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Preventing falls among employees requires different methods than preventing patient falls.
Risk managers always address fall prevention with patients, but do employees get enough attention? Healthcare employees are at risk of falls every day, and the tactics that work best with patients may not be the most effective when preventing potential workers’ compensation claims.
Falls, slips, and trips were the second most common event leading to workplace injuries and illnesses in hospitals, according to a 2017 report from the U.S. Bureau of Labor Statistics, accounting for 25% of all reported employee injuries. Overexertion and bodily reaction, including injuries from lifting or moving patients, was the most common type of injury. (The report is available online at: https://bit.ly/2KWyXT0.)
Addressing fall prevention with employees is different than with patients, says Bette McNee, RN, NHA, clinical risk management consultant at insurance broker Graham Company in Philadelphia. With patients, fall prevention focuses mostly on transfers from beds and wheelchairs, as well as environmental factors, she says, whereas preventing falls among employees is more a matter of how they work with such focus.
Employee slips and falls tend to be the top workers’ compensation claim in both frequency and severity, McNee says.
Addressing employee fall prevention starts with the low-hanging fruit, like flooring materials, mats, footwear policies, and snow and ice removal, she says. Risk managers also should look at what makes the hospital environment dangerous for employees — including employees’ dedication to their work.
“Healthcare employees typically are so focused on their work — nurses walking around, reading a medication label or looking at a patient chart — that they can lack the safety mindfulness you might hope for. Their attention on the one task keeps them from seeing everything going on around them,” McNee says. “When they are focused so intently on the patient, they don’t tend to see the cords at the bedside or the wheelchair legs that have been removed and left on the floor.”
Risk managers can encourage employees to think of a 10-foot circle of safety around them, McNee says. They do not necessarily have to be aware of everything in the room, but they can keep an eye out for hazards within 10 feet. This encourages a situational awareness with a limited scope, which can be more realistic for someone highly focused and multitasking than simply telling them to watch for hazards, she explains.
“They are constantly told that everything is a top priority and they have to pay such close attention, so it can be hard to tell them to watch out for hazards on the floor, too. But if you keep it to that 10-foot circle of safety around them, that can be more attainable,” she says. “You also build interdependence when your circle of safety overlaps with your co-workers’.”
An aging workforce also increases fall risk, McNee says, as well as health issues such as obesity. Hospitals have addressed these issues successfully with wellness programs, she says.
Even in an organization in which patient falls are treated with the utmost seriousness and no excuse is acceptable, employee falls may be excused sometimes as just an isolated event, McNee says. If a nurse is rushing to a code call and trips on a trash can, supervisors may dismiss it as an unfortunate accident and say the trash can should not be in the way next time, she says.
“They tend to treat it as a very unfortunate one-off accident, treat her, and get her back to work,” she says. “They don’t look at the situation as something that happens because of the laser focus they have on their duties and how the environment should be tailored to accommodate that.”
Hospitals can begin addressing employee falls by assessing fall reports to identify trends, says Meaghan Crawley, MSN, RN, CEN, trauma injury prevention/outreach coordinator at Spectrum Health Butterworth Hospital in Grand Rapids, MI. Are there any common environmental factors such as wet floors or obstructions? Are the falls occurring on a particular hallway or in any one unit?
“It’s a root cause analysis to find out why you have falls on this one hallway and with this one job code. You’re finding out what the risk is and why it is occurring,” Crawley says. “You may find that there is a broken pipe leaking water on the floor, in which case you can not only get the pipe fixed but also provide the staff a card that has a number for them to call if they see the leak again.”
Employee safety is a top priority at Butterworth Hospital. Falls and other safety incidents are included in the daily reports to hospital leaders.
“The data is where you can find out what kind of problems you’re having at your own hospital, and how much those falls are costing your organization,” she says. “It all affects the care you provide to patients as well, because if employees are not healthy and don’t feel safe when they come to work, they can’t provide the best care possible.”
A common mistake is to implement fall prevention tactics without first looking at the data, says Farheen S. Khan, PhD, director of the Human Factors Division for the Rimkus Consulting Group in Chicago. Hospital leaders often think they know where the falls are occurring and why, and implement prevention tactic without first consulting the data to determine if their assumptions are correct, she says.
Also, remember that solutions might not have to be facilitywide, she says. It is possible that environmental changes, such as new flooring, or policy changes, such as required footwear, might apply only to particular units. That can make implementation easier and less costly, Khan says.
“Falls among employees don’t get written up as much in the literature because the focus of hospitals is medical care for employees, but it is a problem recognized by OSHA and the Bureau of Labor Statistics. There is literature available if risk managers are looking for resources,” Khan says.
Hospitals can encourage the same kind of tailored fall prevention with nurses as with patients, suggests Christine Ninchich, clinical specialist with Medline in Northfield, IL.
Patient fall prevention techniques are designed for the patient’s unique needs, and a similar approach can be used in nursing, Ninchich says. Nurses working in certain patient environments can be reminded that they face greater trip-and-fall hazards than in other areas and should exercise more care, she says.
“If I am working in a patient room that has dozens of cords and tubes, lots of equipment around, I need to be more aware of that and move more carefully,” she says. “The nurse needs to be more deliberate about movement in that kind of environment, more so than might be necessary in a typical patient room or other area.”
Video monitoring can help prevent employee injuries, and investigate the injuries afterward, notes Paul Baratta, business development manager for healthcare at Axis Communications, a company that provides security cameras. Hospitals often monitor employees as a way to identify causes of on-the-job injuries, and address a workers’ compensation claim. It also can be used to determine whether employees are properly using best practices provided in safety training.
Financial Disclosure: Author Greg Freeman, Editor Jill Drachenberg, Editor Jonathan Springston, Editorial Group Manager Leslie Coplin, Accreditations Manager Amy Johnson, MSN, RN, CPN, and Nurse Planner Maureen Archambault report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Consulting Editor Arnold Mackles, MD, MBA, LHRM, discloses that he is an author and advisory board member for The Sullivan Group and that he is owner, stockholder, presenter, author, and consultant for Innovative Healthcare Compliance Group.