Presentation on theme: "Fall and Harm Prevention A Top Safety Priority 5/2/20151."— Presentation transcript:
Fall and Harm Prevention A Top Safety Priority 5/2/20151
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.
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% 3
5/2/20154 C OMMUNICATE 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. A UDIBLE ALERTS Bed exit alarms, sitter select R educe Harm Low Beds, Floor Mats and increased observation ie chart in room, patient at front desk, sitter E ducate patient and family Provide written and verbal information, use teach back, document fall prevention education in the detailed assessment S tandardize hourly rounding HMC CARES about Fall Prevention
Why do people fall? 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 5
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) 6
Medications are a major extrinsic risk factor for falls. Another factor is the environment. alertness and judgment Medications that cause sedation, dizziness, confusion (impair alertness and judgment) dizziness or syncope Medications that cause postural hypotension (lead to dizziness or syncope) hurrying out of bed Medications that stimulate bowel or bladder function (lead to hurrying out of bed) alter coordination and gait Medications that impair balance (alter coordination and gait) 7
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
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
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.
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!
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. 12
5/2/ Go to Ad Hoc to pull up the Morse Fall scale if Morse needs to be re-scored
Interventions will flow into the Plan of Care 5/2/201516
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 5/2/201517
Detailed Assessment band 5/2/201518
Patient Education on Falls Information for patients and families about fall prevention. Inpatient and outpatient materials Materials on “Falls and anticoagulation” 5/2/201519
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.
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 5/2/201521
5/2/ 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.
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 23
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.
The nursing fall prevention checklist (page two) Focuses on: Patient and family education. Documentation Delirium prevention Bed selection
Equipment Patient activity alarms Floor mats Low bed Broda Chair Mattress on the floor Pocket talkers 5/2/201526
Low bed and floor mats 5/2/201527
Broda Chair 5/2/ 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
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 5/2/201529
Post- fall assessment A more detailed post-fall template in ORCA is coming in Will be used for documentation purposes and to help guide the process of assessment and patient handling after a fall event. 5/2/201530
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. 5/2/201531
Resources Charge Nurse Nurse Manager Clinical Education Falls Committee (SOFT = Safer Outcomes from Falls Team) Members Fall Prevention Website 5/2/201532
5/2/ Search the intranet for Fall or Fall Prevention If you have any suggestions or questions
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. 5/2/201534