Running head: AN INTEGRATIVE REVIEW: FALL PREVENTION PROTOCOL 1

An Integrative Review: Fall Prevention in the Emergency Department

Janet Heath

Bon Secours Memorial College of Nursing

Nursing Research for RN's

NUR4222

K. Austin

July 24, 2015

On my honor, I have neither given nor received aid on this assignment or test, and I

pledge that I am in compliance with the BSMCON Honor System. Janet L. Heath
Running head: AN INTEGRATIVE REVIEW: FALL PREVENTION PROTOCOL 2

Abstract

The goal of this integrative review is to evaluate the literature regarding whether a fall

prevention program for (those) geriatric patients who are at risk for falling is beneficial, or not,

during the current emergency department admission/visit. Falls are a risk during hospitalization,

as well as, a safety concern, especially for the elderly, in which health care systems are trying to

prevent. The use of various strategies and prevention programs to prevent falls are used hospital-

wide in order to decrease the number of occurrences. The research design is an integrative

review. The literature search using computer based search engines that consisted of PubMed,

Science Direct, and Nursing Reference Center within the EBSCO database. The search yielded

238 research articles in which only five met the criteria for inclusion. The analysis of the

research findings supported the use of a fall prevention protocol immediately upon arrival into

the emergency department. The benefits of implementing a fall prevention program resulted in

positive outcomes as indicated by the enhancement of quality and safety initiatives. The findings

revealed that a fall prevention protocol which is activated immediately upon arrival into the

emergency department, proved to decrease the number of falls sustained while in the emergency

department. Limitations to the review are related to the researchers inexperience, knowledge

deficit, and time constraints. The number of articles used, also, limited the review. Further

research should focus on different fall prevention models available in order to decrease the

number of accidental events that occur in acute care settings and the impact it has on fall rates.
Running head: AN INTEGRATIVE REVIEW: FALL PREVENTION PROTOCOL 3

An Integrative Review: Fall Prevention Protocol

The purpose of this integrative review is to search literature pertaining to the

effectiveness of a fall prevention protocol in the emergency department compared to not using a

specific protocol to prevent the occurrence of falls in the geriatric population. Preventing falls,

especially, in the geriatric population is a problem that hospitals are confronted with daily which

should be addressed before the incident occurs in order to prevent harm. Research studies have

shown that falls are rated one of the most frequent causes of injuries and accidental death in

patients over the age of sixty-five (National Institute of Health, 2008). Therefore, fall prevention

is an area of concern in which the emergency department is currently directing focus on. Upon

admission into the emergency department, there is a questionnaire that includes the history of

frequent falls. In fact, if the cumulative score reaches a certain point, the patients chart is

populated into a category in which a group of specialists review their need for further assistance

and determines if their safety is at risk. At that time, a yellow band is placed on their arm in

order to identify them as a fall risk. In an effort to provide patient-centered care, programs are

being developed in order to promote the health, welfare, and safety of patients. Fall prevention

programs have been developed and are being monitored. In the hospital setting, patient falls are

considered a preventable occurrence, therefore, fatal fall-related injuries should never occur

while a patient is under hospital care (National Institute of Health, 2008, p. 9).

A toolkit for improving quality of care by preventing falls and fall related injuries in

hospitals has been established. It focuses on overcoming the challenges associated with

developing, implementing, and sustaining a fall prevention program and is focused on

Running head: AN INTEGRATIVE REVIEW: FALL PREVENTION PROTOCOL 4

successfully negotiating a change process in hospitals (Toolkit for Improving Quality of Care.

2013). Fall prevention involves managing a patients underlying fall risk factors and optimizing

the hospitals physical design and environment in order to decrease the risks of such

occurrences (Toolkit for Improving Quality of Care , 2013).

In order to implement the quality improvement project revolving around fall prevention,

you must first assess your organizations readiness to improve fall prevention, assessed the

needs of the population involved, set goals, and have already started preparation for change, and

examined best practices (Toolkit for Improving Quality of Care, 2013).

In the Geriatric Emergency Department, guidelines have been implemented to provide

better patient centered care centered on the geriatric population, falls being one of the areas of

concern. These guidelines create a template for staffing, equipment, education, policies and

procedures, follow-up care, and performance improvement measures. When implemented,

patient-care, customer service, and staff satisfaction are improved upon (Geriatric program

quality improvement plan related to falls, 2013, p. 5).

In the emergency department implementation of fall prevention starts when the patient

arrives, either through triage or by emergency medical services. The fall risk assessment is a

series of questions providing information that helps distinguish if the person is at risk for falling.

If they are found to be a fall risk, a yellow armband is placed on their arm. This is the first

indicator that provides the caregiver with information alerting them that the patient is at risk for

falling. After that, all fall related precautions are taken, such as, handrails to provide stability

and support when ambulating, wet floor signs posted when spills are present, avoiding clutter in

rooms, no scatter rugs, and encourage the use of safety rails while in the bathroom and use of

floor mat while in the bath tub. The most recent implementation of quality improvement
Running head: AN INTEGRATIVE REVIEW: FALL PREVENTION PROTOCOL 5

measures taken to prevent falls is the addition of alert under pads used on the stretchers for

patients who are prone to getting out of bed and who are subject to falls. This project is fairly

new in our department and is only being done on a trial basis. Currently, data is being collected

in order to provide information as to whether the change will be beneficial. Of course, this is

only one aspect of preventing falls and it is important to incorporate all means of prevention.

High risk patients require close observation which can be managed more efficiently by making

hourly rounds, moving the patient closer to the nurses station, using electronic warning devices

on their beds; such as the alert under pads, putting the bed lower to the floor, and by

incorporating environmental safety measures such as proper lighting or nonskid mats

(Lippincott Nursing Center, 2008). The goal of the evaluation of a patient who has fallen or is

at increased risk of falling is therefore to diagnose and treat traumatic injuries, discover and

manage the predisposing causes of the falling geriatric ED patients, which is

challenging(Geriatric Fall Assessment, 2012).

Since the development of this project, our department has not had any falls that resulted

in harm which were related to patients in which the warning devices had been implemented.

However, due to other factors, the device is not used unless there is specific data recorded that

verifies the need for the electronic device. Like I said, it is a trial program and is costly.

Hopefully, after seeing the positive outcomes that have been a direct result of this device in order

to prevent falls, it will become standard practice.

Running head: AN INTEGRATIVE REVIEW: FALL PREVENTION PROTOCOL 6

References

Geriatric Emergency Department Guidelines [PDF file]. (2012, May 29). Retrieved from

www.acep.org/Geri_ED_Guidelines_FINAL-3.PDF

Geriatric Emergency Department Guidelines [PDF file]. (2013). Retrieved from

www.acep.org/Geri_ED_Guidelines_FINAL.PDF

Lippincott Nursing Center. (2008). www.nursingcenter.com/Inc/cearticle?tid=776342

National Institute of Health. (2008). www.ncbi.nlm.nih.gov/books/NBK2653/

Preventing falls in hospitals [PDF file]. (2013, January). Retrieved from

www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/