More than 1 million falls occur in hospitals each year, with as many as half resulting in at least minor injury and up to 10 percent resulting in major injury. A session Monday looked at whether many of those are preventable.
“In-Hospital Falls: What Causes Them and How Can We Prevent Them?” looked at the myths and facts surrounding falls related to patients with orthopedic injuries, quadriceps weakness, adductor canal blocks (ACBs), the use of knee immobilizers and the effectiveness of fall-prevention programs.
Sandra L. Kopp, M.D.
The session was originally planned as a pro/con discussion, “In-Hospital Falls: Are Peripheral Nerve Blocks to Blame?” but was changed to clarify information and misinformation regarding falls, said the session moderator, Sandra L. Kopp, M.D., Anesthesiologist at the Mayo Clinic.
The first type of falls examined were those suffered by orthopedic patients. Orthopedic patients are thought to generally be healthy, but may overestimate their abilities following surgery; postoperative pain and weakness also may increase risk, she said.
Studies show, however, that total knee arthroplasty (TKA) patients are among this population, and many are older and have more comorbidities. Yet another study indicated that of the orthopedic patients who fall, 20.2 percent were confused and 45.8 percent were related to patients wanting to go to the bathroom.
Therefore, Dr. Kopp said, the idea that orthopedic patients fall more frequently is a myth.
Linda Le-Wendling, M.D.
Linda Le-Wendling, M.D., Associate Professor of Anesthesiology at the University of Florida, addressed the idea that quadriceps weakness is the main reason patients fall. She reviewed the Morse Falls Scale, the Hendrich High-Risk Fall Model and the STRATIFY assessment tool, which report that the most cited risk factors for falls are mental status, mobility, incontinence and medications.
In addition, age, sedatives, gait instability and lower extremity weakness are other risk factors, according to another study. That led her to report that it is a myth that quadriceps weakness is the main reason patients fall.
Rebecca L. Johnson, M.D.
Rebecca L. Johnson, M.D., Assistant Professor at the Mayo Clinic, discussed a related topic — that quadriceps weakness is the main reason TKA patients fall. These patients do have quadriceps weakness, which reduces knee stability and affects their ability to brace a fall, she said. However, other intrinsic patient factors can play a role in falls, so the idea is a fact, not a myth.
Dr. Johnson also discussed the idea that ACBs will decrease falls. A series of studies compared ACBs with femoral nerve blockade (FNB). Several studies show that ACB is better than FNB in preserving quadriceps strength, but more corroboration is needed, she said, so it is a myth that ACB will decrease falls.
Also explored was the idea that patients with lower extremity blocks should use a knee immobilizer. Immobilizers prevent knee flexion, avoid buckling and reduce the need for quadriceps function to allow tibial-femoral alignment.
Research shows they especially help in cancer patients with femoral neuropathy and patients receiving TKAs, so it is a fact that knee immobilizers help patients, Dr. Le-Wendling said.
Finally Dr. Johnson looked at whether fall-prevention programs can help decrease in-hospital falls. A variety of evidence, from studies that show prevention programs reduced falls to reports from risk assessment tools that have proven successful, is available.
Multi-component strategies are important in these programs, with a focus on working with elderly patients, patients in recovery and patients needing to go to the bathroom, she said.
