Falls in a Psychiatric Unit

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Falls in a Psychiatric Unit

           The psychiatric unit in St. Mary & Elizabeth Medical Center has been experiencing the problem of patient falls associated with medications, such as benzodiazepines, barbiturates, Prozac, and Ativan, which have a drowsiness and dizziness effect. The frequent patient falls that have occurred over the last three months have caught the attention of the head nurse in the psychiatric unit. Falls have become a safety concern as it exposes patients in the behavioral health unit to injuries that lead to additional care needs, prolonged hospital stays, and increased cost of care. Since the use of these psychiatric medications may be inevitable in mental health care, fall prevention has been documented as the priority issue that needs an urgent and effective solution. There is a need to identify an intervention to address the patient safety issue by addressing the risk factors. 

           The head nurse in the psychiatric unit stated that there had been challenges in monitoring patients after they had received the medications due to a large number of patients in the unit. Additionally, the nurse manager has emphasized the need to address the issue and reiterated that it is a priority patient concern. The head nurse has been given the role to explore the cause of the issue and find ways to mitigate the problem.

           The prevention of patient falls after taking the medications would improve the safety and welfare of the patients, which is one of the current objectives of the psychiatric unit. The achievement will also benefit the organization as improvement of patient safety is also a priority for the facility. Fall prevention would improve treatment outcomes and help avoid the complications associated with falls, such as prolonged duration of patient stays; thus, the unit will benefit from a reduced burden of care. 

Literature Review of the Problem

           Research on patient falls in psychiatric facilities have associated psychotropic medications with increased fall risk. 

           Du et al. (2017) investigated the relationship that exists between the psychotropic medication use and falls in older adults. The researchers established that participants who had higher psychotropic medication use experienced falls. The patients that were more likely to fall had used antidepressants. The authors reported that recurrent falls were common among individuals who used psychotropic drugs. The researchers concluded that the psychotropic medication use contributed to higher fall risk in older adults. The article is important for the current project as it provides evidence that associates psychotropic medications with falls, which can be essential in identifying individuals at a higher risk when implementing fall prevention measures. 

           In their study, Lu et al. (2018) investigated the risk factors that contribute to falls in acute psychiatric wards, focusing on gait measures, medications, diagnosis, gender, and age. The findings of the study indicated that the use of multiple medications significantly influenced the fall rate. The medications associated with increased likelihood of falling included laxatives, mood stabilizers, antidepressants, lithium, antipsychotics, H2-blockers, benzodiazepines, non-benzodiazepines, and alpha-blockers. Antidepressants had the highest risk of falls, as individuals taking a few antidepressants experienced falls. The researchers indicated that the diagnoses that have a high risk of fall included substance dependence, dementia, bipolar disorder, and schizophrenia, where all the diagnoses had similar fall risks. The authors added that patients with psychotic symptoms were at a higher risk of falling than those without psychotic symptoms. They concluded that psychotic symptoms interfered with individuals’ executive function, thus, leading to falls. The evidence provided in the article is related to the topic as it provides information on the causes of falls among patients using psychotropic medications. 

References

Du, Y., Wolf, I. K., & Knopf, H. (2017). Association of psychotropic drug use with falls among older adults in Germany. Results of the German health interview and examination survey for adults 2008-2011 (DEGS1). PloS one, 12(8), e0182432.

Lu, S. H., Chen, K. H., Pan, Y. C., Yang, S. N., & Chan, Y. Y. (2018). Influence of medications and psychotic symptoms on fall risk in acute psychiatric inpatients. Journal of Medical Sciences, 38(3), 117. https://doi.org/10.4103/jmedsci.jmedsci_132_17