My hospital last winter experienced very high number of admissions. The county where it is located does not have code diversion or saturation which would divert patient to other hospitals when we are at full. Instead the hospital had to use pre and post op areas for in patients. This created a shortage of CNA's in all areas.

The patients acuity was high and so was their fall risk. Part of our assessment included a fall risk factor based on numbers. Our beds are equipped with bed alarms letting us know when a patient is getting out of bed. With so many elderly confused patients alarms were almost non stop. The problem we encountered was an increase in the number of falls due to the lack of staff making it to the room in time.

The American Nurse Today says " up to 20% of falls cause serious injury, including fractures and subdural hematoma .prolonged hospitalization, up to a year in recovery (americannursetoday.com, 2014). Medical costs related to falls totaled more than $19 billion in 2007-$179 million for fatal falls and $19 billion for nonfatal fall-related injuries.

By 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 billion (americannursetoday.com, 2014). The administration held a mandatory meeting with nursing staff to address the issue but unfortunately it was after the death of two patients from falling injuries.

Starting in 2008 " hospitals no longer receive payments for treating injuries caused by in-hospital falls, based on a 2007 final rule by the Centers for Medicare & Medicaid Services (americannursetoday.com, 2014)" With the lost of life and reimbursement of care the administration added three CNA's on every floor, allowed nurses to place a sitter for patients based on our assessment with out needing a doctors order and tried to keep a CNA on call for every shift.

It was a trail bases that worked well in providing safety for our patients. We are under the assumption it will be in place this winter also. I hope no deaths will be required to make that happen.

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