Patient Fall Prevention Orientation Module Wheaton Franciscan Healthcare
Learning Objectives Define the goals of fall prevention Define a fall Identify patients at risk for falls Identify factors that put patients at risk for falls Describe fall protocols Identify strategies and interventions to prevent falls Describe the process for monitoring patient falls
Commitment to maintaining patient safety Many agencies are involved with setting standards of care and monitoring the incidence of falls, such as : -State and Federal Regulatory Bodies -Center for Medicaid and Medicare Services (CMS) -National Database Nursing Quality Indicators (NDNQI) -Joint Commission
Commitment to patient safety Every patient has the potential to experience a fall. Falls represent a serious hazard and pose a threat to quality and longevity of life, especially in older adults.
Goals of fall prevention Maintain patient safety and reduce fall risk and injury All education provided to patients and families regarding falls is patient and family focused
Defining Falls The definition for falls may vary depending on the patient care area Long Term Care (LTC) Unintentionally coming to rest on the ground, floor or other low level (for instance falling on a piece of equipment) Acute care (AC) A fall is defined as an unplanned descent to the floor (or extension of the floor, e.g., trash can or other equipment), with or without injury to the patient A fall includes assisted falls- when a staff member attempts to minimize the impact of the fall Source: NDNQI 2008
What Constitutes a Fall: Intercepted or assisted falls For instance, patient loses balance and would have fallen had it not been for staff intervention A fall without injury A patient rolls off a bed or mattress that was close to the floor Unless there is evidence suggesting otherwise, when a patient is found on the floor, the most logical conclusion is that a fall has occurred
How Can I Maintain Patient Safety? Provide adequate lighting Have resident/patient wear glasses/hearing aids when awake Place frequently used items within reach (phone, call light, water) Orient patient to surroundings including: Bathroom location Use of bed Location of call light Answer call light promptly
How Can I Maintain Patient Safety? Maximize activity and self care Ambulate with an assistive device if needed (measured and fit by therapy staff) Rise slowly from sitting to standing position Use non-skid footwear Educate patients and family about safety concerns and strategies to minimize risk for falls and injury. Hourly rounding to check in with patient to meet their needs (toileting, offering fluids, repositioning) Bedside reporting
How Can I Maintain Patient Safety? Minimize environmental hazards: Keep bed in low position Locks on beds, stretchers, and wheelchair Keep floor free of clutter and obstacles with special attention to path between bed and bedside commode Tissues, water, call light and phone should be within easy reach
Assessing for fall risk Fall risk assessment tools are used to identify patients who may be at a high risk for falling Each facility has their own risk assessment tool to identify which patients are at risk for falls You will have the opportunity to become familiar with the risk assessment tool at your site Identification of these risk factors are based on best practice guidelines
Common Fall Risk Factors Is there a history of falls? Is the patient taking any medication that could increase their risk for falling? Medications such as: Anticonvulsants Narcotics Sedatives Anti-emetics Benadryl Antidepressants Psychotropics Antihypertensives Anesthesia Laxatives Diuretics
Common Fall Risk Factors Is patient mobility compromised? Ambulates or transfers with an unsteady gait Chair bound or bedfast Needs assistance of person or ambulatory aid (cane, walker, crutches, furniture for support)
Common Fall Risk Factors Nurse Brown encourages her patients to ambulate independently From Nursing Matters: Is there a Nurse in the House? 4. Is the patient experiencing elimination problems? - Incontinence - Infection (UTI) - Urinary Retention - Constipation - Urgency - Diarrhea - Nocturia - Bowel preps - Foley catheter
Common Fall Risk Factors 5. Are there changes in mentation, cognition or perceptual history that may increase their risk for falling? Confused/ disoriented to time, place and person Difficulty understanding, reasoning or making needs known Cannot follow directions Impulsive (quick action taken by patient without thought of consequences) Poor judgment regarding assistance (attempts to get out of chair or bed inappropriately) Is the patient aware of their own limitations?
