Reducing Risk of Falls and Fall-Related Injury in Hospitalized Patients with CKD

Falls among hospitalized patients present a serious safety concern. Patients with chronic kidney disease (CKD) are at increased risk for falls due in part to generalized weakness, neuropathy, issues with blood pressure control, and difficulty regulating blood glucose level. Hospitalized patients with CKD initiating hemodialysis or experiencing complications related to being under dialyzed may be at risk for hemorrhage due to uremic anemia and/or albuminuria. Patients with CKD are also at increased risk for fracture related to CKD mineral bone disease or renal osteodystrophy.

At the virtual 2020 ANNA National Symposium, Kimberly Gengler, RN-BC, and colleagues at Cone Health, Greensboro, North Carolina, reported on a quality improvement project undertaken in an inpatient nephrology nursing unit to address the risk of falls among inpatients with CKD. The project was described in a session titled Preventing Falls and Fall-Related Injuries for CKD Patients with “Blood and Bone” Risks on an Inpatient Nephrology Nursing Unit.

The unit’s nephrology nurses, support staff, unit leaders, nephrology clinical nurse specialist, and clinical nurse educator designed a plan to target patients at high risk for falls as well as to identify those at risk for a fall-related injury.

All patients identified as high risk for falls were placed in the Fall Prevention Bundle. The bundle included evidence-based interventions such as nonskid socks, the use of gait belts, bed and chair alarms, hourly rounding, and safety education. All patients identified as high risk for falls were screened for risk of fall-related injury. Patients with a risk of hemorrhage or bleeding (blood) and/or a risk of fracture (bone) were placed on the Injury Prevention Bundle that included use of specialty low beds, floor mats, and white board communication in patient rooms.

The authors reported that, “After implementation of these bundles, there was a significant decrease in falls and fall-related injuries. The fall rate went from 4.56 in 2018 to 2.98 in 2019, a 35% reduction. The falls with injury rate decreased from a rate of 0.99 in 2018 to 0.14 in 2019, an 86% reduction.”

Source: Gengler K, Moore K, Young R, Johnson D, Kirkman A. Preventing falls and fall-related injuries for CKD patients with “blood” and “bone” risks on an inpatient nephrology nursing unit. Abstract of a presentation at the virtual 2020 American Nephrology Nurses Association National Symposium, August 29-31, 2020.