Presentation on theme: "Fall and Harm Prevention A Top Safety Priority"— Presentation transcript:
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 fallsb) at risk for harm by falls2) 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, inpatientFalls 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 PROVIDERSVisual 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 ALERTSBed exit alarms, sitter selectReduce HarmLow Beds, Floor Mats and increased observation ie chart in room, patient at front desk, sitterEducate patient and familyProvide written and verbal information, use teach back, document fall prevention education in the detailed assessmentStandardize hourly rounding4/14/2017
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 patientWhy do people fall?
6 Intrinsic risk factors History of fallingLower body weaknessBalance problemsGait disturbancePostural hypotensionAltered mental status (delirium, dementia)Incontinence or urgency (bowel, bladder)Alcohol or drug intoxicationSensory 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 assessmentUniversal fall preventions for all patients at all timesVisual CuesCommunicate fall risk with all providersUtilize the fall prevention orders for patients at riskHow can we prevent falls?
9 Adhere to Universal Fall prevention guidelines for all patients Keep bed in lowest positionKeep equipment that patient may need within reachEnsure call light is within reachEnsure that patients access to eyeglasses, hearing aids, walker or caneEncourage non-skid footwearMaintain 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 AIDETPrompted toiletingAssess and treat painRepositionCheck for environmental hazardsPlace personal items within reachThere is evidence to indicate that hourlyrounding decreases falls in the hospital.Conduct Hourly Rounding
11 Visual CuesYellow 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 dayScores 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 procedurethe 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 4/14/2017
16 Interventions will flow into the Plan of Care 4/14/2017
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-fallInclusion of fall precautions into the IView precautions tabSelection of interventions: will flow to Patient Plan summaryDocumentation of the Evaluation of the Plan in the daily noteEducation provided to patients and familiesThere fall related patient and family education on the PFRC website.4/14/2017
19 Patient Education on Falls Information for patients and families about fall prevention.Inpatient and outpatient materialsMaterials on “Falls and anticoagulation”Patient Education on Falls4/14/2017
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 pageNursing 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 incontinenceKnown sensory impairment (vision or hearing difficulties)In ETOH or drug withdrawalFrail Elder4/14/2017
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 KardexCommunicate 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 dizziness2) Lower body weakness3) Altered mental status (delirium /dementia)Engages relevant healthcare professionals (including clinical pharmacists) for each risk factor presentPrompts 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 floorPocket talkers4/14/2017
27 Low bed and floor matsThis 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 slidingCall the lift team for mechanical liftFootrest can removedWipe down with Sani-Wipe between patientsKeep pieces togetherSupervision 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 patientoff the floor, call the lift team to assist ifneeded.Check that all the interventions were in placeDebrief: review the fall the patient and staffRevise the plan if neededComplete a PSN reportTalk to the family about the fallDocument event in medical record4/14/2017
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 assessment4/14/2017
31 Next Steps Be proactive, look for yellow armbands. Think about patient safety every time you interact with a patientDouble check for safetyBed downPatient has call light and knows how to use itPatients at risk for falling are toileted regularly.4/14/2017
33 Search the intranet for Fall or Fall Prevention If you have any suggestions or questions4/14/2017
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 preventharm.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