Should Patient Falls Be Considered a Never Event?

There are currently 11 states that require patient falls to be reported to the state department of health.

Earning an online nursing degree may give you the knowledge on how to use evidence-based practice to prevent such events as patient falls. A recent study suggests that preventable errors – a patient suffering from a fall – contribute to the increase in hospital stays. Falls are a part of larger Congressional discussion on health care between nurses and hospitals over how to ensure a safer stay for hospitalized patients.

Depending on how long you’ve been a nurse, you may remember when the term “never event” was typically applied only to horrifying medical blunders – like a fatal overdose, amputation of the wrong limb, or an invasive procedure performed on the wrong patient. It’s easy to understand that mistakes like this should never, ever happen to the patients who have entrusted us with their care.

Yet today, the list of events classified as “never events” is growing. The National Quality Forum (NQF) defines never events as “any serious reportable event.” The Centers for Medicare and Medicaid Services (CMS) has stopped reimbursing hospitals for certain medical errors that is has deemed to be “reasonably preventable” – in other words, never events. By denying payment, CMS is sending a clear message to hospitals that they must work harder to ensure patient safety.

Yet, some health care professionals are quite concerned to see patient falls classified as a never event. When a patient sustains injury from a fall, CMS will no longer reimburse the hospital for treating that injury – the hospital itself must absorb the cost. Needless to say, hospitals are trying harder to prevent falls. But at what cost to patient care?

Restraining elderly patients or those with dementia is already a controversial practice and some patient advocates fear it may actually increase if falls are seen as a never event. A bulletin issued by the World Health Organization (WHO) thoughtfully suggests that even when restraints or chemical sedation aren’t used, some nurses might discourage patients from getting out of bed – thereby potentially delaying the rehabilitation process or increasing the risk of deep vein thrombosis.

The worst-case scenario is that nonpayment for events that are not universally preventable may reduce access to care. Just suppose that hospitals begin turning away patients known to be at higher risk for falls – the elderly, those with Azheimer’s, stroke patients with balance issues, or those taking certain medications, to name a few.

 

Nursing care has always included assessing patients for the risk of falling and coming up with care plans that include fall prevention strategies. These care plans should be individualized and patient-centered, rather than based on generalized labels like “elderly.” The 75-year-old patient who runs marathons and climbs mountains will need a different care plan from a 65-year-old that uses a walker or cane, for example. Other fall prevention strategies include offering non-slip footwear, encouraging patients to use the call system for help using the bathroom, and making sure pathways are free of obstacles.

Nurses may also advocate for medication adjustments for patients they believe to be at high risk of falls. A recent NPR story reported on the link between falls and drugs like Ambien – one of several sleeping pills that the Food and Drug Administration (FDA) says can lead to sleepwalking. According to the NPR report:

The Mayo Clinic in Minnesota has found that hospital patients who have taken Ambien are four times more likely to suffer a fall. The hospital considers anyone on sleeping pills to be high risk. They’re supposed to get special attention. That would include a bed alarm that goes off when a patient gets up.

Of course, bed alarms can only reduce patient falls when there are sufficient nurses on a shift to respond to them quickly, without leaving an even more critical task.

There are currently 11 states that require patient falls to be reported to the state department of health. From a patient advocacy perspective, the reporting requirement is probably a good thing – it allows trends to be tracked, policy to be shaped and improved on, and quality initiatives to be measured.

But are all falls truly preventable? This is a question that CMS may have to re-address, as it did with pressure ulcers. The original rule categorized all pressure ulcers as never events, and nurses struggled to prevent them in high-risk patients like those who were diabetic, obese or paralyzed. Yet, after hospitals objected, CMS restricted the non-reimbursement policy to Stage Three and Stage Four pressure ulcers, which are deep lesions that involve subcutaneous tissue.

 

We’d like to hear what nurses think about preventing patient falls. Are some falls inevitable? Have you ever seen a case where prevention measures have a negative impact on healing or rehabilitation? Please weigh in through social media, on our Facebook page or on Twitter, using the hashtag #patientfalls.

 
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