I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
Falls and Patient Safety for Older Adults
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America is “graying.” Currently, the elderly (65 years of age and older) represent 12.4% of the US population, with nearly 1.8% over age 85.1 It is anticipated that by the year 2020 more than 20% of the population will be older than 65 years of age.2 States with higher than average proportions of older adults include California, New York, Pennsylvania, West Virginia, and Florida.1
Healthcare professionals faced with the challenge of providing post-fall care frequently required in this population are increasingly concerned about the conditions and events that may be antecedents to falls. For instance, the elderly have a higher incidence of chronic illness compared with acute illness, with each person having at least one chronic illness2 that potentially could precipitate a fall. The medical condition, health, and environmental factors often reported to contribute to falls are listed in Table 1.
Falls have garnered the attention of regulatory agencies. The Federal Nursing Home Reform Act (1987) created a national set of minimum standards of care and rights for people living in certified long-term care facilities. The standards emphasize quality of life and quality of care, including the right to be free of unnecessary or inappropriate physical and chemical restraints. Error reduction in safe care provision also has become a national concern. In 2001, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) began publishing standards for patient safety as a means to protect patients in all types of healthcare settings from injury; the safety standard for fall prevention was added in 2005.3
Federal regulations for long-term care facilities, known as F-tags, were established to set conditions for participation in the Medicare certification and payment system. A recent modification of F-Tag 323, which deals with patient safety in the resident’s environment (eg, throw rugs, furniture), combined preventing accidents and providing residents with supervision. The new tag states that a facility should provide 1) an environment free from hazards over which the facility has control and 2) appropriate supervision for each resident to prevent avoidable accidents. Included in the amended tag are quality improvement measures relating to the identification of hazards and risks, evaluation and analysis of hazards and risks, implementation of interventions, and continuous monitoring of the effectiveness of intervention and modification of the interventions as needed.
Falling and the Elderly
Because older adults are prone to falls, many healthcare providers assert that falling is a major geriatric syndrome.4 According to geriatric experts, older adults are not aware of their risk for falling and may not want to be considered old and dependent, so they do not report their frailty or event(s) of falling to their healthcare providers.5,6 Hence, opinion is that falls are under-reported in this age group.4,6
Secondary sources report nearly one third of adults over age 65 living at home and 50% of institutionalized elderly patients have fallen at least once during a 24-month period6-8; Lord et al9 reported in a prospective cohort study that 65% of intermediate care residents (N = 1,000) have incurred one or more falls. The average incidence rate of falls in long-term care facilities is 200 to 3,600 falls per 1,000 residents.5
References:
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3. Available at: http://www.jointcommission.org/PatientSafety/ NationalPatientSafetyGoals. Accessed August 11, 2006.
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