Common Fall Risk Factors 6. Is there any physical ailment that could increase their risk for falling? - Such as: - Syncope (fainting, lightheaded) - Vertigo (dizziness) - Weakness - Hypovolemia (blood or fluid loss) - CVA/Stroke
Common Fall Risk Factors 7. Is there any medical or physical impairments that could increase the risk for falling? - Such as: - Head injury - Seizures - Hypoxia - Multiple Sclerosis - Guillain Barre syndrome - Deficits in hearing, sight, or touch
Common Fall Risk Factors The chronological and developmental age of the patient should be considered The more risk factors the patient has, the greater the possibility that they may fall and sustain an injury
Fall Prevention Programs Identify patients at high risk for falls Engage ALL associates and volunteers in fall prevention Individualize the patient Plan of Care and reevaluate after any fall Always include the patient and family in fall prevention
Fall Prevention Programs All Saints North Market Franciscan Woods Franklin Iowa Lakeshore Manor Marianjoy St. Francis Terrace at St. Francis
Fall Prevention Programs Practice Location WFH All Saints Symbol Falling star Fall prevention Program Nurses assess all patients ages 3 years and older for fall risk on admission All inpatients are assessed for fall risk: daily with a change in status a fall transfer to a different level of care
Fall Prevention Programs Practice Location WFH All Saints Symbol Falling star Fall prevention Program Fall risk assessments are documented in HED. A safety IPOC should be initiated and updated every 24 hours for at risk patients.
Fall Prevention Programs Practice Location Symbol Fall prevention Program North Market Elmbrook St. Joseph The Wisconsin Heart Hospital Falling Star Magnet Applies to In-Patient Units: Fall risk assessment on admission, daily, and when a fall occurs Individualized plan of care based upon patient fall risk assessment and risk factors All In-Patients wears red slippers as all hospitalized patients have the potential to fall Falling Star Magnet placed on /near doorframe for moderate and high fall risk Patients
Fall Prevention Programs Practice Location Symbol Fall prevention Program North Market Elmbrook Memorial St. Joseph The Wisconsin Heart Hospital Patients who are high risk for falling wear a yellow high risk fall gown Toolkit Reference Sheet for possible interventions: http://policy.wfhealthcare.org/pdf%20polic y/nm_falltoolbox-doc.pdf
Fall Prevention Programs Practice Location Symbol Fall prevention Program North Market Elmbrook Memorial St. Joseph The Wisconsin Heart Hospital An Interdisciplinary Plan of Care [IPOC] for Safety is required as below: Actual Safety IPOC - Patient fell prior to admission or during hospitalization Potential Safety IPOC Patient with a SCHMID Score of 3 or above
Fall Prevention Programs Practice Location Franciscan Woods Symbol None-All residents considere d at risk for falls Fall prevention Program Risk assessment on admission and care plan that is appropriate for each individual. Residents are assessed with change in condition, quarterly and annually. Reassessment is done after each fall. Observation of resident and environment safety at beginning of each shift with CNA rounding.
Fall Prevention Programs Practice Location Franklin MOSH Symbol Orange Leaf Fall prevention Program Yellow wristband Fall risk assessment on admission and daily Individualized plan of care based upon patient fall risk assessment
Fall Prevention Programs Practice Location Symbol Fall prevention Program WFH Iowa Medical/ Surgical Behavioral Health Yellow dot 1. If patient score is 3 or above implement a High Risk Protocol a. Place a yellow ID Band on the patient b. Provide a yellow gown for the patient as appropriate c. High Fall Risk Sign on door (CMC) Yellow dot on door (Sartori) d. Post the yellow High Fall Risk Intervention Sign in the patient room and/or identify on white board that patient is a fall risk 2. Identify on plan of care if patient is assessed as High Risk for fall 3. Plan of care Interventions are individualized according to the patient s fall risk factors 4. Document those interventions you are using in addition to the Universal Fall
Fall Prevention Programs Practice Location Symbol Fall prevention Program WFH - Iowa (Pediatric) Humpty Dumpty 1. Complete Pediatric Fall Risk Assessment upon admission and daily. 2. The Pediatric Fall Risk Assessment upon admission is documented as part of the Pediatric Admission Database Record. Subsequent fall risk assessment scoring is documented. 3. Nursing Interventions that are performed for each patient correspond to the identified Risk Level. 4. Patients that have been identified as a High Fall Risk based on the scoring criteria shall have a yellow ID band and a Humpty Dumpty sticker shall be placed on the front of the patient chart, High Risk Fall sign is placed above bed.
