11 ways to reduce rates of falls with injuries
Eight-three hospitals in the Pennsylvania Hospital Engagement Network (HEN) Falls Reduction and Prevention Collaboration were given two tools to evaluate their falls prevention programs.1 Those tools, provided by the Pennsylvania Patient Safety Authority, were a self-assessment survey and a process measures audit.
"Assessing level of implementation of best practices in falls prevention, auditing for compliance, and analyzing results in relation to rates of falls with injury can identify significant strengths and weaknesses in current hospital falls prevention programs," the authority said.1 The survey and audit tool can be accessed at http://bit.ly/1dUJKtc.
The Pennsylvania Patient Safety Authority analyzed survey results and hospital rates of falls with injury and identified the following practices and/or program elements that were tied to lower rates of falls with injury:1
- Falls prevention program design. A falls prevention team included physicians and transportation managers or representatives. The design and implementation of a falls prevention program did the following: defined the goals of the falls team and responsibilities of each member, performed ongoing assessment of the program's effectiveness (at least annually), and developed and revised protocols and policies when necessary to support the goal of preventing falls.
- Benchmarking. An external benchmark was used to compare facility falls rates.
Policies and protocols. A facility falls prevention policy was developed that included the following:
- a requirement for when an individual should be reassessed for risk;
- a description of appropriate responses to falls, including protocols for post-fall investigation;
- a process for revising assessment and intervention strategies based on data;
- a plan to promote awareness of falls risks and prevention.
- Assessing risk. Falls risks were assessed for inpatients and outpatients. There was a requirement of routine reassessment of patients for their falls risks. Periodic facility review of the effectiveness of falls risk assessment tools was done. The facility used the Hendrich II Fall Risk Model. The facility used the General Risk Assessment for Pediatric Inpatient Falls tools.
- Evaluating the environment. The facility required patients to wear slip-proof socks or shoes.
- Medication review. There was periodic review by the facility's pharmacy and therapeutics committee to identify formulary medications that increase falls risk and to make recommendations about those medications. Physicians were encouraged to modify or eliminate prescribed medications that increase the risk of falling.
- Patient monitoring and sitters (one-to-one observation). Hourly rounds were performed. There was a requirement for staff to stay with patients who are identified as being at risk to fall while they were in the bathroom. Sitter programs were used and designed to include criteria for sitter qualifications, a training program for sitters, and a pool of sitters.
Staff education. Falls prevention education was provided to staff that:
- occurred at orientation and periodically thereafter or as needed;
- addressed the roles and responsibilities of staff as part of the falls prevention education program;
- included education for intrinsic (clinical) and extrinsic (environmental) causes of falls for staff members involved in direct patient care, as appropriate for their roles and responsibilities.
- Patient and family education. Direct education was given to patients and their family members regarding the causes of falls and the interventions used to prevent falls.
- Communicating patient risk. A specific color was used to identify patients as being at risk to fall. Falls risk wristbands were used.
- Postfall assessment and event reporting. A policy was implemented on how to respond to patient falls. Staff were educated and required to document the fall in the patient's medical record and request a post-event systems analysis or postfall investigation. Patients were reassessed following a fall for falls risk, and findings were communicated to staff who interacted with the patient. A standardized patient safety event report was used for internal purposes that required staff to include extrinsic factors.
- Feil M. Falls prevention: Pennsylvania hospitals implementing best practices. Pa Patient Saf Advis 2013; 10(4):117-24. Accessed at http://bit.ly/1fbJHbj.