Patient Education on Fall Risk
Falls encompasses the events that result in inadvertently coming to an abrupt rest among patients on the ground or any surface that are relatively lower than their initial surface of occupation. These occurrences are usually common and at the same time preventable. They can occur when the patient is in the hospital setting or even after discharge. The falls usually lead to exacerbation of the condition or lead to the development of a new one for instance in the occurrence of a fracture (Gu et al., 2015). This paper dwells on the risk of falling and the mitigation measures advocated for by various researchers.
Healthcare Problem
Fall risks forms another critical aspect that threatens the patient safety together with other issues such the medication errors and the violence within the hospital settings. The accidental falls that happen to the patients are likely to complicate their hospital stays as it usually adds other health needs apart from the initial reason for admission. Various factors exist concerning the fall risks. For instance, the falls can be dependent on the type of department in a care setting. Units such as medicine, neurosurgery and neurology departments tend to have many falls compared to the surgical and intensive care units.
Other patient factors that contribute to the risk of falling encompasses the mental health status, age, use of ambulation assistive devices such as crunches as well as the severity of the illness that the patient is suffering from. The falls among individuals occurs in the instances where they encounter weakness, impulsivity, confusion, poor judgment and reasoning as well as the tampered safety awareness. The patients may also have an uncontrolled movement that raises the risk of falling by sliding out of their bed or even chair. In certain circumstances, the patient can encounter assisted falls in the events where patient having limitation in movement is rehabilitated to learn new ways of moving as well as attempting to regain their strength and endure the move.
The significance of Problem
The essence of impacting the patient risk of falling is significant because it affects both the patients as well as the care facilities where the patients are cared for. Approximately 25% of the falls that happen within hospital settings results in injuries while other develop fractures. Other patients can develop internal hemorrhages and lacerations from the falls. In addition to the above effects, the falls increase the costs since additional specialized care may be involved. The length of stay, as well as the liability of the patient, also increases from the occurrences. The falls may also complicate the initial ill health thus deteriorating the health of the patient.
Current Practice
Various health facilities have adopted various ways to go about the risk of fall among their patients. The institutions have adopted integrative programs in approaching the menace. These include staff training, patient evaluations and the environmental medication which all culminates to reduce the risk of falling among the patients. Gu et al., 2016 alludes that the integrative program used by most facilities revolves around taking into account od the design of the care facility, enhanced communication among various healthcare professionals as well as systematic reviews of the various practices that are already in place meant for the reduction of the falls risks.
Concerning the integrative practice, the current practice kicks off with the risk assessment where the chances of getting involved in the accident are determined. With determined risk, various hospitals embrace the use of assistive devices for those with mobility impairment. These include the crunches for the movement as well as alarm buttons within reach of bedridden patients to give an alert to the care providers for assistance. Another practice include the issuing of the patients with foot wears that reduce the risk of falling
Impact on Background
Falling risk has impacted the healthcare delivery in various care settings mainly due to the aging population that is increasingly growing worldwide. The advanced age together with other patient conditions that impair balance have made the risk of falling to be high among the patients. The falls results not only negatively to the patient but also the hospitals. The hospitals are usually responsible at all times while at the same time it deconstructs the reputation of the hospital preventing patients in seeking care in such facilities. For this reason, King et al., 2016 referring to the occurrence as “never event” that ought not to occur in any hospital setting. The falls also usually costs the hospital and the individual additional costs as there is usually the need to treat the new complication erupting from the event.
In addition to the above impact, the fall risks have impacted the care providers especially the nurses in the facilities where “zero falls” are stated as goals. In such cases, the hospital administration has impacted the nurses as they have developed a fear of the falls among their patients. In the event, the falls occur, the nurses protect themselves and unit as a whole and in some cases restraining the patients at risk of falls. In the long haul, the fall risk has impaired the care provision as well as the patient and caregivers safety.
PICOT Table
| P (patient/problem) | Patients with poor balance |
| I (intervention/indicator) | Patient education |
| C (comparison) | Usual patient care |
| O (outcome) | Reduced risk of falling |
PICOT Question
Among the patients with poor balance, does patient education compared to the usual care lead to reduced risk of falling after the teaching session?
Keywords
The search words included patient education on fall risk, the impact of patient education on fall risk, fall prevention through patient education, primary fall prevention via education, patient education concerning fall risks and patient education on patient safety related to falls.