Fall Prevention Programs Practice Location WFH - Iowa (Outpatient Services ) Symbol Fall prevention Program 1. Complete Outpatient Fall Risk Assessment upon admission 2. If patient is at risk for a fall, initiate indicated Interventions per risk level 3. Document interventions in the nursing narrative notes
Fall Prevention Programs Practice Location Symbol Fall prevention Program WFH - Iowa Family Birth Center- Post Partum Yellow Dot 1. Complete Fall Risk Assessment upon admission and daily 2. Using the identified criteria, document in HED 3. Patients that have been identified as a High Fall Risk based on the scoring criteria shall have a yellow ID band, a yellow dot placed on the nursing Plan of Care, and a yellow High Fall Risk sign shall be placed on the patient door 4. Documentation of interventions will be placed in Event Summary in HED and may include, but are not limited to: instruct patient on the use of the call light, assist with ambulation, non-skid footwear provided to patient, bed in low position except when nursing administering care, monitoring the patient while in the bathroom or shower
Fall Prevention Programs Practice Location Symbol Fall prevention Program WFH - Iowa Family Birth Center- Labor Yellow Dot 1. Complete The Post Epidural Fall Risk Assessment Score (PEFRAS) tool prior to ambulating a patient after epidural or spinal assisted delivery 2. Patients with a score of 50 or higher: a) Patient is instructed to not attempt walking or getting out of bed without assistance. b) Reassess patient every thirty (30) minutes until she can pass the Test Stand and can walk independently without a walker.
Fall Prevention Programs Practice Location Lakeshore Manor Symbol Falling Star Fall prevention Program Risk assessment on admission, quarterly, annually, with any change of condition, and if a fall occurs Observation of resident and environment at beginning of each shift and hourly with CNA rounding If a resident is high risk, they are on Fall Precautions, additional safety measures are incorporated in the plan of care, low bed ordered and mat next to bed instituted
Fall Prevention Programs Practice Location Marianjoy Symbol Caution Club Fall prevention Program Assessment is done on admission, weekly, after a fall, and anytime there is an altered condition Yellow wristband Yellow caution club tag on back of wheelchair Caution club magnet on door frame of patient s room Keep patient within sight when patient is sitting in the wheelchair in their room Keep patient within sight when toileting Use bed and wheelchair alarms Remind family and visitors to alert nurse when they are leaving Provide night light Ensure call light and personal items are within patient s reach Regular rounding to address patient needs Remind patient to ask for assistance when getting up
Fall Prevention Programs Practice Location St. Francis Symbol Orange Leaf Fall prevention Program Yellow wristband Fall risk assessment on admission and daily Individualized plan of care based upon patient fall risk assessment Patient wears red slippers
Fall Prevention Programs Practice Location Terrace at St. Francis Symbol Yellow Star Fall prevention Program Universal Fall Precautions apply to all residents Strict Fall Precautions will be initiated if a resident has a history of falls, or has three or more categories checked on the Falls/Injury Risk Screen Fall Care Plan to be completed by the nurse and will develop an individualized Fall Plan of Care and appropriate interventions that reflect Strict Fall Precautions based upon fall risk factors Care Plan interventions must be reviewed and modifications made following every fall with or without injury A Falls/Injury Risk Screen to be done upon admission/every fall, change of condition and quarterly and annually.
