Undeterred, others continued to research the problem and explore better solutions, perhaps most notably the VA’s specialist VISN 8 Patient Safety Center of Inquiry. Focusing increasingly on preventing the fracture—not just the fall that precipitates the fracture—the center published its “Hip Protector Implementation Toolkit,” which extended the scope of its earlier “Falls Toolkit.”5,8
Despite this encouragement, implementation of hip protector programs has been impeded by noncompliance issues. Healthcare providers who understood and accepted the potential value of hip protectors have been repeatedly challenged by patient perceptions or outright complaints of wearing discomfort, along with concerns about personal appearance and the disinclination to admit physical vulnerability that is a common hallmark of advancing age.
In response, the medical supplies industry quickly took up the challenge of how best to improve wearing comfort without compromising efficacy. Initial hard-shell designs gave way to soft pads but gave up some efficacy in the process. Then came hybrid pads that combined hard and soft components, along with different shapes, each with its respective champions. Impact protection via shock absorption versus shunting became the subject of debate among some bioengineers, while healthcare providers continued to struggle with noncompliance.
A NEW GENERATION OF HIP PROTECTION
As is often the case, it takes a technological breakthrough, often in another field, to shift the foundation of well-established behaviors. Recent advances in the molecular engineering of shock absorption materials, spurred by a growing demand for flexible, lightweight, low-profile yet armor-like protection capabilities from the extreme sports, military and law enforcement arenas have spawned a new generation of personal protection clothing that is only now extending to the healthcare field.
Soft, flexible, and pliable in their natural state, such materials become instantly rigid at the moment of impact, only to immediately relax once the energy of the impact is absorbed. As a result, they come closer than ever to the optimal wearable protective device—unnoticeable in everyday use, yet providing maximal impact protection whenever and wherever needed.
The recent incorporation of this technology into hip protectors and other protective devices promises to significantly decrease the challenge of patient noncompliance, resulting in a win-win for long-term care providers not only in terms of improved clinical care but also in the potential for cost savings and enhancement of risk management practices.
With growing rumors of Medicare moving to disallow reimbursement for fall-related injuries occurring in LTC facilities, the bottom-line competitive incentives to such improvements are clearer than ever.
D. Stephen Robins, MD, is CEO of Medical Protection Technologies, distributor of the Fall-Safe Hip Protector. Dr. Robins has championed numerous patient safety issues over his 35-year medical career in clinical practice, clinical research and standards of practice development. He can be reached at firstname.lastname@example.org.
- Leibson C, Tosteson A, Gabriel S, et al. Mortality, disability, and nursing home use for persons with and without hip fracture: A population-based study. Journal of the American Geriatric Society 2002;50:1644-50.
- Quigley P, Campbell R, Bulat T, et al. Incidence and cost of serious fall-related injuries in nursing homes. Clinical Nursing Research 2012;21:10-23.
- Rubenstein L, Josephson K, Robbins A. Falls in the nursing home. Annals of Internal Medicine 1994;121:442-51.
- Van Doorn C, Gruber-Baldini A, Zimmerman S, et al. Dementia as a risk factor for falls and fall injuries among nursing home residents. Journal of the American Geriatric Society 2003;51:1213-8.
- VHA NCPS Falls Toolkit. Washington, D.C.: National Center for Patient Safety, 2004.
- Kannus P, Parkkari J, Niemi S, et al. Prevention of hip fracture in elderly people with use of a hip protector. New England Journal of Medicine 2000;343;1506-13.
- Rubenstein L. Editorial: Hip protectors—A breakthrough in fracture prevention. New England Journal of Medicine 2000;343(21):1562-3.