Number and type of articles
The search resulted in 103,238 articles. The themes of various articles revolved around improved collaboration between patients and caregivers in patient safety, awareness creation among patients, knowledgeability of both the patients and the care providers’ and early detection of patient fall risks. Various programs in the reduction of patients fall risk also emerged including the Healthy Steps for Older Adults, use of assistive devices such as alarms and patient education alongside the strategic design of hospitals such as the use of side rales and nursing patients in ground floors for those at risk.
Research Articles
One of the research article by Albert et al., 2014 dwelt on the primary prevention of the falls by engaging patient in a Healthy Steps for Older Adults (HSOA) program. 814 patients completed the HSOA program which entailed an evaluation of patients fall risk and education on the reduction of the risk while comparing the subsequent results with a control group. The comparison group encompassed 1019 who did not complete the program. The outcome indicated a reduction of the fall risk among the patients who underwent the HSOA program.
The second research article was by Hill et al., 2016 which entailed 30 educators whom the authored opted to seek their perception concerning the patient education. By use of focused group discussions and educators notes, it emerged that the patient education empowered the patients thus leading to collaborative action by the patient towards lowering the patients’ risk of falling.
Non-Research Evidence
One of the non-research articles by Posadas was centered on education to both the patients and the family members on the essence of reducing fall risk. The article claims the impact of patient education which imparts knowledge in them thus improves the patient safety while at the same time, saves time for the nurses in the process of care provision.
The second non-research article was by Cleveland clinic that dwelt on various standard interventions such as patient education, use of yellow socks, bet alarms as well as the use of armbands all of which were vital in the reduction of patient risk o falling. According to the article, the general patient education is ineffective especially in the instances where the patient does not understand what is taught. It, therefore, advocates for the use of a simple tool that groups the content of education in three which will enable the patients to remember and take part in reducing the falling risk. The “My Safety Plan ” allows for the assessment of patients at every shift and this followed a session of patient education.
Evidence Matrix
| Authors | Journal Name/ WGU Library | Year of Publication | Research Design | Sample Size | Outcome Variables Measured | Level (I–III) | Quality (A, B, C) | Results/Author’s Suggested Conclusions |
| Park, K. S., Yoo, J. I., Kim, H. Y., Jang, S., Park, Y., & Ha, Y. C | BMC public health | 2017 | Prospective study | 271 participants | Knowledge on osteoporosis, osteoporosis self efficacy as well as the fall self efficacy. | II | B | From the potential 271 participants, 199 completed the education program and the questionnaire with the intervention leading to an improvement in all the parameters of study. Park et al., 2017 concluded that education on osteoporosis knowledge and regular exercise enhances the self efficacy in relation to falls and osteoporosis. |
| Bates, A., Furber, S., Tiedemann, A., Ginn, K., van den Dolder, P., Howard, K., … & Sherrington, C. | Journal of physiotherapy | 2018 | Randomized controlled trial | 576 participants | Fall rates, limb strength and balance | I | B | The engagement of the participants in education and training on various exercises, the falls were reduced alongside the strength and balance of various limbs. |
| Hill, A. M., McPhail, S. M., Francis-Coad, J., Waldron, N., Etherton-Beer, C., Flicker, L., … & Haines, T. P. | British Medical Journal Open | 2015 | A qualitative exploratory study
|
10 educators | Perception of educators on the patient education and its impact on reducing the risk of fall among older patients. | II | B | From the data obtained via focused group discussions and interviews, educators’ notes as well as the reflective research fields notes, mutual understanding between the care providers and the patients came about thus led to prevention of falls. According to Hill et al., 2015, the individualized patient education on fall prevention enables the patients to be knowledgeable and motivated to come up with and take part in behaviors that reduces their risk to fall especially with the support of the care giving staff. |
| Hill, A. M., Waldron, N., Francis-Coad, J., Haines, T., Etherton-Beer, C., Flicker, L., … & McPhail, S. M. | British Medical Journal Open | 2016 | Qualitative explanatory study | 30 participants | Perception of the staff on education to patients and impact of patient education on prevention of patients’ risk of fall. | II | B | With the 5 focused groups discussions being conducted in various hospitals, the staff members had a feeling that patient education created an enabling culture that prevented the risk of falling alongside the facilitation of teamwork since both the patients and the staffs were involve in the reduction of patients risk of falling. The results led to a conclusion by Hill et al., 2016 that education created positivity on both the patient and the care givers side since it brought out collaboration towards prevention of falls among patients. |
