The Epidemiology of Falls Nursing 702 Maria Lens, RN, MSN, PHN, FNP-BC.
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Transcript of The Epidemiology of Falls Nursing 702 Maria Lens, RN, MSN, PHN, FNP-BC.
EPIDIMIOLOGY OF FALLSMost common in older population and high rank
in clinical problem.
40% of adults 65 and older fall at least once a year at home.
In hospital setting after a fall only half live after a year from a fall.
2/3 of deaths from falls could have been prevented.
In 2000, $0.2 billion was spent on fatal falls, and $19 billion on non-fatal falls.
Estimated to costs in 2020, $ 32.4 billion.
JCAHO implemented national safety goals to reduce falls.
CMS not reimbursing for health care needed after a fall if occurred in hospital.
Incidence of falls in hospital, 1.4 falls per bed per year
Causes of fallsAccidental/environment 31%
Gait/Balance 17%
Dizziness/vertigo 13%
Drop Attack 10%
Confusion/cognitive impairment 4%
Postural hypotension 3%
Visual Impairment 3%
Unspecified or unknown 18%
BackgroundAcute care facility in suburb area
Schmid Fall Scale used
Pt assessed every 4 hours for falls on medical/telemetry, ICU, TCU, and peds, every 8 hours med/surg
Many falls occurring still despite interventions
Bed alarms, restraints, room near nurses station
One death this year from from after hip replacement due to fracture from fall.
auditsBed alarms not on
Score not same from observer.
Least restrictive restraint not used (lap belt)
SurveillanceFigure out PPV and NPV from Schmid Fall
Assessment tool
Determine sensitivity and specificity
Look at retrospectively, for a years worth
Do case-control study.
Look for relationships, associations and causation
Example: diseases (DM, Cardiac, Alzheimer's, CVA)
Diagnosis: (ETOH, ALOC, UTI)
Environment: Specific room, low-staffed day, skill mix
Determine odds/ratios to diagnosis
Health PromotionDo pilot study based on outcomes from
retrospective study.
Target most common reasons for falls at our specific facility.
Implement new interventions (low-beds, chair alarms, hip protectors)
After pilot study, determine outcomes
If benefits are seen, implement change in policy and procedure for falls
Contact CNO, Director of adult care services.
Let it be known, it is evidenced-based practice.
Promote health and wellness.
ConclusionChange policy and procedure based on new data
not on outdated policy.
Disseminate results
Decrease falls, injury from falls, and most important deaths
References Boyer, C. (2010). Falls by Quarter. (Email)
Gordis, L. (2009). Epidiomiology. (Fourth edition ed.). Baltimore, Maryland: Saunders Elsevier.
Jensen J. Nyberg, L., Gustafson, Y., & Lundin-Olsson, L. (2003). Fall and injury prevention in
residential care-effects in residents with higher & lower levels of cognition. Journal of
American Geriatrics, 51, 627-635.
Rubenstein, L. (2006). Falls in older people: epidemiology, risk factors and strategies for
prevention. Age and Aging, 35-S2, ii37-ii47.
Sizewise. (2010). Sizewise fall risk toolkit: Understanding fall risk, prevention, & protection., 1-
37.