Preventing Inpatient Falls

J. McAllister, SNUniversity of South Florida College of Nursing

Quality Improvement Project

PurposeDecrease the number of inpatient falls on the

5 South Trauma Floor through the use of evidence based practice.

Increase the use of fall assessment toolsImplement the appropriate use of fall

prevention equipment (i.e. bed alarms, chair alarms) through the use of daily auditing tools

Increase staff knowledge on fall prevention and risk

Background 700,000 to 1 million inpatient falls occur every year

30 to 51 percent of these falls result in injuryFalls account for 70% of all inpatient injuries More than half of report falls occur due to bladder/bowel

urgency Risk for falls is significantly increased over the age of 65

Centers for Medicare & Medicaid Services do not cover the costs of inpatient falls that result in injuryNational average cost of fall related injury: $13,316 per

patient National average additional hospitalization days: 6.3- 12

days(Moin, 2012); (World Health Organization)

Background

(Moin, 2012)

Bayfront Fall Statistics 2014

BMC Total Hospital Falls 2014

Bayfront Fall Statistics 2014

Total BMC Falls per Unit, 2014

Bayfront Fall Statistics 2014

Total BMC Falls per Patient Day compared to 2014 Target Goals

Implementation and MethodsCause and Effect Analysis (Fishbone

Diagram)

Patient Fall Assessments

Bed Alarm Use Audit

Implementing Standard Fall Prevention Interventions

Cause and Effect Analysis

Fall Risk Assessment Many fall risk assessment tools are available

Hendrich I & II, Johns Hopkins, Morse, STRATIFY, etc.

There is no definite consensus to which tool is the best

These tools predict patient susceptibility to falls but do not prevent falls

Assessments should be performed upon admission, with transfer to a new unit, after a fall occurs, with change in patient condition and after a procedure is performed.

(National Guideline Clearinghouse)

Fall Risk AssessmentsFall risk assessments should be thorough and occur continuously

during treatmentAssessments should include:

Age Level of consciousness Need for an ambulatory aid Characteristics of patient gait Balance Blood pressure Use of tethering devices and devices that limit mobility Fall history Medications Continence status Presence of hearing or visual impairments Predisposing diseases or conditions

(Ohio Public Health Association)

Fall Risk Assessment

Fall Risk Assessment Cont.

Bed Alarm Audit

Adapted from http://www.unmc.edu/patient-safety/images/Fall_Risk_Audit_Tool_Example_2.docx.

Implementing Standard Fall Prevention Precautions Orient patient to the environment

Make sure call light is within reach

Personal Items within reach

Bed is is locked and in lowest position

Provide non-slip footwear and a fall risk arm band

Turn lights on when getting patient out of bed

Remove all clutter

Provide scheduled toileting while patient is awake (Q2 hours

Provide assistive device during ambulation or transfer (walker, cane, etc.)

Use bed/chair alarms if necessary

Place signage outside the door indicating risk

Ensure all walking surfaces are dry

Perform needs assessment during hourly rounding.

(Gardener & Feil, 2013)

The 4 P’s of Hourly RoundingThe 4 P’s

PositionPainPersonal NeedsPlacement

This can result inA reduction in fallsAn Increased patient and staff satisfaction A decrease in call light use

(Gardener & Feil, 2013)

Measuring OutcomesOutcomes of these implementations can be analyzed through

the use of incident reports reported after a fallIncident reports collect data on contributing factors to the

fall such as time of day, location, activity and incontinenceIncidence of fall can be calculated from this data using this

formula: Number of Patient Falls ____________________ X 1,000

Number of Patient Bed DaysThis formula can be used to calculate falls for the entire

hospital or unit specific falls and can be used to evaluate the effectiveness of fall prevention techniques.

(Quigley, Neily, Watson, Wright, & Strobel, 2007)

Process Improvement Taking necessary measures to prevent falls is a team effort. RNs

Assess fall risk during patient admission according to facility guidelines Implement standard prevention precautions Be knowledgeable about the potential risks of certain medications and

conditions relating to falls Educate other staff members about appropriate prevention of falls Educate the patient about preventing falls at home Communicate the needs of the patient to the physician and

physical/occupational therapy

PCTs Answer call lights as swiftly as possible Implement standard prevention precautions within scope of practice Perform a Bed Alarm Audit during shift change with oncoming PCT Communicate patient needs with the RN

Process Improvement Falls can be reduced by 21% when

appropriate interventions such as: Medication adjustmentTreating underlying causesScheduled toileting/mobilizationGait training The use of standard fall precautions are

implemented

(National Institute of Health)

Limitations Fall precautions, assessment tools and

equipment cannot be appropriately implemented when there is a storage of staffLack of staff puts patients at risk because of

increased patient-to-nurse ratioLeads to lengthened response times

Staff non-compliance with precautions, assessment tools and equipment

Facility deficit in the tools necessary to prevent falls

References Gardener, L. A., & Feil, M. (2013, February 28). Falls: Risk assessment, prevention and measurement. National Patient

Safety Foundation. Retrieved April 7, 2014, from http://www.npsf.org/wp-content/uploads/2013/03/PLS_1302_FallPrevention_LAG_MF.pdf

Fall Risk Assessment. (n.d.). Ohio Public Health Association. Retrieved April 7, 2014, from http://www.ohiopha.org/admin/uploads/documents/Fall%20Risk%20Assessment-CMS%200512.pdf

Masica, A., Richter, K., Haydar, Z., & Convery, P. (n.d.). Linking Joint Commission inpatient core measures and National Patient Safety Goals with evidence. National Institute of Health. Retrieved April 7, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2666853/#B6

Moin, L. C. (2012).Preventing Patient Falls in a Hospital Setting: A Persistent Problem. Xtrawise: a publication for the medical community, 14.4. Retrieved April 6, 2014, fromhttp://www.sizewise.net/getattachment/70b1fddf-ca54-4126-8a73-fe272744d109/patient_falls.aspx

National Guideline Clearinghouse | Prevention of falls (acute care). Health care protocol.. Retrieved April 7, 2014, from http://www.guideline.gov/content.aspx?id=36906&search=fall+prevention

Quigley, P., Neily, J., Watson, M., Wright, M., & Strobel, K. (2007, May 2). Measuring Fall Program Outcomes. <i>Measuring Fall Program Outcomes</i>. Retrieved April 7, 2014, from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No2May07/ArticlePreviousTopic/MeasuringFallProgramOutcomes.html

What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls. (n.d.). World Health Organization: Europe. Retrieved April 7, 2014, from http://www.euro.who.int/__data/assets/pdf_file/0018/74700/E82552.pdf