| Pai, Y. C., Bhatt, T., Yang, F., Wang, E., & Kritchevsky, S. | Journals of Gerontology Series A: Biomedical Sciences and Medical Sciences | 2014 | Quantitative randomized controlled study. | 212 older adults | The extent of risk fall reduction fallowing perturbation training | I | A | With the 212 older adults assigned either in a training group and exposed to 24 slips and the control group exposed to one slip, the single session of the repeated slips reduced the annual risk of falling by 50%. The individuals who had only single slip were 2.3 times more likely to experience another fall within the year. Pai et al., 2014 concluded that there is need for repeated slip exposure for those with history of falling and are still at risk of falling to enhance their resilience to postural disturbances. |
| Albert, S. M., King, J., Boudreau, R., Prasad, T., Lin, C. J., & Newman, A. B | American journal of public health, | 2014 | Quantitative control trial study | 814 older adults. | The incidence of falls among the older adults, the impact of education of patients on falls risk. | I | B | The older adults that went through the Health Steps for Older Adults Programs had a marked reduced incidence of fall compared to the control group. There existed lower rates of fall as well as reduced percentage of falls of about 6 to 8% less than the comparison group. Albert et al., 2014 concluded that using the current aging service infrastructure such as the Healthy Steps for Older Adults and evaluation of its impact are feasible strategies that reduces the the rate of falls among patients with poor balance thus ought to be given consideration in improving the safety of patients. |
Recommended Practice Change
With the various intervention put in place to curb patient falls, the event has remained a menace thwarting the patient’s safety in various care settings. By employing patient education, the patients will be made knowledgeable concerning fall prevention. According to Hill et al., 2016, the education of patients creates positivity in efforts geared towards fall risk. It alludes that collaboration is created since both patients and caregivers can contribute towards reducing the risk.
Key Stakeholders
According to Gu et al., 2016, the nurses are on the front line defense of reducing the falls among the patients. This element can be attributed to the fact that nurses are usually in close interaction with the patient alongside their responsibility of monitoring and undertaking the daily care activities of the patients. In comparison with other healthcare providers, the nurses are far much appropriate to be involved in the change program. The nurses will be involved in seminars to make them equipped with the various guidelines that need to be imparted to the patient concerning their risk of falling. The nurses will also be useful in determining the knowledge level of the patient both before and after the education sessions to ascertain the impact of the intervention.
Physiotherapists will also be critical stakeholders to get in touch with the process of reducing the fall risk among the patients. According to Tiedemann et al., 2014, the exercise professional are essential as they can be used to pass critical mobility information to the patients thus making them knowledgeable concerning their risk of falling. The physiotherapists will be engaged in educational workshops where they will be equipped with the information that ought to be imparted to their clients. In so doing, the patient education will be achieved with the result being reduced risk of falling.
Barriers to Change
One of the barriers to education is reaching various patients based on the fact that the educational background is not similar thus may hinder understanding of various patients. At the same time, the intervention may not apply to patients who are unconscious yet are also the risk of fall. The materials required to implement the change may also be unavailable or expensive to purchases.
Strategies for Barriers
To reach people of all education background, the education tool will be made simple to be understood by all the individuals being taught. The administration, as well as other related sectors, will be involved to finance the materials that will be needed to facilitate the education program. In so doing, the financial constraints will be catered for.
Indicator to Measure Change
The prevention of falls will be marked by reduced rate and a ration of falls within a particular unit. This will be an indicator of improved adherence of both the patients and the caregivers on the guidelines to prevent the risk. Another indicator will entail the demonstration by the patients on using preventive measures such as calling assistance as well as the use of other assistive devices.
Conclusion
Falls among the patients are occurrences that can result in secondary complications from the initial diagnosis of the patients. The occurrences are easily preventable in most cases thus mitigation strategies ought to be employed and strictly evaluated to ensure patient safety is attained. Patient education is one of the critical prevention methods that need to be employed to reduce the risk of falling. Albert et al., 2014 resolved for the use of the existing infrastructure to spearhead the patient safety while Pai et al., 2014 advocated for the use of education and exposure to slips to improve resilience towards reducing falls risk.
References
Albert, S. M., King, J., Boudreau, R., Prasad, T., Lin, C. J., & Newman, A. B. (2014). Primary
prevention of falls: effectiveness of a statewide program. American journal of public
health, 104(5), e77-e84.
