Hospital prevention efforts reduce slips and falls by 20%

Multipronged intervention saves thousands

Your hospital is filled with hazards that employees walk past every day. There may be puddles on the floor when it’s raining, grease on the kitchen floor, a spill outside the cafeteria.

Slips, trips, and falls, the second most common cause of injury in hospitals, are not just accidents. They’re preventable — and a sustained effort to reduce hazards can save you thousands of dollars.

In early results from a federally sponsored study, a comprehensive prevention program led to a 20% decline in fall-related injuries at BJC HealthCare in St. Louis. "We’re talking about $200,000 worth of savings on [about] $1 million worth of [systemwide slip-and-fall-related] compensation claims," says James Collins, PhD, MSME, epidemiologist/ engineer and project officer for the Slips and Falls Prevention in Health Care Workers project at the National Institute for Occupational Safety and Health in Morgantown, WV.

Collins and his colleagues are analyzing three years of pre-intervention data and three years of post-intervention data. The interventions began in 2003. "The preliminary results from this study are indicating that a comprehensive slips, trips, and fall prevention program can significantly reduce staff injuries due to falls on the same levels," he says.

Unlike patient handling injuries (the most frequent injury in hospitals), slips and falls often are viewed as isolated events. Not so, says Laurie Wolf, MS, CPE, ergonomist of WellAware program at BJC HealthCare, which has 13 hospitals, five nursing homes, and about 25,000 employees. "We’ve come a long way" in preventing the injuries, says Wolf, who notes that the program also prevents patient falls, as well. It’s important to use many different approaches and to maintain your commitment, she adds.

Here are some of the interventions that made a difference:

Conduct a hazard assessment.

"The first thing we did was look at our environment and try to make changes," says Wolf. While slips and falls rarely come in clusters, there are hazards that can be identified and corrected before an accident happens.

Several employees fell at an icy shuttle bus stop at BJC. A downspout was emptying water near the stop, which pooled and then froze on cold winter days. The health care system spent $3,500 to reroute the drainage and place it under the sidewalk.

A hazard assessment also may identify cords that could be a trip hazard or clogged drains in the kitchen that lead to pooling of water or grease. BJC HealthCare improved lighting in parking garages and added handrails in some areas.

Raise employee awareness.

With the slogan "Save yourself a trip," BJC launched a high-profile awareness campaign with table tents in the cafeteria, highlights in the newsletter, and e-mail alerts. BJC’s "Ergo Rangers," or ergonomic specialists, conducted awareness fairs at the hospitals and helped coordinate the interventions.

Any employee who did something to help eliminate a slip-and-fall hazard was eligible to win a small gift certificate to a local store.

Employees used scoops in special bins placed outside entryways to distribute ice-melting chemicals on icy patches. They stooped over to wipe spilled coffee or rearranged electrical cords away from a pathway.

BJC also urged employees to "put a lid on it" — not to carry open cups out of the cafeteria where they could spill in a corridor or an elevator. Preventing slips and falls "is a responsibility of everybody," says Wolf.

Use specialized housekeeping materials.

BJC mounted rolls of bright yellow absorbent towels. If an employee sees a spill, he or she can place the towel on the spot and call a housekeeping hotline. All housekeeping managers have a beeper to respond to spills.

Wet floor signs — a type designed to cover the spill as well as provide an alert — are available on housekeeping carts and are mounted on a wall on each hospital floor. The facilities also provide plastic umbrella bags at the facility entrances for rainy days.

Meanwhile, Wolf and Collins also are reviewing floor wax or other products that would be less slippery.

Seek slip-resistant products.

With the help of the Finnish Institute for Occupational Health in Helsinki, Collins tested the slip resistance of several different brands of shoes in a laboratory. Nurses wore the shoes for a three-month test. They didn’t find much appeal; at the end, most nurses went back to their previous shoes.

"In the priority order, it seems to be comfort and style, [and] slip resistance seems to be a distant consideration," Collins explains.

He continues to look for products that will reduce the risk of falls. For example, home health nurses can wear shoe covers in the winter that have ice cleats.

"You have to be innovative — look at new things and be persistent," Wolf notes. "You have to keep that awareness going."