Decreasing Patient Falls by Including Medication Induced Factors in Fall Assessment

Inpatient falls are the primary cause of injuries in health care facilities. The intended project goal was to reduce inpatient falls in the cardiac stepdown unit (CSU). Adding the Medication Fall Risk Score to the current fall risk assessment resulted in fewer falls. The CSU had the highest fall rate and the highest increase in patient falls. Patients in the CSU are often older. Medications used to treat this patient population are betablockers and antihypertensive meds. These medications are in the class of falls risk inducing drugs (FRIDs), which increases the possibility of falls in this population.

The Cardiac Stepdown Unit (CSU) showed a 51% increase in falls while all other hospital units showed a decrease. Fall rates of the CSU are 4.12 per 1000 patient days which is above the hospital average of 1.89, and the national stepdown unit average of 3.44 (AHRQ, 2022). The CSU falls rate prompted discussion of current practices with the Quality Improvement Coordinator (QIC).1 Current hospital falls prevention protocols include the Hester-Davis Scale for Falls Risk Assessment (HDS), bedside assistance, and hourly rounding which are recommended by the AHRQ.2 Patient education, using brochures, and the teach-back method, is utilized to improve outcomes (Heng, 2020). High-risk patients receive additional bedside assistance depending on the impairment (gait, visual, cognitive). The Quality Improvement Coordinator (QIC) performed a root cause analysis, and then the project team discussed the results. 

Nurses followed regular protocols regarding fall prevention, and patients understood their falling risk. According to the QIC, following a review of the medication taken by the patients that experienced a fall, those patients were continuing medication regimens that included FRIDs (J.F. personal communication, March 7, 2021). Analysis of patient vitals determined medication orthostatic hypotension as contributing factor in patients that fell. Therefore, a gap in nursing practice for falls prevention was identified. The Project Manager suggested an update to the assessment criteria for falls risk.

https://www.stephypublishers.com/tnhcr/pdf/TNHCR.MS.ID.000513.pdf 


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