Fall prevention is serious business
According to the Joint Commission’s Sentinel Event database, since 2009 there are been 465 falls that caused injury. Most of those falls occurred in hospital and worryingly, more than 60% of those falls were fatal. This makes them a serious concern for hospitals and other healthcare facilities. Although we might usually consider the elderly and the frail to be most at risk of a fall, any patient, no matter what their age, can be at increased risk, especially if they’re suffering from incontinence.
To put this further into perspective, every 15 seconds in the U.S. an older adult visits an Emergency Department suffering from a fall-related injury. 5% of older people who fall injure themselves seriously enough to necessitate a hospital stay and if someone has fallen once, they are at a much increased risk of subsequent falls.
The direct medical costs of fatal and non-fatal injuries from falling totals over $28 billion every year. For those aged 72 and older, the average health care bill for a fall injury came to $19,440 in 2010, a figure which will only continue to increase.
When the Centers for Medicare & Medicaid Services (CMS) announced that it was reducing Medicare payments by 1% to over 700 hospitals in 2015, this should have been a wakeup call to all medical facilities to take the issue of fall prevention seriously. This reduction in payments came as part of CMS’ pay for performance program that penalized hospitals with the worst record for hospital acquired conditions. Although a number of factors determined where a particular facility was ranked, one of the most important categories was the number of preventable patient falls during their hospital stay.
Risk factors to consider
Although incontinence is one of the major complicating factors when it comes to patient falls, this is often accompanied by one or more other risk factors, including mobility issues, visual impairment, problems with self-care, e.g. bathing and toileting, cognitive impairment and being aged 80 or older. All of these issues means that every patient’s fall risk needs to be individually assessed in order to make certain that the appropriate fall prevention measures are put into place.
Even moderate lower urinary tract issues will significantly increase the chance of a fall, especially among elderly men, and this risk increases as symptoms worsen. This may include urinary urgency, urinary frequency and how hard a patient needs to strain in order to urinate.
Another issue is medication. Diuretics are frequently prescribed to combat hypertension, but can make incontinence worse. In addition, many of the drugs used to combat incontinence may cause side effects that increase the likelihood of a fall, such as blurred vision, dizziness and weakness. If a patient is taking more than one anticholinergic, this risk increases even further, as does the chance of a fall being more severe. Any patients prescribed such drugs need to have these potential side effects fully explained so that their fall risk can be appropriately assessed and managed.
Why does incontinence increase the chance of a fall?
Numerous studies have linked incontinence with an increased risk of falling, but what causes this correlation? There are number of different ways in which incontinence can cause a fall, including:
- Slipping on a wet floor, following an incontinence episode
- A sudden urge to go to toilet resulting in a patient hurrying to the bathroom to avoid an episode
- Micturition syncope (fainting during or after urination)
- Transient incontinence is frequently related to other issues, including confusion, drowsiness, and hypotension
- Side effects from the medications used to treat incontinence
- Frequently waking during the night to visit the bathroom can mean poor quality sleep, which is a risk factor for falls
Other complicating factors related to incontinence may also include:
- Reduced mobility and problems with balance, which can make it difficult to travel to and from the bathroom
- The need to use walking aids (Urinary incontinence is a major risk factor among those who need support to stand)
- Frequent night-time incontinence, when lighting may be dim
- Problems with manual dexterity, making it difficult to remove clothing, etc.
- Impaired cognition or difficulties concentrating making it hard to carry out more than one task at a time
- A frequent urge to urinate — needing assistance with toileting combined with the need to urinate frequently results in a greater risk of falling than incontinence alone
All of the above means that it is vital that you consider the issue of incontinence when devising your fall prevention strategy. If you don’t take incontinence into consideration, you risk your patient’s health and safety.
How to prevent incontinence related falls
Given the seriousness of incontinence when it comes to fall prevention, it needs to be taken into consideration when putting into place your fall prevention strategy. Fortunately, there are a number of effective steps that can be taken to ensure that you’re doing everything you can to prevent falls in your facility.
Provide an appropriate environment
Make sure patients suffering from incontinence are located as near to the toilet as possible. If there is not an available bathroom nearby, you may want to consider providing a bedside commode or urinal as an alternative. If the patient needs a walker or cane to move around, make sure that it is always close to hand.
Make sure that the route to the bathroom is free of obstacles and clutter and leave a nightlight on to make it easier for patients to find their way without becoming disoriented. Parasol’s new wireless falls prevention monitor comes with strong LED lights so that patients can make their way from bed to bathroom safely. You also might want to place a non-slip mat on the floor next to the bed if your patient suffers from urinary incontinence.
It is important that patients wear appropriate clothing that can be easily taken off or undone, either by themselves or with the assistance of staff, to minimize the chances of clothing causing a fall. You should advise patients to wear non-skid footwear to avoid slipping in urine.
Install a fall prevention system that incorporates incontinence monitoring
Parasol offers a number of specialized incontinence monitoring devices designed to integrate with your fall prevention system. For example, the Parasol Medical Combo Pad is suitable for use on beds and chairs and combines pressure sensitive fall prevention technology with real-time incontinence monitoring to identify any potential issues immediately. Parasol’s Medical Potty Pad is also a useful product that allows clinicians to monitor patients using the commode or toilet to ensure their safety at all times.
Take a personalized approach to falls prevention
- Every patient suffering from incontinence has different needs and it is important to make sure that they receive an individual risk assessment to identify their personal risk factors before putting together a toilet assistance program that best suits their needs. This should include:
- Identifying and treating or modifying the causes of incontinence where possible. If incontinence is the result of medication, consider changing the medication if an alternative is available.
- Identifying other fall risk factors, such as transfer ability, dizziness, disorientation, etc. which may have an impact on toileting and put in to place strategies to address these factors where possible.
- Ensuring that all staff respond to toileting requests immediately, particularly if the patient is known to need support and assistance to get to the bathroom. Patients with reduced mobility should be able to easily reach the nurse call bell and if this is not possible, you may want to install a fall alarm to alert staff when a patient is attempting an unassisted transfer. In additions, you might consider using hip protectors for those patients with an identified risk of a hip fracture.
- Ensuring the patient is fully briefed about their personal responsibility in avoiding falls so that they are aware of everything they can do to keep themselves safe.
Keeping patient safety at the forefront
If you haven’t included incontinence monitoring in your fall prevention strategy until now, it should be clear that you need to consider the impact of incontinence moving forward. When you include incontinence monitoring in fall prevention, you make a commitment to doing everything in your power to make sure your facility is safe, meeting all your legal obligations and ensuring you don’t face any negative consequences should a patient fall while in your care.
Are you doing everything you can to prevent falls in your healthcare facility? Click here to get your FREE Fall Prevention Checklist today!