What’s New in the Patient Safety World

October 2015

Patient Perception of Fall Risk

So why do patients whom we identify as being at high risk for falls still fall? One reason may be that the patients themselves do not perceive that they are at risk for falling. A new study used several survey tools to assess patients’ perceptions of fall risk and compared these to nursing assessments of fall risk (Twibell 2015). Twibell and colleagues surveyed 158 patients identified by nurses as been high risk for falls (most had fallen in the previous year). They found a striking disparity between the perceptions of patients and nurses regarding the risk of falling. More than half the patients deemed at risk by nurses did not perceive themselves as being at risk for falling. Those patients who had a low intention to participate in fall prevention reported a low fear of falling, low perceived likelihood of adverse outcomes from falling, few consequences of falling, and high confidence in safely performing risky behaviors.

The study strongly suggests that a measure of the patient’s perception of fall risk needs to be part of any fall prevention program individualized for each patient. Twibell and colleagues stress the importance of teach-back in helping the patient understand both the risk of falling and the dangers they may encounter if they do fall. The same recommendation for teach-back was stressed by Quigley (Quigley 2015) in our August 2015 What’s New in the Patient Safety World column “Not All Falls Are the Same”.

In the latter column we noted the VA National Center for Patient Safety Falls Tool Kit which has many very useful fall prevention resources available for download. In addition, the Joint Commission Center for Transforming Healthcare now has a Targeted Solutions Tool for Preventing Falls. The 7 hospitals participating in that project were able to reduce the rate of patient falls by 35 percent and the rate of patients injured in a fall by 62 percent. Extrapolated to a typical 200-bed hospital the number of patients injured by falls could be reduced from 117 to 45 annually and almost $1 million in cost reduction.

Some of our prior columns related to falls:

• April 16, 2007 “Falls With Injury”
• July 17, 2007 “Falls in Patients on Coumadin or Heparin or Other Anticoagulants”
• January 1, 2008 “Fall Prevention”
• October 7, 2008 “Lessons from Falls....from Rehab Medicine”
• November 18, 2008 “Ticket to Ride: Checklist, Form, or Decision Scorecard?”
• August 4, 2009 “Faulty Fall Risk Assessments?”
• September 22, 2009 “Psychotropic Drugs and Falls in the SNF”
• December 22, 2009 “Falls on Toileting Activities”
• January 2010 “Falls in the Radiology Suite”
• June 2010 “Seeing Clearly a Common Sense Intervention”
• May 29, 2012 “Falls, Fractures, and Fatalities”
• June 5, 2012 “Minor Head Trauma in the Anticoagulated Patient”.
• January 15, 2013 “Falls on Inpatient Psychiatry”
• March 2013 “Sedative/Hypnotics and Falls”
• December 3, 2013 “Reducing Harm from Falls on Inpatient Psychiatry”
• June 2014 “New Glasses and Fall Risk”
• July 8, 2014 “Update: Minor Head Trauma in the Anticoagulated Patient”
• August 2014 “Cataract Surgery and Falls”
• November 4, 2014 “Progress on Fall Prevention”
• March 2015 “Another Paradox: Falls Due to Walking Aids”
• June 9, 2015 “Add This to Your Fall Risk Assessment”
• August 2015 “Not All Falls Are the Same”

References:

Twibell RS, Siela D, Sproat T, Coers G. Perceptions Related to Falls and Fall Prevention Among Hospitalized Adults. Am J Crit Care 2015; 24: e78-e85

http://ajcc.aacnjournals.org/content/24/5/e78.full.pdf+html?sid=505c0e5d-3b39-49f2-a056-9be99da336c9

Quigley P. Types of Falls and Suggestions to Reduce Them. VA TIPS (Topics in Patient Safety) 2015; 15(4): 3

http://www.patientsafety.va.gov/docs/TIPS/tips2_july_aug_15.pdf#page=3

VA National Center for Patient Safety. Falls Tool Kit.

http://www.patientsafety.va.gov/professionals/onthejob/falls.asp

Joint Commission Center for Transforming Healthcare. Targeted Solutions Tool for Preventing Falls.

http://www.centerfortransforminghealthcare.org/tst_pfi.aspx

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http://www.patientsafetysolutions.com/

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