Protecting Confused Patients from Falls

ails are well known to compromise patient outcomes, resulting in loss of independence and confidence as well as susceptibility to future falls. While the majority of falls don't result in serious physical injury, they can influence morbidity and mortality. A general hesitancy among hospital staff to file incident reports makes it difficult to obtain actual fall statistics, but falls are estimated to account for nearly 90% of all reported hospital incidents. It's also well documented that falls increase hospital costs and length of stay. Depending on cognitive impairment, muscle weakness, and balance and visual impairment, a patient with a hip fracture requires a sevento 10-day stay in the acute care setting. National expenses for fall-related fractures are calculated at $10 billion annually. The confused patient, who's at risk for falls, presents a particular nursing challenge. You're often called upon to intervene before the cause of the patient's confusion is even identified. And though immediate action is necessary, you must comply with the standards of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the Omnibus Budget Reconciliation Act (OBRA) in using any physical or chemical restraints. That's why, in 1992, as part of a quality improvement project, nurses at Lutheran Medical Center in Wheat Ridge, Colorado, implemented a fall-prevention program with special emphasis on the confused patient. We developed an algorithm for assessing confused patients and intervening appropriately. Here we'll present our algorithm and describe how it works.