Outline strategies applied by different medical facilities in addressing patients.
Patient falls on a hospital setting is a reality, and it has been rated as a persistent problem that must be addressed. Managing patient falls in a hospital setting is part of risk management in hospitals. The significance and extent of the patient falls in the hospital setting varies with the immediate environment. A patient fall is characterized with a sudden fall of the patient mainly due to unintentional positional change. In most cases, patient falls and lands on objects or on a level platform complicating the medical situation, this paper focus at risk management in Kaiser Permanente based in the United States.
Kaiser Permanente
Kaiser Permanente is an American nonprofit making organization based in Oakland, California. The corporation was founded in 1945 offering integrated managed care consortium (Halvorson, 2012). The corporate operates in three distinct groups identifying with Kaiser Foundation Hospitals, Kaiser Foundation Health Plan and Permanente Medical Groups. Founders of Kaiser Permanente were Sidney Garfield and Henry Kaiser. Bernard J. Tyson is the current Chief Executive Officer of the Health Plan and Hospitals while Jack Cochran is the Managing Director and the Federation Executive Director. The corporation employs more than 180,000 employees as part of the human capital (Halvorson, 2012).
Kaiser Permanente has set up some objectives in addressing patient falls within the facility. The first step was by defining the types of patient falls and the importance attached to the prevention of the patient falls within the facility. Kaiser Permanente also defined the evidence of patient falls within the facility in shedding light to the existence of risk within the facility. Kaiser Permanente researched on the current evidence of the available strategies in preventing patient falls. Kaiser Permanente supported the argument that each and every patient has a risk of falling depending on context.
Types of Patient Falls
Types of patient fall experienced at Kaiser Permanente are: predictable or anticipated physiological falls accounting to seventy eight percent, unpredictable physiological falls accounting to eight percent and accidental falls accounting to fourteen percent. Predictable physiological falls are related to patients who are prone to falls according to risk factors that are known. Kaiser Permanente employs Fall Risk Assessment Tool in identifying the risk factors. Unpredictable physiological falls are connected to physiologic causes such as drug reaction, acute illness, fainting and seizure among other causes. Accidental falls are connected to tripping, slipping or mishap caused by misjudgment. Accidental falls are managed through keeping the health care environment free from hazards that contribute to accidental falls.
In the United States, it is estimated that roughly one million patients fall on a yearly basis, hence termed as one of the adverse events in a hospital setting. The rates of falls vary with medical facilities, considering that some of the medical facilities have taken up measures of addressing the problem (Meade et al., 2006). Quality Indicators in nursing sensitive to patient falls are connected to structures, outcomes and processes involved in the heath care facility. Metrics associated in nurse sensitivity, in risk management is attached to the patient falls, fall related injuries and on the restraints involved in managing the problem within the facility.
Addressing Patient Falls
Kaiser Permanente has developed mechanisms of preventing patient falls within the health care facility. Surveys conducted in the community argued that, in every three older adults, one of them have experienced patient falls. One of the most prominent patient falls management device is related to hourly rounding in the medical facility as a way of preventing patient falls. The second method used in preventing patient falls in Kaiser Permanente is related to the application of the Fall Prevention Toolkit. The third method is by environmental management in preventing the accidental falls in the health care facility.
Kaiser Permanente first screen for possible and predictable factors facilitating patients falls in the health care center. Risk factors related to predictable falling are attached to altered elimination, history of patient on previous falls, altered mental status and altered mobility. Common fall related injuries risks addressed by the Kaiser Permanente identify with Metastatic bone disease, Anti-platelet agents, Osteoporosis, Elevated coagulation laboratory results, Anticoagulant therapy, Coagulopathy and Decreased platelet count.
Environmental management is facilitated by initiating interventions gearing at environmental management. Some of the interventions relates to beds for patients being placed at a low position, locking the wheels of the beds, placing items needed by the patients at their reach and offering footwear that do not slip among other interventions. Patients are also provided with patient safety measures such as ambulatory assist devices and sensory devices. The health care practitioners also evaluate the ability of the patients in using conventional call light if the need arises. The health care professionals in Kaiser Permanente also monitor the changes in the willingness of the patients in actively participating in preventing falls in the medical care facility. The problem must be addressed from the two perspectives, with patients and the health care practitioners both willing to reduce the risks of patient falls.
