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Falls, slips, and trips were the second most common event leading to workplace injuries and illnesses in hospitals, according to a report1 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.
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. Employee slips and falls tend to be the top workers’ compensation claim in both frequency and severity, she says.
Addressing employee fall prevention starts with the low-hanging fruit, like flooring materials, mats, footwear policies, and snow and ice removal, she says. Employee health professionals also should look at what makes the hospital environment dangerous for workers — including the potential blinders of an intense focus on their duties.
“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.”
Encourage employees to think of a 10-foot circle of safety around them, she says. They do not necessarily have to be aware of everything in the room, but they should keep an eye out for hazards within this circle surrounding them. 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,” she says. “But if you keep it to that 10-foot circle of safety around them, that can be more attainable. 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 seen sometimes as an isolated event, McNee says. For example, if a nurse is rushing to a code call and trips on a trash can, supervisors may dismiss it as an accident.
“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 are 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. 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 Atlanta.
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, but it is a problem recognized by OSHA and the Bureau of Labor Statistics,” 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 for nurses, 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.”
Financial Disclosure: Nurse Planner Kay Ball, PhD, RN, CNOR, FAAN, reports she is a consultant for Ethicon USA and Mobile Instrument Service and Repair. Medical Writer Gary Evans, Editor Jill Drachenberg, Editor Jonathan Springston, Editorial Group Manager Leslie Coplin, and Accreditations Manager Amy M. Johnson, MSN, RN, CPN, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.