December 2004 Bulletin

Patient safety tip

Preventing falls: Walk the walk

By Robert L. Brooks, MD, PhD

On Oct. 14, 2004, the U.S. Surgeon General released a Report on Osteoporosis and Bone Health. Intended to be a comprehensive review in layman’s terms of all metabolic bone diseases, the report took several years to develop and is more than 13 chapters in length.

It places new public emphasis on the importance of strong bones. The report also calls on medical professionals to help patients maintain bone health by evaluating risk and recommending bone density tests for all women over the age of 65, and for any patient over age 50 who sustains a fracture.

More than 10 million Americans have osteoporosis, the report says, and another 34 million are at risk. Osteoporosis contributes to more than 300,000 fractures every year, resulting in disability, mortality and more than $17 billion in national health care costs.

“Despite these staggering numbers, most people do not realize their personal risks of developing osteoporosis and a related fracture,” said Judith Cranford, executive director of the National Osteoporosis Foundation. “This report serves as a wake-up call to the American public to take action now to minimize the disease. Osteoporosis may be a silent disease, but we cannot be silent about it.”

As the report was released, Department of Health and Human Services Secretary Tommy G. Thompson said, “This report will shape the way we approach, talk and act about bone diseases.”

Orthopaedists play key role

The public recognizes orthopaedic surgeons as authorities on bone disease and injury treatment. We can protect the safety of our patients by minimizing bone loss and by helping them to avoid the risk of falls.

Because most patients with osteoporosis first present with fracture, orthopaedic surgeons have a key role to play in early diagnosis and avoiding future injury. Many of us evaluate and treat osteoporosis as part of our practices. Others participate in multi-disciplinary programs, that include internists and endocrinologists. By so doing, we protect our patients’ safety in their communities and their homes.

Strategies for fall avoidance make a distinction between “accidental falls,” those falls caused by slips and trips, and “physiologic falls,” those due to weakness, poor coordination and other factors intrinsic to the patient. We recognize that environments that are safe for healthy individuals may be treacherous for weakened patients with unsteady gait. Early diagnosis of physiologic fall risk allows intervention to protect the patient.

Top patient safety tip

AAOS Fellow Joseph M. Lane, MD—a recognized authority on metabolic bone disease and a member of the Academy’s Women’s Health Issues Committee—submitted the following “Patient Safety Tip” that ranked among the Top 10 Tips at last year’s Annual Meeting in San Francisco.

“Ask the patient to stand on their best leg without support,” he wrote. “If an individual cannot stand for 12 seconds, he/she is at risk of falling and should enter a fall prevention program.”

Similar measures include timing how long it takes the patient to rise from a chair and observing the patient’s ability to advance from the waiting room to the examination suite. Performed in the presence of appropriate family members, such tests can lead to home evaluations for environmental risks and the need for adaptive devices, and can even begin the difficult discussion regarding a move to assisted-living arrangements.

Orthopaedic surgeons also have a key role to play in fall prevention for hospitalized patients. The Joint Commission on Accreditation of Healthcare Organ-izations requires hospitals to develop a fall-protection strategy as part of their Patient Safety Goals for 2004. Nurses now assess every patient upon admission and daily thereafter, using standardized scales for risk of falling. Beyond increasing awareness and educating families, most current fall-prevention strategies rely on technological devices such as activity alarms and beds that can be lowered to the floor. Orthopaedic surgeons should review their hospitals’ fall-prevention policies and actively take a leadership role in their revision.

Protecting frail patients from injury

The American public believes that our institutions should be able to better protect our most frail patients from injury. More research is needed to develop other effective methods of protecting at-risk patients from falls.

“Thirty years ago, doctors thought weak bones and osteoporosis were a natural part of aging, but today we know they are not,” said U.S. Surgeon General Richard Carmona, MD. “Let’s get started by taking action today in homes, health care settings and communities across our nation.”

For patients in the hospital and in the home, orthopaedic surgeons are on the frontline to evaluate and treat both metabolic bone disease and physiologic gait disorder. As leaders and educators in our medical communities, we can again take another “turn of the wrench” and improve the health and safety of our patients.

Robert L. Brooks, MD, PhD, is a member of the AAOS Patient Safety Committee.

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