The call you do not want to make
Martie L. Moore, RN, MAOM, CPHQ
I can still remember it clearly when the phone rang and a serious voice on the other end of the line told me what happened. My loved one fell and, luckily, didn't break any bones.
No one saw it happen and she was found on the floor. Bloody, bruised and confused – she did not remember what happened. She thought she was going to the bathroom, or maybe it was to get a drink of water. She made a joke about being forgetful and clumsy.
I knew better. I knew she was high risk due to her age and medications. I also knew she most likely had a physiological fall because of drop in blood pressure from her new medications. Falls are now being characterized by the contributing factors to the falls. Do you debrief falls and use the data to advance improvements in safety and injury reduction?
As we figured out the right dosage of medications, I knew she might fall again. I needed to think about how to mitigate severe injury. Falls management programs have morphed into Falls and Injury Management Programs. The assumption is, falls will occur and focus needs to be on minimizing injury.
Traditional falls programs look at motor coordination, mental status, tripping hazards, medical condition and medications, toileting and medical devices. What we now understand is that fall programs need to expand to address things like sleep hygiene, assessment of clothing and footwear, nutritional intake (including review of calcium), vitamin D intake, and does the person knows what to do as he or she falls?
Wait, “Does the person know what to do as he or she falls?” That is right. Now part of a Falls and Injury Management Program is teaching someone at high risk for a fall, how to fall. It seems counterintuitive, but the research shows when those who are high risk for falls are “taught how to fall,” there is actually reduction of severe injuries.
We also know falls cause an Emergency Department visit every 11 seconds here in the United States and that 44% of falls result in life-threatening injuries. Out of those who experience fractured hips, 50% die within six months of the injury. The Centers for Disease Control and Prevention data also reflects falls with injury contribute to more than 800,000 patients a year being hospitalized, most often because of a broken hip or head injury. Fall injuries are among the 20 most expensive medical conditions. The average hospital cost for a fall injury is above $30,000.
Clinicians and caregivers can learn more about free tools, strategies and education aimed at falls prevention by visiting Medline University at www.medlineuniversity.com.
No one wants to make the call to their residents' loved ones to tell them there's been a fall, or worse, a fall with an injury.
Fall and injury prevention is an organizational issue. Everyone must work together and be clearly engaged to assure a culture of safety.
Martie Moore, RN, MAOM, CPHQ, is the chief nursing officer at Medline Industries Inc. and a corporate advisory council member for the National Pressure Ulcer Advisory Panel.