BackgroundFalls in the hospital affect around 1 million people a year (2013). Anywhere from 30-51 percent of falls result in injury estimating an additional $13,000 per patient stay and an average increase in the length of stay by 6.27 days (Butcher, 2013). Federal and state policies have been enacted to solve this ongoing problem.
Initiatives have implemented fall reduction techniques, yet falls still occur despite several efforts to prevent them. Policy can guide nursing practice in reducing patient falls by mandating fall prevention, continuing education for nurses, and integrating interdisciplinary stakeholders. Current healthcare reform has placed increased emphasis on patient quality and value while simultaneously decreasing healthcare costs through policy. The Patient Protection and Affordable Care Act (ACA) urges the government, insurance providers, and healthcare providers to improve healthcare quality and decrease costs (Glogovsky, 2017). The demand for fall prevention increases as our population ages. The chance for falls, and falls with injury is higher in the elderly. Currently, at least 22 percent of patients are 74 or older (Butcher, 2013).
Older adults will account for 83.7 million people by 2050 in the U.S (Butcher, 2013).
Fall prevention is viewed as a priority for the elderly population, and multiple initiatives have developed to reduce falls in this population. Payment and finance are potent drivers of quality incentives (2015). Falls Free National Action Plan was published in 2005 by the National Council on Aging. Shortly to follow, the Safety of Seniors Act of 2007 helped the identification of fall risk, prevention methods, and data collection. By increased national awareness of fall reduction, in 2008, the Centers for Medicare & Medicare (CMS) decided the Deficit Reduction Act of 2005 decided to no longer reimburse the healthcare costs associated with a patient fall during the hospital stay (Glogovsky, 2017). This made fall prevention of high importance in the hospital system, and hospitals increased fall prevention awareness and education.
Many nongovernmental parties also play a meaningful role in quality enhancement. The NCOA issued action plans to guide fall prevention tactics. A toolkit was developed to maintain fall prevention programs in the hospital. The Robert Wood Johnson Foundation and the Institute for Healthcare Improvement created a guide to prevent falls through their Transforming Care at the Bedside initiative. Concentrating on accurate fall risk assessment, bedside reporting, assessing high fall risk medications, and applying multidisciplinary fall prevention programs. Policy can benefit quality, value, and safety. The first policy change I would adjust is, having multidisciplinary stakeholders reinforce policy changes. To advance fall prevention strategies, the identification of invested stakeholders is imperative.
Key stakeholders include CMS, state policymakers, mobility experts, and nurses. Nurses are fundamental stakeholders driving fall prevention through the application of fall prevention techniques. Nurse education will turn the interventions and knowledge of fall prevention should be standardized across all nursing practice. Policy can drive change, but how good is a system without practice? “Policy mandated continuing education can help standardized nursing practices for fall prevention and bridge the gap between theory and practice (Glogovsky, 2017). The American Nurses Association states falls are a direct result of nursing care (Butcher, 2013).
The policy supported evidence-based practice education should be mandated for all nurses. Nurses need to be consistently educated on the most recent fall prevention strategies and techniques. Fall education should begin in nursing school programs, providing a firm foundation. SummaryInpatient falls continue to be an ongoing issue in the hospital. By identifying key stakeholders and implementing education for nurses through evidence-based practice, falls can be profoundly decreased resulting in improved patient care quality. Nursing should be the forefront of fall prevention education and involved in policy changes.