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Maryland Program Provides Road Map for Reducing Patient Falls

More than two dozen hospitals are participating in the Maryland Patient Safety Center's (MPSC) SAFE from FALLS initiative. The project, based on a program by the same name being run through the Minnesota Hospital Association, has been providing facilities around the state with a road map for forming a comprehensive falls prevention program since July 2009.

The program is not mandatory, but is a valuable initiative in which to take part, says Susan D. McDonald, BSN, JD, director of risk management at Peninsula Regional Medical Center (PRMC) in Salisbury, MD. Her facility, a 375-bed acute care hospital, has been a part of the SAFE from FALLS program since its beginnings.

"We really already had many of the best practices in place," says McDonald. "Most hospitals have had falls programs in place for years, quite frankly. But what this forced you to do was really take a hard look at what your program consists of." For example, PRMC re-evaluated its method for flagging patients as fall risks. The organization has "moved away from the clever" and taken a more direct route to doing this, says McDonald. The hospital now places signs that say "risk of fall" on patients' doors, and prints orange arm bands with the words "fall risk" on them to place on the wrists of patients who are at risk of falling.

Developing a statewide initiative
MPSC was created through the Maryland legislature, with the Maryland Hospital Association and Delmarva Foundation selected as joint operators. The two organizations are involved in many of MPSC's initiatives, including SAFE from FALLS. Wendy Gary, MHA, vice president of healthcare quality and patient safety at the Delmarva Foundation, says that the state was looking for a way to standardize the way in which falls are measured to achieve a universal improvement.

"You really can't compare apples to oranges when you're looking at falls and looking at falls prevention and the severity of falls, especially if everyone is dividing them up in a different way," says Gary.

The falls road map was created with the help of workgroups for each of the three settings that the project addresses: Acute care, home health, and nursing homes. The next step was pilot testing in each of these settings during 2008 and 2009. Today there are about 30 hospitals using the road map, along with 50-60 nursing homes and 12 home health agencies, says Gary.

On a quarterly basis, the users report outcome and process measures. The outcome measures include things like falls, falls with injury, severity of falls, etc. The process measures are audit questions that align with the road maps, says Gary. The project also seeks to measure any cost savings that have been realized due to falls prevention.

"We can do a couple of things: We can look at the decrease in falls overall and a decrease in severity, but we can also take a look at what elements these folks are implementing off the road map on a progressive basis," says Gary. "We're looking to prevent the preventable and then make sure whoever falls has the least severe fall that they can possibly have."

One of the more important aspects to consider when using the road map is that because it is a guide, it's perhaps not necessary for each facility to implement all of the suggested prevention techniques; instead, finding the best combination of strategies is the goal. It is a comprehensive guide, but not prescriptive, says Gary.

"Maybe it's not about implementing all of the audit questions or all of the strategies—maybe there's a perfect recipe, that if you implement x, y, and z, you're going to get the best results, so that's really what we're looking for in each of the settings," says Gary. The goal is to provide each facility the option of creating its own personalized falls program.

That sentiment was taken to heart at PRMC, and the facility has seen a decrease in both the number of falls and the number of patients who had falls with significant injury from 2007 through 2009.

"We decided that there might be things [on the road map] that we were not going to try to do," says McDonald. "I don't think this is an exercise where you answer 'yes' to everything—some things might not work for you." For instance, PRMC has elected to not have a pharmacy consult with a fall risk because of staffing and technology issues.

The goal of the SAFE from FALLS initiative in the coming months is to continue to recruit more hospitals and gather more data, says Gary. Additionally, the program will roll out a best practice monitoring tool statewide in July. The program will continue to develop an outpatient module for acute care facilities to use as well.

One of the largest benefits of participating in the collaborative for PRMC has been improving staff engagement levels, says McDonald. When someone from the MPSC visits the facility to check in on how the facility is working with the road map, staff plan events to display efforts on fall prevention. One instance involved a contest with each nursing department's falls educational boards exhibited in the hospital's lobby.

"That got people in the spirit, and that prompted many other similar types of [efforts] with other educational boards."