Vince is a technical writer working in the medical research field. He also enjoys exploring literature in his free time.
Falls are a very common problem in geriatric care facilities and can not only result in physical damage but also in lack of trust in the staff as well as negative self image for the patients. Fall risk assessment combined with preventative measures to improve patient’s ambulatory abilities can reduce patient fall risks, significantly. The purpose of this paper is to propose the use of wearable, momentum based sensors for tracking patient movements and better understanding how their ability to move may contribute to their propensity to fall, thus allowing for targeted therapy regimens to be devised.
Purpose of the Program
Part of the problem in fall risk prevention is patients transferring or returning from more acute settings such as the hospital. Nurses is geriatric care facilities may not have gauged the level of ambulatory assistance these patients need. Thus, Johnson, Camp, Lardner, Bugnariu, and Knebl (2015) suggest using a transitional physical therapy model for these patients. The physical therapy helps determine the patient’s range of motion and ability to ambulate while also improving these very things at the same time, thus giving them a lower chance of fall risk.
Wearable inertial based sensors have shown improvement in hospital falls and, for that reason, are the second part of this proposed fall reduction policy. Clients who are suspected of fall risk can be difficult to properly assess without assumptions being made. Wearable inertial sensors are comfortable monitors patients can wear throughout the day that collect data on the patients’ movements which can be reviewed to determine the risk of fall. It is a quantitative based system that provides statistically valid reasoning for placing someone on high fall risk or not, can reduce the number of falls, and can protect the hospital from liability should a fall occur due to the scientific backing of the sensors (Howcroft, Kofman, & Lemaire, 2013).
The target population for this quality improvement initiative is any geriatric patients within the health care system, with a specific focus on nursing home facilities. This paper focuses geriatric care facilities and is designed specifically for such a place of care, but could be generalized to work for patients in acute settings and who are being treated in their own homes. Any nurse working in elder care could benefit from improved fall risk protocol.
Impact and Outcomes
According to Jarvis (2016), falls are one of the leading cause of injury for patients over 65 years old. Howcroft, Kofman, & Lemaire (2013) elaborate on this by explaining that about one third of people over 65 will fall each year and that this rate increases with age. Falls in the United States among elderly patients cost as much as 20 billion dollars, and this number is increasing over time with an estimate of falls costing 32.4 billion dollars in the year 2020. Reducing the number of falls decreases the risk of serious injury or death and improves patient satisfaction, but it is also a substantial enough problem to affect the entire health care economy. Reducing falls saves the United States money in the long run, which can then be reinvested into even further improvements of the health care system.
The estimated cost for implementing this three part plan to reduce falls is 52,500 dollars for the first year. This number was arrived at by adding up the costs of each part of the plan. Fifteen wearable inertial sensors would be sufficient since these are not to be worn by all patients but only those admitting or returning, and at 100 dollars a piece would come out to 1,500 dollars. The changes to the medication sofware are estimated to cost 1,000 based on speaking with the in-house technology director. The hospital employs a physical therapists, but the increased strain on his schedule may necessitate hiring an additional assistant at approximately 50,000 dollars a year. Of course, additional physical therapy means additional billing and not all of this money would be coming from the hospital’s budget, but since the details of insurance coverage are not known at this time, the assumption must be made that this comes from the hospital’s funds.
This approach to care has the benefit of having an easily measurable effectiveness rate. The hospital already keeps records of patient falls which can easily be added into a spreadsheet or statistical analysis program such as SPSS. The rate of falls for the year after the program is initiated can be compared to the years before for immediate feedback and for all of the years after to establish a trend and to give time to account for any issues that may arise in the transition.
Given the serious risk to elderly patients and the high costs involved, falls are something which hospitals that cater to the geriatric population must take seriously. Thanks to advances in technology and monitoring systems, there is little reason not to improve nursing facilities’ methods of reducing fall risk. This proposal offers an evidence based method by which a hospital can monitor and prevent falls in elderly patients.
Howcroft, J., Kofman, J., & Lemaire, E. D. (2013). Review of fall risk assessment in geriatric populations using inertial sensors. Journal of NeuroEngineering and Rehabilitation, 10(1), 91.
Jarvis, C. (2016). Physical examination & health assessment. St. Louis, MO: Saunders Elsevier.
Johnson, V. W., Camp, K., Lardner, D., Bugnariu, N., & Knebl, J. (2015). Reducing falls in post-acute Medicaid patients enrolled in the safe transitions for the elderly patient (STEP) program. Retrieved November 19, 2016, from http://digitalcommons.hsc.unt.edu/rad/RAD15/Other/32/
© 2017 Vince