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Fall and Harm Prevention A Top Safety Priority

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1 Fall and Harm Prevention A Top Safety Priority
We want to shift from reacting to falls to preventing falls. Programs to prevent falls benefit patient and the health care system Falls can injury patients. Time consuming and stressful for staff. Healthcare costs resulting from a fall in the hospital may not be covered by insurers. Will likely be considered a “never event” in the future. 4/14/2017

2 Currently our fall prevention goals at HMC are to:
1) Increase awareness of patients: a) at risk for falls b) at risk for harm by falls 2) Conduct fall risk assessments on a regular basis and communicate perceptions of risk to all members of the health care team. 3) Emphasize that everyone has a role to play in preventing falls and injuries from falls. 4) Decrease inpatient fall rates by 20% or greater; decrease the number of patients experiencing recurrent falls; and reduce the number of serious injuries that result from falls. 5) Encourage communication between disciplines regarding fall risk and shared responsibility for fall prevention.

3 Patterns of falls at Harborview
1-2 falls per day, on average, inpatient Falls with injury: 17% Falls with serious injury: <1% Repeat (>1) fallers: ~20% Percent of falls that are witnessed: 77%

4 HMC CARES about Fall Prevention
COMMUNICATE FALL RISK TO ALL PROVIDERS Visual Fall Alerts : Yellow armbands and blankets, Falling Person & Fall Plan on white board, discuss fall and harm risk and prevention plan at hand-off. AUDIBLE ALERTS Bed exit alarms, sitter select Reduce Harm Low Beds, Floor Mats and increased observation ie chart in room, patient at front desk, sitter Educate patient and family Provide written and verbal information, use teach back, document fall prevention education in the detailed assessment Standardize hourly rounding 4/14/2017

5 People of all ages can fall. There are many risk factors for falls
People of all ages can fall. There are many risk factors for falls. Intrinsic Risk Factors Risk factors that are due to the patient’s internal (cognitive or physical) conditions Extrinsic Risk Factors Risk factors that are external to the patient Why do people fall?

6 Intrinsic risk factors
History of falling Lower body weakness Balance problems Gait disturbance Postural hypotension Altered mental status (delirium, dementia) Incontinence or urgency (bowel, bladder) Alcohol or drug intoxication Sensory impairments (vision, hearing) Intrinsic risk factors

7 Medications that cause sedation, dizziness, confusion (impair alertness and judgment)
Medications that cause postural hypotension (lead to dizziness or syncope) Medications that stimulate bowel or bladder function (lead to hurrying out of bed) Medications that impair balance (alter coordination and gait) Medications are a major extrinsic risk factor for falls. Another factor is the environment.

8 How can we prevent falls?
Risk and harm assessment Universal fall preventions for all patients at all times Visual Cues Communicate fall risk with all providers Utilize the fall prevention orders for patients at risk How can we prevent falls?

9 Adhere to Universal Fall prevention guidelines for all patients
Keep bed in lowest position Keep equipment that patient may need within reach Ensure call light is within reach Ensure that patients access to eyeglasses, hearing aids, walker or cane Encourage non-skid footwear Maintain clutter free environment and alert staff of any spills. If patient is newly admitted to unit or post-op or post procedure, regardless of fall risk place bed alarm for 24 hours. AND

10 Conduct Hourly Rounding
AIDET Prompted toileting Assess and treat pain Reposition Check for environmental hazards Place personal items within reach There is evidence to indicate that hourly rounding decreases falls in the hospital. Conduct Hourly Rounding

11 Visual Cues Yellow blankets, socks, and arm bands identify those at high risk of falls while hospitalized. On the white boards , the “falling man” icons indicate fall risk. Do not throw the yellow blankets in the laundry!

12 Assessment of fall risk and harm risk
Morse fall risk assessment is to be done every day Scores greater than 50 indicate fall risk. Patients must to be reassessed for fall risk when condition or level of care changes. For example reassessment is indicated when: the patient returns to unit post-op or post procedure the patient transfers from ICU to acute care.