Falling Care Plan (Path to Remedy the Problem)
Kaiser Permanente has developed a falling care plan that addresses injuries caused by the patient falls within the facility. The outcome of the falling care plan is to make the patients understand that they have a personal responsibility of taking the necessary precautions in reducing the risks connected to patient falls. The interventions in the Falling Care Plan are enhanced by communicating the precautions to patients and to the caregivers. Members of Falling Care Plan also assist and supervise in periods in which unpredicted falls have a probability of occurring based on special conditions and the disease.
Falling Care Plan initiate fall risk identification process, communicate the risk associated with patient conditions, avoids hypnotic and sedatives medications, promote special care for patients associated with mobility risks. Other benefits are connected to fostering special care for patients with elimination risk and promoting interventions for the patients associated with mental status, and finally developing management plans for patients participating in the patients falls (Morse, 2008).
Kaiser Permanente has tailored fall prevention interventions in the health care facilities. This has been possible through creating a care plan linking interventions to the patient risk factors, actively engaging all the caregivers to the fall prevention interventions, engaging nurse leaders and nurses in applying the evidence in the right way in addressing the needs of a patient. Engaging the patients in the fall prevention has been influential in Kaiser Permanente. The patients feel part of the programs used in preventing patient falls, and fully participate in making the programs a success. Nurses communicate to the patients on the benefits associated with the health care interventions in reducing cases of patient falls.
Methods adopted by Other Hospitals
in addressing the issue
Patient falls in different hospitals vary due to multiple reasons. Common reasons for patient falls are connected to extrinsic factors such as environmental issues, intrinsic factors such as individual issues and situational factors such as reaching the bedding. Organizational factors such as equipments available and the number of nurses attending the patients also contributes to an increase or decrease of the patient falls (Alvord, 2007). Patient fall in the health care facilities varies with the heath care setting. There is no one perfect model that fits all. The medical practitioners in the heath care facility must come up together and address issues affecting that health care facility (Meade et al., 2006).
There are different strategies applied by different medical facilities in addressing patients. There is no exclusive intervention or strategy that works in all situations. If strategies work well in oncology unit, it does not necessarily mean that the strategies will work well in general medical unit (Dykes et al., 2010). Each case is unique, and the medical practitioners must be willing to customize the strategies in reducing chances of patient falls. The differences in the management of patient fall in the different units may be attributed to the differences in the patient population and on the environment within the unit. Units in the same hospital vary with the organizational readiness, culture and models of health care delivery. Strategies in fall intervention must be customized in accordance within a unit and target patient (Meade et al., 2006).
The first method is identifying the patients with a high likelihood of falls. Second method is to identify with strategies that work best in that unit and patient. Third method involves educating the nurses and patients on the necessity of reducing patient falls (Alvord, 2007). There are different risk assessment tools in the medical practice. The tools can be considered to be equal with no tool being superior to the other tool. Classifications of the patient’s falls are attached to patients in the high risk category and patients in low risk category.
Patient factors contributing to patient falls are connected to impaired gait, impaired vision, impaired cognition, weaknesses of body organs, depression, hypotension, acute event, urinary incontinence and certain medications. Environmental factors causing patient falls are clustered pathways, furniture with wheels, inadequate lighting, slippery floors, height of furniture, medical devices and unit layout. Situational causes of patient falls are connected to reaching up, leaning forward and transferring of objects. Organizational factors contributing to patient falls are connected to inadequate staffing, policies in place, availability of equipments and availability of furniture supporting patient safety (Dykes et al., 2010).
Comparison on the patient fall research
and practices in Kaiser Permanente
Kaiser Permanente has been sensitive in addressing patient falls within the facility. The measures applied by Kaiser Permanente in managing patient fall are almost similar to the steps used by other health care facilities in the United States. The only difference is attached to the organizational culture that defines the ways medical practitioners carry out their day to day activities.
Patient falls in the health care facilities is a manageable risk upon active participation of the nurses and patients. Medical interventions and strategies must be customized in meeting the needs of each unit and patient within the health care facility.
References
Alvord, L. S. (2007). Falls Assessment and Prevention: Home, Hospital, and Extended Care. San Diego, California: Plural Publishing Inc.
Dykes, P. C., Carroll, D. L., Hurley, A. Lipsitz, S. et al. (2010). Fall prevention in acute care hospitals: a randomized trial. JAMA , 1912-1918.
Halvorson, G. C. (2012). KP Inside – 101 Letters to Us at Kaiser Permanente. New York: CreateSpace Independent Publishing Platform.
Meade, C. M., Bursell, A. L., & Ketelsen, L. (2006). Effects of nursing rounds on patients’ call light use,satisfaction, and safety. American Journal of Nursing , 70-71.
Morse, J. (2008). Preventing Patient Falls. New York: Springer Publishing Company.
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