After reading this article, you will be able to:
- Construct an efficient patient fall prevention plan
- Recognize ways to improve face-to-face communication between staff members, patients, and their families
- Identify the characteristics of a high-fall risk patient
In addition to being the focus of National Patient Safety Goal #9, preventing patient falls has taken on even more importance for hospitals this year. Beginning in October, CMS will no longer reimburse hospitals for the cost of care following patient falls that could have been prevented.
Implementing policies and procedures to reduce patient falls can be a challenging task for hospitals and their staff members, but there are practical and effective ways to comply with this regulation. When implementing a patient fall prevention program, facilities should address three areas: communication, patient room adjustments, and identification.
Although communication can be passed on through documentation and medical records, there is nothing more effective than face-to-face communication among staff members, and between staff members and patients. There are many ways in which patient falls can be reduced by using more effective communication strategies within your hospital. "One of the most underutilized communication tools is one-on-one walking rounds. It's nothing new, but it's gone by the wayside," said Linda Smith, PT, CCE, quality improvement coordinator for Iowa-Des Moines Health, during the February 19 HCPro audioconference, "Assessment, Intervention, and Communication: Strategies to Prevent Harm." This tool not only benefits staff members but also includes patients and their families by giving them an opportunity to ask questions and be involved with the staff.
Smith also suggests using whiteboards in break rooms. These boards highlight the high-fall-risk patients and are updated frequently. "Nurses can circle who's at risk for falls daily and then talk about prevention with the patient and families," she said.
Des Moines Health stresses intra-staff communication by doing postfall huddles and sharing findings from unit to unit. "The huddles allow for staff to quickly evaluate and learn from the fall," said Smith. The huddles happen within 24 hours of a fall and are a time to facilitate learning, not blame anyone. "Avoiding words like 'you should have' and being aware of body language allows for coaching and future prevention," she said.
Sharing unit findings hospitalwide has also been an effective tool. "We bring it down to the unit level and profile each unit while looking at root cause analysis, trends, patterns, age, and sex," said Smith. The units engage in frequent brainstorming based on the information from their unit.
Implementing these communication techniques has reduced patient falls by 50%, said Smith, adding that better communication has also resulted in an improved culture of safety, more staff empowerment and respect, and, ultimately, a safer environment for patients.
Patient room adjustments
When patients are admitted to Sentara Norfolk (VA) Hospital, a set of universal fall prevention guidelines are addressed. "We assess and instruct all admitted patients on fall prevention," said Stephanie Jackson, MSN, APRN, CS, manager of the educational department, diabetes program, and enterostomal therapy services program at Sentara Norfolk, during the audioconference.
After the assessment, specific safety precautions are put in the patient's room. At Sentara Norfolk, each bed is adjusted, nonskid slippers are given to the patient, a bedpan is placed within easy reach, and the furniture is rearranged so that the patient has easy access to the bathroom and exit.
"Bed and chair alarms and sometimes less-restrictive restraints are used. We've found that enclosure beds work well," said Jackson. Other injury-reduction devices, such as helmets, hip protectors, and fall mats, are given as needed, she said.
Other fall interventions hospitals may want to adopt are identification bracelets, physical restraints, bed alarms, and special flooring, which were found to have the potential for effectiveness by a research-based fall prevention program launched by Yale University Schools of Medicine and Public Health. For more information on the study, click here.
"In our hospital, we tell our patients that safety trumps privacy," said Jackson. "We got pushback on this initially, but now it's well accepted if the patient is high-risk."
Using a graph to measure patient falls over time-monthly, quarterly, and annually-allows for a good reference and trend evaluation, she added.
Studies can also serve as informational tools to those trying to assess their facility's performance.
To gauge the prevention of patient falls in its medical and surgical units, Beth Israel Deaconess Medical Center in Boston, MA, conducted a study measuring the facility's fall rates against those of a nationally recognized database of comparable institutions. The results not only gave the organization a clearer perspective on where it stood against other institutions, but also allowed it to set improvement goals and strategies, such as implementing a hospital-wide fall prevention team to lower fall rates. To read more about the hospital's program, click here.
Better patient identification is not only needed for quality improvement, but also to reduce patient falls. Because patients travel from unit to unit, hospitalwide identification of fall-risk patients is crucial.
Sentara Virginia Beach Hospital developed a patient ID system, known as the ABCs of harm, that evaluates whether the patient is at high risk. The ABCs are:
- Age-Noting whether the patient is older than 85
- Bones-Examining bone history, fractures, or other diagnoses
- Coagulation-Knowing whether the patient is on any medications that would cause prolonged bleeding if he or she fell
Risk factors associated with patient falls have also been identified and categorized by the U.S. Department of Veterans Affairs. The VA National Center for Patient Safety states that nurses need to be aware of both the intrinsic factors, including the patient's cognitive impairment and mental status alterations, but also the extrinsic factors outside of the patient's body, such as clutter and loose electrical cords, to prevent patient falls. The VA has developed a tool for fall prevention and management, which can be accessed here.
"Identification and then intervention is important," said Suzanne Retta, RN, MSN, team coordinator of Sentara Virginia Beach's quality management and performance improvement department, who also spoke during the audioconference. "We got a team together to focus and simplify procedures. We went from a seven- or eight-page policy to about a one-and-a-half-page policy. We also use color identification. Purple blankets travel with patients as a standardized handoff tool hospitalwide."
Retta also communicates through staff huddles. "We look at the common cause, put an intervention in place, and then track it," she said. By properly identifying patients that are at high risk for falls, Sentara reduced patient falls by 12% and serious injury by 25%.
Source: Adapted from Quality Improvement Report, April 2008, HCPro, Inc.
- "Chapter 26. Prevention of falls in hospitalized and institutionalized older people." Yale University Schools of Medicine and Public Health. Available at http://www.ahrq.gov/clinic/ptsafety/chap26a.htm
- "The Facts at BIDMC: We're putting ourselves under a microscope." Beth Israel Deaconess Medical Center. Available at http://www.bidmc.harvard.edu/display.asp?node_id=9669
- "VHA NCPS Fall Prevention and Management." United States Department of Veteran Affairs. Available at http://www.va.gov/NCPS/CogAids/FallPrevention/index.html