Bates, A., Furber, S., Tiedemann, A., Ginn, K., van den Dolder, P., Howard, K., … &
Sherrington, C. (2018). Trial Protocol: Home-based exercise programs to prevent falls
and upper limb dysfunction among community-dwelling older people: study protocol for
the BEST (Balance Exercise Strength Training) at Home randomised, controlled
trial. Journal of physiotherapy.
Falls Prevention Tool Closes Gap Between Nursing Practice and Patient Education. (2018).
Consult QD. Retrieved 17 April 2018, from https://consultqd.clevelandclinic.org/falls-
prevention-tool-closes-gap-between-nursing-practice-and-patient-education/
Gu, Y. Y., Balcaen, K., Ni, Y., Ampe, J., & Goffin, J. (2016). Review on prevention of falls in
hospital settings. Chinese Nursing Research, 3(1), 7-10.
Hill, A. M., Etherton-Beer, C., McPhail, S. M., Morris, M. E., Flicker, L., Shorr, R., … &
Boudville, A. (2017). Reducing falls after hospital discharge: a protocol for a randomised
controlled trial evaluating an individualised multimodal falls education programme for
older adults. BMJ open, 7(2), e013931.
Hill, A. M., McPhail, S. M., Francis-Coad, J., Waldron, N., Etherton-Beer, C., Flicker, L., … &
Haines, T. P. (2015). Educators’ perspectives about how older hospital patients can
engage in a falls prevention education programme: a qualitative process evaluation. BMJ
open, 5(12), e009780.
Hill, A. M., Waldron, N., Francis-Coad, J., Haines, T., Etherton-Beer, C., Flicker, L., … &
McPhail, S. M. (2016). ‘It promoted a positive culture around falls prevention’: staff
response to a patient education programme—a qualitative evaluation. BMJ open, 6(12),
e013414.
Hill, A. M., Waldron, N., Etherton-Beer, C., McPhail, S. M., Ingram, K., Flicker, L., & Haines,
- P. (2014). A stepped-wedge cluster randomised controlled trial for evaluating rates of
falls among inpatients in aged care rehabilitation units receiving tailored multimedia
education in addition to usual care: a trial protocol. BMJ open, 4(1), e004195.
King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2016). Impact of fall prevention
on nurses and care of fall risk patients. The Gerontologist, gnw156.
Pai, Y. C., Bhatt, T., Yang, F., Wang, E., & Kritchevsky, S. (2014). Perturbation training can
reduce community-dwelling older adults’ annual fall risk: a randomized controlled
trial. Journals of Gerontology Series A: Biomedical Sciences and Medical
Sciences, 69(12), 1586-1594.
Park, K. S., Yoo, J. I., Kim, H. Y., Jang, S., Park, Y., & Ha, Y. C. (2017). Education and exercise
program improves osteoporosis knowledge and changes calcium and vitamin D dietary
intake in community dwelling elderly. BMC public health, 17(1), 966.
Posadas, R. Patient Education and Falls Prevention. Www1.ucirvinehealth.org. Retrieved 17
April 2018, from
http://www1.ucirvinehealth.org/magnetnursing/clienthtml/69/attachments-and-reference-
documents/118/EP7g.pdf
Sherrington, C., Fairhall, N., Kirkham, C., Clemson, L., Howard, K., Vogler, C., … &
Sonnabend, D. (2016). Exercise and fall prevention self-management to reduce mobility-
related disability and falls after fall-related lower limb fracture in older people: protocol
for the RESTORE (Recovery Exercises and STepping On afteR fracturE) randomised
controlled trial. BMC geriatrics, 16(1), 34.
Tiedemann, A., Rissel, C., Howard, K., Tong, A., Merom, D., Smith, S., … & Lindley, R. I.
(2016). Health coaching and pedometers to enhance physical activity and prevent falls in
community-dwelling people aged 60 years and over: study protocol for the Coaching for
Healthy AGEing (CHAnGE) cluster randomised controlled trial. BMJ open, 6(5),
e012277.
Tiedemann, A., Sturnieks, D. L., Hill, A. M., Lovitt, L., Clemson, L., Lord, S. R., … &
Sherrington, C. (2014). Does a fall prevention educational programme improve
knowledge and change exercise prescribing behaviour in health and exercise
professionals? A study protocol for a randomised controlled trial. BMJ open, 4(11),
e007032.
