Evidence-based practice: Educating nurses about fall prevention

Editor’s note: This is the third installment of an ongoing series highlighting the progress of North Adams (MA) Regional Hospital as it works through its first evidence-based practice project. This month’s article focuses on education implementation.

After identifying an increase in patient falls, Debbie Durant, RN, BSN, director of the medical-surgical unit at North Adams (MA) Regional Hospital, and Peg Daly, RN, BS, education specialist at the 120-bed hospital, joined forces to develop an evidence-based initiative to:

• Decrease falls by 10% within 12 months of plan implementation
• Review and revise falls policy and procedures based on evidence-based data
• Recommend necessary education for staff members
• Develop ongoing performance improvement monitoring

The second and third objectives were achieved by mid-April and education is being implemented.

During the next 12 months, nursing assessments and documentation will be closely monitored in terms of risk assessment and implementation of the new fall prevention program. Data will be collected to determine whether the primary objective, decreasing falls by 10% within 12 months of plan implementation, has been achieved.

Daly credits the staff nurses who are members of the falls subcommittee for the program’s success thus far. “This effort has really been nurse driven,” she says.

In addition to Daly and Durant, the other members of the committee are:

• Stacy Gentile, an RN on the critical care unit
• Lou Ann Quinn, RN, MS, director of surgical services
• Sue Vareschi, an LPN on the medical-surgical unit

Hospital staff members received training in May. Non-nursing personnel were trained by their managers with support from Daly and Durant, who provided visual aids, talking points, and in-person clarification as requested. Emphasis was placed on reinforcing the fact that fall prevention is the responsibility of all employees, not just nurses or other patient care providers.

Implementation of nursing education

It will come as no surprise to staff development specialists that it was a challenge to educate all members of the nursing department. Time is always a problem with educational initiatives, so Daly and her team combined fall prevention training with other education.

“There was no way to pull nurses off their units for separate education programs, so we combined several critical, mandatory programs into one major education event,” Daly says.

Because computer access was necessary for the initial two hours of training, class size was limited to 10 nurses. One benefit of the small class size was that it facilitated effective role-play and discussion.

During the first two hours, the class reviewed the new bedside delivery medication system, the medication reconciliation process, and an allergy conversion process. A review of the eHealth portal process that allows nurses to access health information from physicians’ offices was provided.

The final two hours of class were devoted to the fall prevention plan, which included:

• Demographics on the incidence and costs of falls. According to the Centers for Disease Control and Prevention, falls cost the healthcare industry $20 billion annually. It is estimated that by 2020, the cost of falls will reach $32.4 billion.
• Specific criteria for fall assessments.
• Role-play using life-size puppets—affectionately referred to as Fred Faller and Penelope Pill Pusher. Fall assessment scenarios were enacted, and nurses had to score the fall risk and document their findings.
• A demonstration of fall assessment electronic documentation.
• Specific fall prevention interventions.
• Introduction of the pediatric fall assessment program.

The pediatric fall assessment program was a new initiative at North Adams Regional Hospital. “Our pediatric unit is small, only six beds. But the more we learn about falls, the more we realize that every patient, regardless of age, needs to be formally assessed for fall risk and appropriate interventions taken,” Daly says.

How were fall prevention criteria determined? “We used reliable sources from the literature. For example, we found two books from HCPro on fall assessment and prevention especially helpful. They are well-worn copies,” she says.

Evaluation

Fall prevention guidelines mandate that every patient is assessed and findings documented on admission, every eight hours, and with every change in patient condition.

“We’ll be looking critically at every fall that takes place and also looking at our fall assessment tool. Did we ask critical questions? Are we doing everything we can do to prevent falls?” Daly says.

Additionally, falls are categorized as accidental, anticipated, and unanticipated. For example, an anticipated fall is used to describe the possibility of falling for patients who are at high risk, such as those with impaired mobility or cognition or who take a variety of medications. “In fact, we believe the revision of our falls assessment tool will actually score more of our patients at high risk for fall,” says Daly. “Did you know that research shows that one out of every three persons 65 years of age or older fall every year? And we have an elderly patient population.”

Primary interventions will be in place for all hospital patients, regardless of the fall assessment score. “ ‘Back to basics’ might describe some of the strategies to prevent falls,” says Daly. “We want patients and staff to be aware of the safety of the patient environment. Staff are reminded to introduce themselves, to make sure that call lights are within patients’ reach, as well as canes or walkers, if needed, and that bedroom slippers are non-skid. We’ve even put signs in all patient rooms and bathrooms that remind patients to ‘Call, Don’t Fall.’ ”

Daly and her team developed a one-page teaching tool for patients titled, “Let’s work together to keep you safe.” It includes basic tips on fall prevention with illustration and is written at basic literacy levels. “We’re committed to keeping our patients safe,” Daly says, “and to reducing the number of falls.”

Editor’s note: In the coming months, Daly will share the effect of education on fall reduction.

References

Eldridge, C. (2007). Evidence-Based Falls Prevention. Marblehead, MA: HCPro, Inc.

Payson, C., and Haviley, C. (2005). Patient Fall Assessment and Prevention. Marblehead, MA: HCPro, Inc.