Reducing Falls in Inpatient Rehabilitation Facilities
Falls are a common and serious problem for patients in inpatient rehabilitation facilities (IRFs). According to a study by Heinemann et al. (2018), the fall rate in IRFs was 12.3 per 1000 patient days, and 32.9% of falls resulted in injury. Falls can lead to physical and psychological harm, increased length of stay, higher costs, and lower functional outcomes. Therefore, it is important to identify the risk factors and implement effective interventions to prevent falls in IRFs.
Risk Factors for Falls in IRFs
Several factors can increase the risk of falls in IRFs, such as:
– Age: Older patients are more likely to fall due to age-related changes in balance, vision, cognition, and muscle strength.
– Medical conditions: Patients with neurological disorders, stroke, orthopedic surgery, or cognitive impairment are more prone to fall due to impaired mobility, coordination, sensation, or judgment.
– Medications: Some medications can affect the central nervous system, blood pressure, or blood glucose levels, causing drowsiness, confusion, hypotension, or hypoglycemia, which can increase the risk of falls.
– Environment: Environmental hazards such as slippery floors, poor lighting, cluttered spaces, or inadequate equipment can contribute to falls.
– Behavior: Patients may fall due to overestimating their abilities, not using assistive devices, not following safety instructions, or being unaware of their surroundings.
Interventions to Prevent Falls in IRFs
To reduce the risk of falls in IRFs, a multifactorial approach is recommended that involves assessing the individual patient’s risk factors, implementing tailored interventions, and monitoring the outcomes. Some of the interventions that have been shown to be effective are:
– Education: Educating patients and staff about the causes and consequences of falls, and providing them with strategies to prevent falls.
– Exercise: Providing patients with individualized exercise programs that target balance, strength, endurance, and mobility.
– Medication review: Reviewing patients’ medications and adjusting them as needed to minimize the adverse effects that can increase the risk of falls.
– Environment modification: Making the environment safer by removing or reducing hazards, improving lighting, providing adequate equipment, and ensuring accessibility.
– Assistive devices: Providing patients with appropriate assistive devices such as walkers, canes, wheelchairs, or bed rails, and instructing them on how to use them properly.
– Supervision: Providing adequate supervision and assistance to patients who are at high risk of falling, especially during transfers, toileting, or ambulation.
Conclusion
Falls are a major concern for patients in IRFs, as they can negatively affect their health and recovery. By identifying the risk factors and implementing effective interventions, falls can be prevented and patient safety can be improved. IRFs should adopt a comprehensive and evidence-based approach to fall prevention that involves education, exercise, medication review, environment modification, assistive devices, and supervision.
References
Heinemann AW et al. (2018). Falls in Inpatient Rehabilitation Facilities: Risk Assessment and Prevention. Archives of Physical Medicine and Rehabilitation 99(1): 63-71.
https://doi.org/10.1016/j.apmr.2017.06.016
