Hip Fracture Prevention Programs
Given the large number of people at risk for hip fracture from falls in nursing homes and other long term care facilities, considerable attention has been given in recent years to fall prevention programs. Comprehensive implementation toolkits and clinical practice guidelines have been developed to encourage wider implementation of not only clinical care improvement but also risk management practices.
Nurses play a critical role in educating patient about hip protectors, which are an important part of hip fracture prevention programs in nursing homes.
Promoting a Culture of Safety
Organizations such as the American Medical Directors Association have formally recognized the importance of reducing hip fractures in long term care facilities through their publication of a clinical practice guideline dedicated to the topic.1
In the public sector, led by the extensive work of its Tampa-based VISN 8 Patient Safety Center of Inquiry, the U.S. Department of Veteran Affairs has blazed a trail of awareness about the growing crisis of hip fractures in an aging population. Its Falls Toolkit documents a comprehensive blueprint for managing this crisis, not just in its own facilities but also among the larger community of private sector nursing homes.2
Hip Protectors Play Key Role
While understandably not endorsing any one particular brand, the VA has also been a leading force in promoting the use of hip protectors as a key component of hip fracture prevention programs, most notably through its Hip Protector Implementation Toolkit3 and its ongoing program of extensive research into the field.
Notably, the VA recommends that facilities:
- Incorporate a policy on hip protectors into their existing fall prevention protocols
- Develop prescribing guidelines to ensure that at-risk patients are prescribed the use of hip protectors
- Educate patients on risks for hip fracture and the benefits of hip protectors
- Leverage their staffs, who are in best the position to counsel and influence residents and their relatives
Economic Benefits
Hip fracture prevention programs can have highly tangible economic paybacks, given the $29,000 average cost for direct treatment of each hip fracture.4 Though widely varying among institutions, this figure does not include the significant costs associated with ongoing skilled nursing care—to say nothing of the additional financial burden incurred by other factors such as loss of mobility and independence.
For institutions, recent rumblings about changes in Medicare payment policies that disallow reimbursement for fall-related injuries that occur in hospitals may be extended to nursing homes in the future as well.2 Should this come to pass, the incentives to reduce the incidence of hip fractures from falls will significantly increase.
References
1. American Medical Directors Association. Falls and Fall Risk Clinical Practice Guideline. Columbia, MD: AMDA 2011
2. VHA NCPS Falls Toolkit. Washington, D.C.: National Center for Patient Safety;2004
3. VISN 8 Patient Safety Center of Inquiry. Hip Protector Implementation Toolkit. Washington, D.C.: United States Department of Veterans Affairs, VA Sunshine Healthcare Network;2009.
4. Quigley P, Campbell R, Bulat T, et al. Incidence and cost of serious fall-related injuries in nursing homes. Clin Nurs Res. 2012;21:10–23
