Fall Prevention
Purpose and Objectives Purpose: Review the UC Health Fall Prevention Program. Objectives: 1. Present evidence about patient safety and falls. 2. Review the UC Health Fall Prevention Policy and Fall Risk Assessment Tool. 3. Identify current interventions to prevent falls. 4. Take a post-test to verify knowledge competency.
Evidence Of all falls, up to 45.2 % occurred during toileting with majority occurring on the way from the chair/bed to the bathroom (Tzeng H.M., 2010) Individualized and targeted fall prevention strategies in addition to universal fall prevention interventions work better than universal interventions alone (Ang et al, 2011)
Regulatory Requirements Reducing falls: a UCH Critical Success Factor! Magnet re-designation requires inpatient fall rates to be at or below the median of comparison hospitals Falls with major injury are a CMS hospital acquired condition (HAC). Hospital acquired falls w/injury will impact reimbursement Major injury = fracture, surgery, casting or traction; intercranial injury; internal injuries such as burns, electric shock or crushing. UCH must work hard to keep our fall rate below the national benchmarks. UCH Hospital Goal starting July 1 st, 2013 = 2.79 UHC Consortium Inpatient Benchmark = 3.17
Mrs. Smith (fictitious name) came to UCH with a stroke and at the time of the expected date of discharge had accrued expenses of $24,099. On the day of discharge, she fell and broke her hip. The additional costs associated with this fall are as follows: Surgical expenses: $15, 214 Rehab recovery: $24, 005 Total Additional Expenses: $39, 313 Original expenses: $24,099 New Total expenses: $63,412 Instead of going home, Mrs. Smith went to a nursing home. Her health outcomes are now uncertain.
Preventing Patient Falls Fall Definitions and Assessment
What is a Patient Fall? A patient fall is an unplanned descent to the floor with or without injury. Assisting the patient to the floor is a fall. What is a Near Miss Fall? A near miss fall is when the patient begins to fall but does not reach the floor. The patient is assisted to the chair or bed without injury. What is an Intentional Fall? Patient falls on purpose or falsely claims to have fallen. When a patient falls back into bed or into a chair, it is not considered a fall. Click here to review the policy.
Nursing Fall Prevention Activities At UC Health the Fall Risk Assessment Tool is used across services and systems. This tool was created by Poudre Valley Hospital and implemented system wide due to their resounding success in preventing falls. This tool is based on patient symptoms and gait disturbances.
When to Assess Patient Fall Risk Inpatient Assessment Assess and rate the patient fall risk on admissions and at the start of each shift. Assess and re-rate fall risk if the patient s condition changes. This change in condition may include such examples as a newly ordered medication or altered mental status. Reassess immediately after a fall and 24 hours post fall to ensure there are no delayed injuries. Ambulatory/Outpatient/Procedural Areas Fall Assessment Use the same Fall Risk Assessment Tool as inpatient areas. Fall Prevention Interventions will adhere to specific area s guidelines on Fall Prevention.
Fall Risk Assessment Tool This shows the tool and the different colors indicate which patient characteristics correlate with each fall risk level. The next slide will show what the assessment looks like in EPIC.
