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For many, falls mean re-hospitalization
Ongoing assessment of risk reduces falls
Surveyors from The Joint Commission (TJC) look for a comprehensive, well-planned program to assess each patient's risk of falling, identify steps to reduce the risk, and ongoing evaluation of the patient's risk. Not all home care agencies meet the requirements of this National Patient Safety Goal [NPSG.09.02.01], because they don't always include all patients just those who are typically at higher risk for falls, says Margherita C. Labson, RN, MS, executive director of home care accreditation for TJC.
In addition to evaluating patients of all ages, agencies that provide personal care services should also screen for risk of falls, even if the client is generally healthy, says Labson. Even though the patient may not be receiving medical care from the home care agency, a slippery floor or a poorly placed electrical cord can cause a fall that requires a trip to the hospital, and perhaps a higher level of care, she says. For these reasons, home health agencies should screen all patients and patients' homes for fall risks, she adds.
The staff members of 24/Seven Health Care Services in Chicago had no problem meeting the requirements of the falls risk reduction patient safety goal in their 2010 Joint Commission survey. "We perform a thorough falls risk assessment when the patient is admitted; then we repeat the falls risk assessment at every visit," says Juliet Falar, RN, director of nursing for the agency. Medications that might cause dizziness, rugs or placement of furniture that might trip a patient, and the patient's physical condition which might contribute to a fall are all documented. "If a patient needs a physical therapy consultation to identify therapy or equipment that might help the patient avoid falls, the nurse contacts the therapist," she explains.
The key to preventing falls is to conduct the assessment each time you see the patient, points out Falar. "A patient's medications or physical condition might change between visits, so it is important to evaluate the patient and the home continuously," she adds.
Even with a diligent falls assessment program, there will be times that home care agencies cannot prevent a fall, admits Labson. "We can't control environmental factors, such as the width of doors or the number of stairs a patient has in the home, but we can offer as many suggestions as possible to improve the patient's safety," she says. Document your assessment, your suggestions, and the patient or family's response to suggestions, she says. Although reconfiguring a room setup might create a less risky environment for a patient, if the family refuses to change the room, it is their right to do so, she points out. "The surveyor will be looking for your process to assess risk, recommend activities that reduce risk, and document response to your recommendations," she says.