REDUCING F ALLS AND F ALL-RELATED INJURIES IN ACUTELY AND CRITICALLY ILL P ATIENTS Clinical Evidence Review By Margo A. Halm, RN, PhD, ACNS-BC, and Patricia A. Quigley, PhD, MPH, ARNP, CRRN F alls are a major public health problem around the world, and are the number 1 adverse event in the hospital. From 3% to 20% of inpatients fall at least once, with injury prevalence ranging from 30% to 51%. 1 Of these, 6% to 44% experience simi- lar injuries such as fractures, subdural hematomas, or excessive bleeding that may cause death. Certain to affect morbidity and mortality, injury falls are “never events” that also cut reimbursement. Adjusted to 2010 dollars, a fall without serious injury costs an additional $3500, whereas 2 or more falls without serious injury cost $16 500. Falls with serious injury are the costliest, with additional costs of $27 000. 2 Interventions to prevent falls and fall-related injuries require multidisciplinary support for program adoption and reliable implementation for specific at-risk and vulnerable subpopulations, such as frail elderly persons and those at risk for injury. The pur- pose of this clinical evidence review is to address the effects of fall and injury risk assessment and targeted interventions on fall and injury rates in acutely hos- pitalized patients. Methods The search strategy involved CINAHL and MEDLINE with the following key words: falls, fall prevention, injury prevention and reduction, acute and critical care. The search was limited to the past 10 years. All forms of evidence were considered. Results Eleven reports focused on in-hospital fall pre- vention in a variety of settings (medical/surgical, neu- rological, geriatric, all units). The reports included 1 A regular feature of the American Journal of Critical Care, Clinical Evidence Review unveils available scientific evidence to answer questions faced in contemporary clinical practice. It is intended to support, refute, or shed light on health care practices where little evidence exists. To send an eLetter or to contribute to an online discussion about this article, visit www.ajcconline.org and click “Respond to This Article” on either the full-text or PDF view of the article. We welcome letters regarding this feature and encourage the submission of questions for future review. meta-analysis, 2 randomized controlled trials, 2 observational studies, and 6 quality improvement studies. The interventions to prevent falls that were evaluated are noted in Table 1. Fall metrics were assessed in the studies for periods from 6 months to 5 years. The meta-analysis 9 did not reveal significant reductions in fall-associated metrics (level A evidence in Table 2). However, examination of the results of individual studies shows that the fall rate per 1000 patient-days decreased in 4 studies, 6,8,12,13 including 1 study with older patients. 13 The relative risk of falling was reduced by 23% to 29% in 2 studies. 4,8 Significant reductions were also realized in the injury rate in 2 studies. 6,10 Other investigators found a reduction in both minor and serious injuries, includ- ing fractures. 3,5,7 Collectively, these findings represent level B-C evidence (Table 2). Recommendations for Practice Falls are rare events in progressive and critical care settings owing to higher patient acuity and staffing ratios. However, falls do still occur and are devastating to patients, their families, and nurses. Nurses manage competing priorities for these patients, dealing with medically acute conditions and unexpected acute/emergent situations and complications while ensuring the patient’s safety. These safety needs include protecting patients from falls and fall-related injuries, and nurses must be sensitive to the geriatric population. 15 The Ameri- can Association for Critical-Care Nurses’ scope and standards document 16 provides the framework for specialty practice and these fall prevention practice recommendations: assessment, diagnosis, out- comes management, planning, implementation, and evaluation. ©2011 American Association of Critical-Care Nurses doi: http://dx.doi.org/10.4037/ajcc2011606 480 AJCC AMERICAN JOURNAL OF CRITICAL CARE, November 2011, Volume 20, No. 6 www.ajcconline.org by AACN on December 16, 2016 http://ajcc.aacnjournals.org/ Downloaded from