Inpatient Fall Assessment Tool
PROPERTIES On passing, 'Finish' button: On failing, 'Finish' button: Allow user to leave quiz: User may view slides after quiz: User may attempt quiz: Goes to Next Slide Goes to Next Slide After user has completed quiz At any time Unlimited times
Falls Interventions 13
Low Fall Risk Interventions Green Side rails raised x2 or x3 (x1 for beds with 2 long side rails) Low bed position, brakes on, call light in reach Remove obstacles Glasses/hearing aids in reach as appropriate Assess the patient at a minimum of 1 time per shift WARNING! Not capable of bed exit makes the patient automatically a low risk. Use this very cautiously (i.e. end of life, quadriplegic, pharmaceutically paralyzed)
Moderate Fall Risk Interventions Yellow All of the Low Risk interventions PLUS: Check patient every 2 hours Offer/encourage toilet every 1-2 hours as appropriate Assess for use of standing/transfer devices
High Fall Risk Interventions Red All of Low and Moderate interventions PLUS: Institute fall-alert marker on door jamb and chart (on bed in ED) Place colored fall-alert socks on patient unless contraindicated (e.g. risk of skin breakdown-heel, excessive swelling-lower extremity, or cause pain/discomfort) 3 side rails raised with bed alarm Chair alarm when up in chair Remain within reach of the patient when in chair or Check on bed without alarm (including when in bathroom) Check on patient every hour Gait belt or up with standby assist Additional fall risk interventions as appropriate/available
High Fall Risk Interventions
Side Rail Use in Fall Prevention All high risk fall patients must have 3 side rails raised with a bed alarm. The 4 th side rail is considered a restraint and would require a restraint order if used. May be used with specialty mattresses for safety (not requiring a restraint order). You must follow the policies: Fall Prevention and Physical Restraint Non-behavioral
Beds and Fall Strategies Look, Listen, Feel to make sure properly alarmed (for med/surg beds) Look: Green light means the bed alarm is set, bed is low, locked and both side rails up Yellow light means the bed alarm is set but 1 of the other parameters is not set Listen: One solid beep, bed alarm is set! Feel: Zero bed and weigh each new patient
Key Points about Patient Falls Keeping patients safe requires vigilance and teamwork. Work closely with patient, family and inter-professional team to maintain successful surveillance. Educate the patient and family. Keep them informed about the patient s fall rating. Engage them in helping prevent injury. Review room signage. Learn ALL components of the Fall Prevention Program and policy. Your patient s safety depends on it! When in doubt of risk, rate patient higher not lower to rate patient risk. May use RN-Increased Risk Level.
Key Points about Patient Falls EPIC auto calculates the fall risk based on the fall assessment form. This then directs interventions, but it is up to the nurse to ensure high fall risk interventions are in place! EPIC populates moderate and high fall risk banners for patients on their patient summary tab (see screen shot). 21
Preventing Patient Falls 22
Strategies to Prevent Falls Keep patient environment free of clutter; clean up spills with the assistance of Environmental Services Report any equipment issues impacting falls to Anytime, Anywhere (88351) Use bed or chair alarm. Check bed alarm system connection to head wall by pushing the nurse call button on bed rail Familiarize yourself with equipment in use in your area (bed alarms, chair alarms)..continued
Strategies to Prevent Falls, Continued On inpatient services, 35% to 40% of falls relate to toileting. Implement toileting checks during hourly rounds, schedule toileting to prevent falls! Use commodes If the patient is a high risk for falling, remain within arms reach of patient in bathroom; this is not considered a fall prevention intervention----it is nursing protocol and the patient cannot refuse Complete and document hourly rounding on all high fall risk patients
Check out the Fall Prevention Resources website! From the HUB home page, click on the Departments and Services tab. Then click on the Champions / Committees link and lastly the Fall Prevention Champions link. Many helpful resources relating to fall prevention may be found here under the Resources and Documents link.
Medical Surgical Units EBP Intervention: Purposeful Hourly Rounding UCH implementing on Medical Surgical Units 5 P s of Purposeful Hourly Rounding (on all patients) (see next slide) Rounding helps prevent falls, improve patient satisfaction, decrease call light frequency, decrease skin breakdown and improve pain control continued
Purposeful Hourly Rounding, continued 5 Ps of Purposeful Hourly Rounding Pain: address pain scale Potty: ask patient if he/she needs to go to the bathroom Position: complete turning or ask patient if he/she is comfortable Personal Needs: make sure bedside table & all belongings are within reach. Ensure call light is with patient. Presence: let patient know you are available & have time. Hourly rounding is expected on every patient (per service excellence) but documentation of safety checks/hourly rounding is based on fall risk 27
Medications and Fall Risk It is known that certain medications and interactions between multiple medications can increase patient fall risk. RN must assess patient fall risk as it relates to prescribed medications. An RN can order a pharmacy consult for pharmacy staff medication review at any time and is required to order one after any patient fall. Partner with your physicians to discuss medications and fall risks!
