Data help show fall risk with design, assessments

When Our Lady of Lourdes in Pasco, WA, brought in outside engineers to give them a fresh perspective on reducing falls, the team came up with several solutions. Anita Kongslie, director of quality management, notes these as two of the most significant findings:

  • The investigators found that the hospital had converted an acute care unit into a physical medicine rehab unit without designing in certain safeguards to reduce falls. Toilet paper holders were placed in a position that required the patient to lean too far forward, then potentially lose their balance and fall. The toilets also were mounted on risers that made it difficult for some patients to use them without falling.

"So, some of the fixes were simple, such as moving the toilet paper holders and getting different toilets that didn't require risers," Kongslie says. "We also identified other measures we could improve, like monitoring medication and how often the staff was toileting patients so they wouldn't try to go on their own."

  • The analysis also revealed that observation patients had been overlooked in the Lourdes fall assessment and prevention program.

"Here we had these patients in our hospital for 24 to 48 hours, and no fall assessment was done on them because they were considered outpatients," Kongslie says. It was a significant oversight, she said. "We needed to be all-inclusive with fall assessment and educate our staff more about what to do with those fall assessment results," says Kongslie, referring to the need for staff to act by implementing standard fall reduction strategies when an increased risk was revealed.