Fall Prevention Interventions Research shows that targeted interventions based on patient risk factors are most effective in reducing falls
Additional Fall Prevention Interventions Educate patient and family Use of low beds and protective pads Bed/chair alarm Patient relocation for closer monitoring Additional therapies (OT, PT)
Fall Prevention Interventions Assist with transfers Have the patient move at his/her own speed: Take your time Decrease environmental stimuli Establish toileting schedules in collaboration with patient Remain with high risk patients during toileting Remove tubes if appropriate (Foley catheter, for instance) or conceal tubes
Fall Prevention Interventions Provide for companionship Encourage family to stay with patient Bring in familiar items from home, for instance, pictures or a calendar Offer comfort measures (TLC, pain medication if appropriate, non pharmacological pain relief measures)
Fall Prevention Interventions Offer diversional activities for instance, watching T.V., playing cards, or listening to music Some sites may provide an organized activity box called a busy box. This box contains puzzles, magazines, and other items to keep a patient busy and occupied. It is especially useful for patients who are confused, have dementia, or developmental delays Pharmacy consult (if polypharmacy is a risk factor) Purposeful hourly rounding Bedside reporting
Fall Prevention Monitoring Despite our best efforts, sometimes patients do fall It is important to identify the cause of these occurrences, modify the plan of care, and take action to prevent them from occurring again All WFH facilities monitor falls
Fall Prevention Monitoring All Saints North Market Franciscan Woods Franklin or MOSH Iowa Lakeshore Manor Marianjoy St. Francis Terrace at St. Francis
Falls Monitoring Location WFH - All Saints Falls Monitoring Program Staff RN identifies strategies and revises plan of care (IPOC) to prevent further falls Occurrence reports are forwarded to Risk Management Unit nursing leadership reviews occurrences Fall data is reported through Quality to the NDNQI
Falls Monitoring Location North Market Elmbrook St. Joseph The Wisconsin Heart Hospital Falls Monitoring Program Occurrence reports are forwarded to Risk Management Unit Director/PCS/Manager reviews occurrences Staff RN identifies strategies and revises plan of care to prevent further falls Falls are identified in the Quality Report and hospital scorecard
Falls Monitoring Location Franklin MOSH Falls Monitoring Program Occurrence reports are forwarded to Risk Management. Unit Director/PCS reviews occurrences Staff RN identifies strategies and revises plan of care to prevent further falls Falls are identified in the Quality Report and hospital scorecard
Falls Monitoring Location Franciscan Woods Falls Monitoring Program Each fall is initially investigated at the time it occurs. The supervisor assesses the resident, reviews and revises the current care plan, and the report goes to the DON and the Falls Team. Interdisciplinary Falls Team Committee meets weekly to review each fall that has occurred and to identify strategies to prevent further falls.
Location Falls Monitoring Falls Monitoring Program Iowa Complete a Post-Fall Huddle including notification of the house supervisor Incident reports are completed for all falls and reviewed by the manager and Quality Services Results are tabulated and shared with managers to review with staff Falls sustaining injury are reviewed by a member of Quality Services and the Fall Team The Fall team discusses and determines if there was some way the injury/fall could have been prevented
Falls Monitoring Location Lakeshore Manor Falls Monitoring Program If fall occurs: Occurrence report and Investigation with root cause analysis completed CNA and Nurse Care Plan Updated Measures are put into place immediately based on charge nurse assessment Falls discussed daily at morning report with IDCPT All falls tracked/ monitored by QI.
Falls Monitoring Location Marianjoy Falls Monitoring Program Occurrence reports are forwarded to Risk Management and reviewed with Nurse Manager Staff RN identifies strategies and revises plan of care to prevent further falls Falls are identified in the Quality Report and hospital scorecard
Falls Monitoring Location St. Francis Falls Monitoring Program Occurrence reports are forwarded to Risk Management. Unit Director/PCS reviews occurrences Staff RN identifies strategies and revises plan of care to prevent further falls Falls are identified in the Quality Report and hospital scorecard
Falls Monitoring Location Falls Monitoring Program Terrace at St. Francis After a fall, a report is completed ASAP with statements from staff and further investigation if needed. Documentation occurs in the progress notes and Plan of Care. Family and MD are notified and residents are placed on 24 hour report. Measures are taken to reduce further falls.
Summary We maintain patient safety and promote fall prevention by providing guidelines, standards and policies that protect all patients, no matter whether they are at risk for injury or not
We assess our patients and look for risk factors that might identify those who are more likely to experience a fall Summary
Summary We place our patients who are identified at risk into our fall prevention programs
Conclusion We individualize plans of care and identify goals to meet the needs of our patients
Summary And finally, we monitor falls and continually look for ways to keep our patients safe
Summary As a result of our fall prevention programs, we are establishing safer environments for our patients We continually strive to decrease the number and, more importantly, the severity of falls (those that result in patient injury) We accomplish this by establishing consistency within our facilities as it pertains to our guidelines, policies and procedures In addition, we maintain standards of care that are outlined by regulatory agencies (state, federal government, nursing quality databases, etc. ) In doing so, we demonstrate to our patients and families our commitment to their safety
Review Committee: Jennifer Bigler, Joan Lang, Nancy Brueggeman, Kate Holmes, Chelsea Loiselle, Christina Dzioba, Sally Strong, Cynthia Bright, Angela Corona, Julie Becker, Debra Lewendowski, Bev Abbott, Sherry Thompson E-learning: Diane Coppola June 30, 2013