In-Hospital Falls

According to the Centers for Disease Control and Prevention (CDC), each year one in every three “older adults” (65 years and older) falls. Centers for Disease Control and Prevention, Falls Among Older Adults: An Overview, available at http://1.usa.gov/19A97Zb. According to the CDC’s report, in 2010, approximately 21,000 older adults died from unintentional fall injuries. The most common fall-related injuries were fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.

Among older adults who sustain a hip fracture, studies show that nearly 50% never regain their previous level of functioning, while 30% die within six months. John Jorgensen, MPA, RN, Reducing Patient Falls: A Call to Action, Best Practices for Falls Reduction: A Practical Guide, Mar. 2011, p. 2.

In addition to the recovery and mortality problems falls create for older adults, these events carry significant costs. When adjusted for 2010 inflation, “falls among ‘older adults’ cost the U.S. health care system $30 billion in direct medical costs.” Centers for Disease Control and Prevention, Costs of Falls Among Older Adults, available at http://1.usa.gov/19huwbH.

Since in-patient falls are avoidable, in 2008, the Centers for Medicare and Medicaid Services (CMS) joined with the CDC to enact a new payment provision whereby Medicare and Medicaid would no longer reimburse hospitals when one of eight so-called “never events” during a hospital stay led to injury. Falls were included on that list of events that should never happen after a hospital admission. Consequently, hospitals would no longer receive payment by Medicare and Medicaid for treatment related to injuries caused by in-hospital falls. Jorgensen, supra at 2. CMS and others assert that that the initiative is a “strong incentive for healthcare providers to implement practices that reduce the number of preventable patient falls.” Jorgensen, supra at 2.

Efforts to increase health care quality and decrease costs are causing hospitals throughout the country to take steps to reduce the amount of inpatient falls by adopting fall-reduction programs. One of the first places hospitals turn to for guidance on establishing these programs is the Joint Commission on Accreditation of Healthcare Organizations. Accordingly, attorneys representing individuals who suffered injuries resulting from an in-hospital fall should also look to the Joint Commission in order to determine whether a hospital’s fall-reduction program, protocols, or policies deviated from acceptable standards of care.’

The Joint Commission

The Joint Commission on Accreditation of Health Care Organizations is an independent, not-for-profit organization whose mission is to “continuously improve health care for the public ‘ by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.” The Joint Commission, About the Joint Commission, http://bit.ly/1aaLEi9. To gain accreditation, hospitals must allow on-site surveys to determine whether the hospital is in compliance with the Commission’s current National Patient Safety Goals and Provisions of Car Standards.

According to the Commission, the purpose of the National Patient Safety Goals is to improve patient safety and focus on problems in health care safety and how to solve them. The Joint Commission, 2013 Hospital National Patient Safety Goals, http://bit.ly/17WV9Ei. Because these goals and standards are revised annually, it is important for hospitals that are seeking accreditation to ensure that their safety programs are up-to-date with any new requirements or compliance procedures.

National Patient Safety Goal 9

In 2005, the Joint Commission introduced a National Patient Safety Goal to help to reduce the risk of patient harm resulting from a fall. Jorgensen, supra, at 2. Dubbed National Patient Safety Goal 9, or NPSG 09.02.01, the goal consisted of two requirements: Requirement 9A and Requirement 9B. Joint Commission Resources: Special Report! 2005 Joint Commission National Patient Safety Goals: Practical Strategies and Helpful Solutions for Meeting These Goals, http://bit.ly/15VzcHh. At the time the goal was introduced, hospitals seeking accreditation were only expected to comply with Requirement 9A, which stated that hospitals must “assess and periodically reassess each patient’s risk for falling, including the potential risk associated with the patient’s medication regimen, and take action to address any identified risks.”

Requirement 9B, which was only applicable to long-term care facilities at the time, required: 1) the implementation of a fall reduction program, “including a transfer protocol”; and 2) that the “the effectiveness of the program” be periodically evaluated. Special Report! 2005 Joint Commission National Patient Safety Goals: Practical Strategies and Helpful Solutions for Meeting These Goals, http://bit.ly/1e915M7.

In addition to complying with Requirement 9A, in 2005, hospitals were also expected to regularly assess each patient’s risk for falling by reviewing “risk factors such as previous history of falls, cognitive impairment, impaired balance or mobility, musculoskeletal problems, chronic diseases, nutritional problems, and use of multiple medications.” Id. At the time, the Commission also offered the following compliance “suggestions” as part of their risk reduction strategies: