patient Safety - Achieving a new Standard for.1

Care. Washington, DC: The National Academies Press;

.2004

World Alliance for Patient Safety Forward Programme.2

[2005 [www.who.int/patientsafety

Doran TB, S. Mendez, P. Poe, S. S. Newhouse, R.: Patient.3

Safety as a Measure of Health-care Quality. In: Measuring

Patient Safety. Edited by Poe SSN, R. Sudbury, MA: Jones

.and Bartlett; 2005

ICN: Safe staffing saves lives - International.4

Nurses Day 2006. Geneva: International

.Council of Nurses; 2006

Gibson MA, RO. Isaacs, B. Radebaugh, T. Worm-Petersen,.5

J.: The prevention of falls in later life. A report of the

Kellogg International Work Group on the Prevention of

Falls by the Elderly. Danish Medical Bulletin 1987,

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Gaebler S: Predicting which patient will fall again. and.6

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Lamb SE, Jorstad-Stein EC, Hauer K, Becker C:.7

Development of a common outcome data set for fall injury

prevention trials: the prevention of falls network europe

.consensus. J Am Geriatr Soc 2005, 53(9):1618-1622

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Rene Schwendimann: patient falls, akey issue in patient.8

.safety in hospital, 2006

Gaebler S: Predicting which patient will fall again . . . and.9

.again. Journal of Advance Nursing, 18:1895–1902, 1993

Englander F, Hodson TJ, Terregrossa RA: Economic.10

dimensions of slip and fall injuries. J Forensic Sci 41:733–

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Evans D, Hodgkinson B, Lambert L, Wood J: Falls risk.11

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Lichtenstein MJ, Griffin MR, Cornell JE, Malcolm E, Ray.12

WA: Risk factors for hip fractures occurring in the hospital.

.American Journal of Epidemiology 1994, 140(9):830-838

Heinze CL, N. Dassen, T.: Sturzhäufigkeit in deutschen.13

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