Post Fall Actions It is critical to assess any patient who falls, regardless of inpatient or outpatient setting Do not move patient until it is safe. Take vital signs. Call the MD or LIP provider; ensure F/U tests ordered and completed as indicated. Reassess patient frequently for changing condition. Inform family as soon as possible. Provide comfort and support to patient. Complete PSN Analyze cause of fall to prevent 2 nd fall; post fall huddle with debriefing form Reassess patient in 24 hours to assure there are no lingering effects from patient fall.
Post Fall Huddle Fall Huddle debriefing immediately after a fall or by end of the shift Acts as a way for teams to debrief and analyze fall Look at ways to prevent the fall from happening again Fall Huddle Debriefing Form helps ensure that all post fall actions are completed
Fall Huddle/Debriefing Form Perform Huddle in Pt s room with Pt s input! Room# Date/Time of fall: Patient Sticker RN s: Situation esent for Huddle:? How did it happen? s: ns/pain Level: Fall Assisted by staff? Yes No Injury Level: No Harm Minor Moderate Severe ocation/locations: would you prevent this fall from happening in the future? Fall Prevention Strategies in Place at Time of the Fall cumented Fall Score: New Fall Score: Pt. scored appropriately? Yes No If no, Pt. CAM/CAM ICU + per charting? Yes No Is the Pt. CAM/CAM ICU + now? Yes No rounding completed. Yes No If no, en was the last time staff was in the room? en was the last time the patient was toileted? the unit fully staffed with CNA s? Yes No If no, CNA: Pt ratio: L High Fall Risk medications the Pt. received in the last six hours: gh Risk Interventions red prior to fall) If not in place explain: ir Alarm ON. Yes No If no, ed/chair alarm on was it functioning appropriately? Yes No, What type of bed? Old New alarm ring through the call bell system? Yes No -If NO to either, contact Mechanic on Duty 8-4845 or Engineering 8-8351. ks on. Yes No If no, ker on door/chart. Yes No If no, th assistance. Yes No If no, p. Yes No If no, p. Circle one: Safety/Rest Yes No If no, mental Adjustment Yes No If no, cy Consult Yes No If no, Yes No If no, Post Fall Task List New Intervention(s) are in place to prevent future falls? ete PSN lled to see pt ent Fall under Clinician Communication ss Fall NIC, automatic 16 points t sticker on this form IP Consult to Pharmacy in EPIC (RN to put in order). s form to Risk Management 40457 Patients Family of fall within 6 hours of fall this form is delivered to unit Fall Champion or placed in unit Fall Notebook FF HOURS (weekends and nights): page Hospital Manager (Business hours) page Unit Manager. vised 1/28/13 NH) Fall Huddle Form
Post Fall Actions, continued If, despite all best efforts, a patient fall happens, the RN or other provider must report the fall using the Patient Safety Net database Each item on the form must be filled out completely to provide accurate information to departments managing fall data; if PT/OT involved, include this in the narrative Document the fall in EPIC under Notes New Note Types Significant Event. Any fall resulting in serious injury or death should be called immediately to Professional Risk Management at ext. 4-7475 (4RISK), in addition to completing the PSN report
Transport orders, including Ticket to Ride, in EPIC must include fall risk information Document Patient/Family education in EPIC Always use a gait belt when mobilizing patient for the first time. Gait belt use is encouraged with all high fall risk patients Document assessment and interventions accurately If you believe your patient needs a sitter, consult with the charge RN
Patients fall at UCH because: Inconsistency in charting/ shift report that pt. previously fell Bed alarm not turned on or not plugged into call system Patient cognitive status changes; does not follow instructions Medication interactions that are not detected or known to increase risk for falling Assuming patient mobility is better than reality Toileting, toileting, toileting! Patient may need schedule, commode, support and presence to prevent falling
References Ang, E., Mordiffi, S.Z., & Wong, H.B. (2011). Evaluating the use of a targeted multiple intervention strategy in reducing patient falls in an acute care hospital: a randomized controlled trial. Journal of Advanced Nursing. 67(9). P. 1984-1992. Tzeng, H.M. (2010). Understanding the prevalence of inpatient falls associated with toileting in adult acute care settings. J Nurse Care Qual. 25(1). P.22-30.
36 You may now take the test for this selflearning module. Please exit the course using the exit tab in the upper R corner of the screen. Once you exit the module, you will be able to access the test. You must complete the test with 100% correct to receive credit.