preventing inpatient falls
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Preventing Inpatient Falls . J. McAllister, SN University of South Florida College of Nursing Quality Improvement Project . Purpose. Decrease the number of inpatient falls on the 5 South Trauma Floor through the use of evidence based practice. Increase the use of fall assessment tools - PowerPoint PPT PresentationTRANSCRIPT
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