13 Go to Ad Hoc to pull up the Morse Fall scale if Morse needs to be re-scored

14 4/14/2017

15 4/14/2017

16 Interventions will flow into the Plan of Care

17 Fall Documentation Includes
Daily fall risk assessment (Morse Fall Scale) daily and whenever patient condition changes i.e. post- op, transfer to/from acute care/ICU/post-fall Inclusion of fall precautions into the IView precautions tab Selection of interventions: will flow to Patient Plan summary Documentation of the Evaluation of the Plan in the daily note Education provided to patients and families There fall related patient and family education on the PFRC website. 4/14/2017

18 Detailed Assessment band

19 Patient Education on Falls
Information for patients and families about fall prevention. Inpatient and outpatient materials Materials on “Falls and anticoagulation” Patient Education on Falls 4/14/2017

20 NEW: Fall Prevention Order Set
Utilize these orders for patients with: A High Morse Fall Scale score (>50) and/or one or more risk factors for harm. The Provider order set is on the first page Nursing interventions are on second page.

21 Increased Risk of Falls
A report of falls at home in the admission assessment or a history of falling in the hospital. Known or suspected dementia or evidence of confusion and /or delirium (disoriented, somnolent, agitated or day/night reversal) Bowel or bladder incontinence Known sensory impairment (vision or hearing difficulties) In ETOH or drug withdrawal Frail Elder 4/14/2017

22 Increased Risk of HARM from Falls
Craniectomy (no cranial bone) Currently on therapeutic anti-coagulation or at high risk for bleeding (e.g. low platelet count) History of osteoporosis, bony metastasis or other conditions causing fragile bones. 4/14/2017

23 Communicate fall risk information to rest of team
Prompt MDs to complete Fall Prevention Orders for patients at high risk of falling (first page of order set). Implement nursing-driven interventions (second page of order set) for high risk patients, and keep copy of plan in patient’s Kardex Communicate fall risk information to rest of team

24 The provider order set (page one):
Focuses on 3 key modifiable fall risk factors found in hospitalized persons: 1) Postural dizziness 2) Lower body weakness 3) Altered mental status (delirium /dementia) Engages relevant healthcare professionals (including clinical pharmacists) for each risk factor present Prompts documentation of plan for fall prevention in medical record.

25 The nursing fall prevention checklist (page two) Focuses on: Patient and family education. Documentation Delirium prevention Bed selection

26 Equipment Patient activity alarms Floor mats Low bed Broda Chair
Mattress on the floor Pocket talkers 4/14/2017

27 Low bed and floor mats This bed had NO built in alarms. Use with floor mat. Best for patient who are unable to come to standing independently. Use an alarm with the bed and connect the alarm to the nurses’ station. 4/14/2017

28 Broda Chair Patients who need direct supervision
Comes with a tray for meals etc. Seat tilts to reduce sliding Call the lift team for mechanical lift Footrest can removed Wipe down with Sani-Wipe between patients Keep pieces together Supervision when up in the Broda chair is key. Bring them to the front desk. 4/14/2017

29 What to do after a fall Check for injuries and notify the physician
about the fall. Use safe patient handling to move the patient off the floor, call the lift team to assist if needed. Check that all the interventions were in place Debrief: review the fall the patient and staff Revise the plan if needed Complete a PSN report Talk to the family about the fall Document event in medical record 4/14/2017

30 A more detailed post-fall template in ORCA is coming in 2012.
Will be used for documentation purposes and to help guide the process of assessment and patient handling after a fall event. Post- fall assessment 4/14/2017

31 Next Steps Be proactive, look for yellow armbands.
Think about patient safety every time you interact with a patient Double check for safety Bed down Patient has call light and knows how to use it Patients at risk for falling are toileted regularly. 4/14/2017

32 Resources Charge Nurse Nurse Manager Clinical Education
Falls Committee (SOFT = Safer Outcomes from Falls Team) Members Fall Prevention Website 4/14/2017

33 Search the intranet for Fall or Fall Prevention
If you have any suggestions or questions 4/14/2017

34 Thank you for joining our Fall Prevention team!!
Maintaining safety in the hospital is everyone’s job. Identifying patients at risk for falls is key to preventing falls. We can effectively intervene, reduce falls and prevent harm. Efforts to reduce falls in the hospital are showing results. Our fall rate is decreasing and our harm rate remains low because of the efforts of staff to keep patients safe in the hospital. 4/14/2017

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