THE TUG OF WAR BETWEEN FALL PREVENTION AND MOBILITY IN THE HOSPITAL July 5, 2017
Here’s an eye-opening statistic: “According to a 2009 estimate, hospital patients spend more than 95% of their time in bed.”
That’s from a study cited in a recent opinion piece in JAMA Internal Medicine,which suggests that the increased focus on fall prevention in recent years has done little to reduce the incidence of falls with injury but has contributed significantly to the troubling trend of mitigating fall risk by keeping patients in bed.
Hospitals have become more proactive about fall prevention for good reason. First there was the CMS ruling in 2008, which cut reimbursement for eight hospital-acquired conditions (HACs), including falls with injury. Then, a program launched in 2010, as part of the Affordable Care Act, began to levy fines on hospitals scoring poorly on HAC measures.
As a result, patient safety and fall-prevention programs became a must-have. Typically these programs involve risk assessment and an array of interventions, such as alarms, documentation of risk, and education for patients and families. Unfortunately, they haven’t worked that well. The JAMA piece cites more than one study indicating that these multifaceted programs were ineffective at reducing falls. They did, however, seem to do a pretty good job of keeping patients bed-bound.
Safety in Motion
It’s well-known that immobility in the hospital contributes to functional decline and susceptibility to hospital-acquired conditions such as DVT, pneumonia and pressure ulcers. But what has been less clear is the correlation between mobility and fall prevention. What we’re learning, according to these authors, is that “promoting mobility in the hospital may actually help to prevent injurious falls.”
They find evidence of this in the Hospital Elder Life Program (HELP), a multifaceted program designed to prevent delirium using a number of methods including ambulation and mobility. The program has been associated with “decreasing delirium, cognitive and functional decline, length of stay, hospital costs and institutionalization.”
Other studies cited in the article support these findings and warrant a stronger push to promote mobility as a means to prevent injury. The JAMA piece calls for fall-prevention teams in hospitals to be “transformed into mobility teams” and for the CMS to “develop quality measures that promote mobility as part of routine clinical care.”
Equipped for Change
A mobility initiative worth its salt includes staff protocols and education as well as the implementation of mobility aides that actually support rather than impede ambulation. That’s why more hospitals are choosing the IVEA for use bedside and during ambulation. The IVEA is specifically designed to make ambulation safer, easier and more efficient. Innovative yet practical, it supports every clinician’s aim to help patients of all ages leave the hospital in better health than when they arrived.
It’s ironic that many hospitals are limiting mobility to keep patients safe when, as the JAMA article suggests, it’s mobility that actually helps to prevent harm. Don’t fall into this trap. Avoid the false choice between safety and mobility and make ambulation central to your fall-prevention strategy by contacting us to learn more about the IVEA and schedule a product demonstration.
You can reach us at (970) 472-5323 or [email protected].
 Growdon, M., Short, R., Inouye, S., “The Tension Between Promoting Mobility and Preventing Falls in the Hospital,” JAMA Internal Medicine, (June 2017)