Don't miss patients at risk for falling in your ED

Different patients are at risk in the ED

When ED nurses at Methodist Hospital in Indianapolis performed a literature search on fall risk, they were disappointed.

"There is not a lot of information on falls in acute care settings like emergency departments," says Mary Ross, RN, ED nurse. It is difficult to identify who is at risk for falls in the ED, she adds. "There is no benchmark to compare the number of falls we have had in our ED to other EDs across the country."

Nurses decided to do their own research and looked at all of the falls in the ED over the past two years. "Our hope is that with our study we will be able to have a better perspective on who is falling in our ED," Ross says. "We can then come up with an action plan to prevent falls."

ED falls: Younger and impaired

ED falls were compared to falls in the inpatient setting, using the Hendrich 1:1 Fall Risk Model. The findings were surprising: The ED patients often were younger than the inpatients who fell and often had alcohol and drugs in their system, says Ross.

"We found that the patients that are falling in the ED at Methodist are not the same population of patients that fall on the inpatient units," says Ross. "Our fall patients are unique, and I doubt that we are different from other EDs across the country."

To reduce fall risk in your ED, do the following:

  • Assess each patient.

At Trident Medical Center in Charleston, SC, every patient is assessed for fall risk on admission to the ED after any diagnostic treatment or after medications have been given, says Mindi Huckabee, RN, CEN, director of emergency services

"We put in process an educational program on the risk of falls," she says. "This is mandatory training for all ED nurses. They go through a self-study module and take a test for competency."

Each room has a sign posted informing patients and family members of ways to prevent falls in the ED, says Huckabee. (See wording of sign below.)

Sign in ED targets prevention of falls

Here is the sign posted in treatment rooms at Trident Medical Center in Charleston, SC, to inform ED patients about fall prevention:

"In an effort to provide a safe environment for our patients, we have developed plans to recognize conditions that could lead to injury as well as things we can do that may help prevent falls.

As a health care team, we know that some conditions make you more at risk for falls. Some of these conditions are chronic medical conditions, medications, changes in environment, and altered mental status.

While in the emergency room, it is important to follow the directions of the staff and to help us maintain an environment that is safe and conducive to healing. Below are some of the things that both the health care team, you as a patient, and your family and visitors can do. If you have concerns about potential for falls, please discuss with your nurse or other appropriate health care provider.

  • Use your call bell to request help from the staff.
  • Request assistance before getting up if you are unsteady, dizzy, or unsure of your ability to walk or move about safely.
  • Wear nonskid footwear. Non-skid slippers are available.
  • If you use a cane, walkers, or crutches, please inform the staff.
  • If you should spill something, please request assistance in making sure it is cleaned up quickly.
  • As a family member or visitor, please let the nurse know if you note changes that require special monitoring.
  • Family members and visitors are important members of the health care team. Your assistance in keeping the patient safe is appreciated.
  • To monitor our patients, orange armbands and door magnets are used to alert all members of the health care team that a patient may be a risk for falling. Please talk with the nurse if you have questions."

Most falls involve patients who are intoxicated with drugs or alcohol or have not asked for assistance getting off stretchers, says Huckabee. "All high-risk patients should be told to ask for help prior to getting off the stretchers," she adds.

If a patient is identified as a fall risk, an orange bracelet is placed on the patient and an orange magnet is placed outside the patient's door. There are no identifying marks on the bracelet or magnet to protect the patient's privacy, adds Huckabee.

"We have very few falls in our ED," says Huckabee. "We attribute this to the education program for the staff and the education that is provided for both the patients and their family members."

  • Don't overlook children.

At Franciscan Skemp Healthcare-LaCrosse (WI), ED nurses classify all patients older than the age of 5 as either "high risk" or "low risk" and all children younger than age of 6 are classified as "high risk," says Patricia Formanek, MSN, CEN, education coordinator for the ED.

"There is a tendency to think of the elderly first when you are developing a falls prevention program," says Formanek. "Ours did not include a special section on pediatrics when it was first released, and the pediatric nurses asked, 'What about our patients?'"

Even if the parents are present, they may be distracted by the illness or injury that brought their child to the ED and not focusing on fall prevention, says Formanek. "The ED may not be a familiar environment for them, and they may need assistance in keeping their child safe from falls," she explains. (See the steps taken to prevent falls in children, box below.)

Follow these steps to protect children from falls

These are the steps taken to protect children at high risk for falls at Franciscan Skemp Healthcare-La Crosse (WI)'s ED:

  • Nurses document "high" for fall risk assessment on the patient record.
  • Parents or guardians are instructed to remain in the exam room with the pediatric patient at all times.
  • Parents are encouraged to hold infants and small children or have them sit in a chair rather than placing them on a cart, except for examination and/or treatment.
  • Both side rails are raised whenever a pediatric patient is on a cart, except during examination and treatment.
  • Ancillary personnel such as security, a social worker, or volunteer are utilized as needed to monitor patients.
  • Patient and family are encouraged to use the call light for assistance.
  • Share results with inpatient nurses.

ED nurses at Franciscan Skemp send the fall assessment screening tool with the faxed report to the floor, so admitting nurses can select a safe place on their unit for high-risk patients. "If a patient is considered high risk, a green arm band is placed on the patient prior to their transport from the ED for diagnostic tests, thus alerting all who provide services to the patient that they are high risk," says Formanek.

Sources

For more information on preventing patient falls in the ED, contact:

  • Patricia Formanek, MSN, CEN, Education Coordinator, Emergency Department, Franciscan Skemp Healthcare-La Crosse, 700 W. Avenue S., Lacrosse, WI 54601-4783. Telephone: (608) 791-7856 Fax: (608) 791-7808. E-mail: formanek.patricia@mayo.edu.
  • Mindi Huckabee, RN, CEN, Director of Emergency Services, Trident Medical Center, 9330 Medical Plaza Drive, Charleston, SC 29406. Telephone: (843) 797-4104. Fax: (843) 797-4972. E-mail: mindi.huckabee@HCAhealthcare.com.
  • Mary J. Ross, RN, BSN, CEN, Emergency Medicine Trauma Center, Methodist Hospital at Clarian Health Partners, 1801 N. Senate Blvd., Indianapolis, IN 46202. Telephone: (317) 962-8355. E-mail: MJRoss@clarian.org.