Is your falls prevention program getting results?
Is your falls prevention program getting results?
JCAHO will look for evidence of reduced risks
To comply with the Joint Commission on Accreditation of Healthcare Organizations’ new National Patient Safety Goal to reduce the risk of patient harm resulting from falls, you must assess and periodically reassess each patient’s risk of falling — including the potential risk associated with the patient’s medication regimen — and take action to address any identified risks.
However, even if your organization has a falls prevention program in place, it doesn’t mean you’re getting significant results. At St. Marys Hospital Medical Center in Madison, WI, a program had been in place for years to prevent falls, but the organization wasn’t seeing a reduction in the fall rate.
"Our population was getting older, sicker, and more acute," says Christine Baker, RN, PhD, APRN, BC, CEN, clinical nurse specialist and director of clinical outcomes management and decision support. "So it was difficult to know if we were actually making gains, when our population was more prone to falls."
The organization’s nursing research council began by researching existing fall prevention programs and grading scales. "We decided to borrow from the best of them and then incorporate our own twist," she explains.
All of the existing grading scales ask questions such as whether patients are on a certain medication or if they have fallen in the past year, Baker notes.
"That really takes away that aspect of nursing judgment. You could have healthy people on Lasix who aren’t at increased risk of falling; or a patient may have fallen twice on the ice, but that doesn’t mean that they are at risk for falling in the hospital," she says.
An algorithm was developed that identified all patients as being at universal risk of falling because of factors such as being sick, sleep-deprived, and in an unfamiliar environment.
"We borrowed that element from universal precautions — something that exists for all patients just because they are in the hospital," Baker says.
A second category of patient is put at higher risk for falls because of specific risk factors such as disorientation.
"The last question on the algorithm asks the nurse to put all of that together and make a nursing assessment, as to whether this patient is at high risk for falls," she says.
Even after the algorithm was implemented, the fall rate didn’t drop significantly, so the organization trialed two interventions. The first was a protocol that reduced the use of sleeping pills, particularly those that had long half-lives and would make patients drowsy the following day. Instead, patients were offered comfort measures such as a backrub, warm milk, or herbal teas.
"Although physicians did adopt the protocols and use of sleeping pills dropped markedly, we still didn’t see significant reductions," Baker says.
"Where we saw our payoff was in our Safe Room’ setup — we cut our fall rate by half." This intervention involved making the patient’s room safer, by placing IV poles on the same side where patients would exit the bed and removing physical barriers so they were less likely to trip on the way to the bathroom. As a result, the number of injuries due to falls fell sharply, she continues.
"By having the beds in a low position, the patient didn’t have far to fall," Baker adds. "We’d like to prevent the fall, but if it happens, to have no injury result is the best outcome."
Posters placed in every room reminded family and visitors to call a staff member to assist the patient with getting to the bathroom, as opposed to trying to help the patient themselves. "So we involved another pair of hands and eyes in watching the patients," Baker explains.
"We also teach patients who are cognitively intact about how to prevent falls, such as using their call light and not trying to exit when there’s a side rail up," she says.
As a result, the severity of injuries has dropped significantly, Baker says. "It’s been a long time since we had more than a minor bump or bruise from a fall," she reports. "The nurses are pleased as well. It was frustrating to put a patient on fall precautions when they knew the patient wasn’t really at risk. Also, this gives them license to use the protocol when the nurse has a gut feeling that a patient is at risk, even if they don’t screen in."
The organization uses comparative data from the Maryland Hospital Association database and the National Database of Nursing Quality Indicators to set fall rate goals for the year, which are incorporated into the annual nursing QI plan.
"Each unit reports fall rates at a monthly QI council. If they exceed the fall-rate goals, the unit has to have a plan in place to bring the fall rates down," Baker adds.
The organization’s fall prevention program recently was revised by its falls workgroup to reflect the most current research. "What we needed to do was clarify things that should trigger a reassessment, such as the patient coming back from surgery and a new medication added," she says.
"Typically, patients are reassessed after a shift, but something could happen midshift to increase a patient’s risk of falling," Baker adds. "Every time you have patient contact, the caregiver should be thinking, Has anything been done to put this patient at risk for falling?’"
To comply with the Joint Commission on Accreditation of Healthcare Organizations new National Patient Safety Goal to reduce the risk of patient harm resulting from falls, you must assess and periodically reassess each patients risk of falling including the potential risk associated with the patients medication regimen and take action to address any identified risks.Subscribe Now for Access
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