A literature review published in the Journal of
the American Academy of Orthopaedic Surgeons has reported many of the
risks that frequently cause falls are not adequately addressed with fall
prevention initiatives used in health care facilities.
Approximately 3% to 20% of inpatients fall at least once
during their stay, according to an American Academy of Orthopaedic Surgeons
press release, and because these falls are considered preventable by the
Centers for Medicare and Medicaid, the health care facilities they occur in are
held accountable for any resulting injuries. However, the authors of the review
found hospitals may not be able to prevent most falls — because many risk
factors are not under the caregivers’ direct control.
“Our review of the literature revealed that the
risk of fall is only slightly greater in the hospital environment than in the
home and that there is no medical evidence that evidence-based guidelines are
effective in fall prevention,” review authors Terry A. Clyburn, MD, and
John A. Heydemann, MD, wrote.
One of the studies examined in the review found
comprehensive fall prevention programs — including patient education,
vision assessments and walking aids — did not reduce the incidents of
falls for patients undergoing a typical inpatient hospital stay. It noted that
such strategies are more effective in long-term care or carefully managed home
care settings.
The review noted fall reduction methods currently used
by health care settings are not harmful and do not increase risks, so they may
be continued. Many patients who suffer falls in the hospital have internal risk
factors or other conditions or disabilities that increase likelihood of
falling. Evidence suggests there is no conclusive difference in the number of
falls during typical, shorter-length hospital stays at institutions with or
without multifaceted fall prevention programs.
“Of course hospitals should educate patients and
families, use bedrails, keep beds low, keep floors dry and clear of clutter
— all the common-sense things that can reduce the risk of falls,”
Clyburn said in the release. “But we found no proof that falls in hospital
are, in fact, preventable. And if not, they should not be categorized as a
preventable occurrence and the burden shouldn’t be borne by
hospitals.”
For more information:
- Clyburn TA, Heydenmann JA. Fall prevention in the elderly: Analysis
and comprehensive review of methods used in the hospital and in the home.
J Am Acad Orthop Surg. 2011;19(7):402-409.
