Fall Prevention Interventions It Starts with You… Preventing Falls Improving Lives 2014 Fall Prevention Education Series brought to you by the Washington State Hospital Association

Why focus on preventing falls? 30% of Inpatient Falls Result in Serious Injury Preventing falls: Increases patient trust Improves care Improves patient satisfaction Decreases unnecessary costs for both the patient and the hospital Why should we focus on preventing falls? According to evidence-based research, out of all inpatient incidents, such as medication errors, pressure ulcers, hospital-acquired pneumonia or surgical site infections, 84% are patient falls. An estimated 30% of inpatient falls results in serious injury, such as a fracture, subdural hematoma, injury requiring surgery, or death. A serious injury due to a fall increases the average length of stay by 6.27 days – increasing the risk of other potential complications, such as pressure ulcers, infections or medication errors. Preventing a patient from falling increases patient comfort, patient & family satisfaction, and confidence in the care they are being provided. How does preventing falls keep health care workers safe? According to the Bureau of Labor Statistics, six of the top ten professions with greatest risk of back injuries are: Nurse’s Aides, LPNs, RNs, Health Aides, Radiology Techs, and Physiotherapists. 38% of RNs and 42% of all Direct Caregivers suffer injuries as a result of patient handling activities. Preventing additional patient handling that will be required after a patient falls is definitely in your best interest. Ensuring you have a fall prevention plan with every patient actually improves your safety and work satisfaction. Identifying and reducing the risk for patient falls often reduces staff workload. How do patient falls impact the health care system as a whole? Falls are considered preventable in most cases. The morbidity, mortality and financial burdens attributed to patient falls in hospitals and other healthcare settings are among the most serious risk management issues facing the healthcare industry today. Preventing falls: Increases patient trust. Improves quality of care and patient and family satisfaction and decreases unnecessary costs for both the patient and the hospital. Reduces Risk of Injury to the Caregiver

What can I do to prevent falls? Leadership & Frontline Staff Involvement Identify Fall & Injury Risk Patients Fall Prevention Interventions Patient/Family Engagement & Culture Monitor Performance The Washington State Hospital Association Fall Prevention Safety Action Bundle is an evidenced-based document outlining five core strategies necessary for preventing falls. This presentation is focused on the importance of screening patients and identifying those who are at risk for fall and injury.

Research Proven Interventions Significant research has been accomplished to give us the evidenced based tool to prevent patients from falling. Highlight of several key prevention interventions that can be incorporated in your care plan and within your daily routine. Incorporating evidence-based interventions in your practice will prevent falls. The most important fact to remember, it does not matter how many great tools we have available if we don’t use them or hold others accountable to implement in our practice of patient care. We are going to talk about teamwork and culture in a bit, however, as we review the interventions, keep in mind that patient care is a team effort and your fall prevention plan for your patients will be stronger when working as a team.

What can I do to prevent falls? Design Individualized Care Plan Complete Falls Risk Assessment Bedside Shift Report - Including Patient and Family Completing a Falls Risk Assessment is necessary to give you a falls risk baseline and on-going status of your patient. A care plan should always be based on your assessment findings because every patient is different – which means your care plan, although standardized for best practice –is still unique for every patient. Especially because you are involving your patient or their loved ones in the care plan. Preventing falls through bedside shift report allows for caregivers to give discuss the risk and any potential changes that had occurred or will occur during the shift, such as the patient going to surgery or changing medications. Hand-off communication with the patient and family involved empowers the patient with knowledge and also helps you give them expectations and education regarding their care.

What can I do to prevent falls? Use Patient White Board in Room for Communication When completing your initial assessment and with bedside shift report, the patient communication white board is a great way to share important information with your colleagues, physicians, and the patient/family regarding their plan of care, including what they should do or not do with fall prevention.

What can I do to prevent falls? Shift Huddles In addition to bedside shift report, it is a good practice to identify in your department shift huddles those patients that are high risk so everyone can be on the look out for potential safety concerns. Although shift huddles vary from hospital –to-hospital, and even from department-to-department shift huddles typically involve everyone on the unit to review unit safety and quality concerns, patient admissions and discharges, education moments, and other important information that needs to be communicated with every shift change.

What can I do to prevent falls? Frequent or Hourly Rounds Frequent or hourly rounds have been extensively researched and found effective for decreasing falls. Hourly rounds with purpose - such as ensuring toileting needs, personal items are within reach, repositioning assistance, and pain control is addressed - have been proven to decrease falls by up to 50%.

What can I do to prevent falls? Within Arm’s Reach During Toileting Many hospitals have implemented the caregiver staying within arms reach for all patients who are at a risk for falls. This means being readily available to assist the patient should they try to get up on their own after using a bedside commode, toilet, or urinal.

What can I do to prevent falls? PT/OT Consult Bed alarm Chair alarm Door and Chart Signage High Risk Armband Call Button within Reach Place Bed in Lowest Position Notification devices include use of signage, placing a high risk armband, and ensuring the call light is within reach. Utilization of bed or chair alarms is an imperative part of your care plan for high risk patients, however, remember, if the alarm goes off there needs to be an immediate response. The alarm alone should not give you a sense of security about your patient falling – it is a latent notification and may not prevent a fall or injury. However, it is important to have an alarm in place to assist with monitoring risk.

Culture of Fall Prevention - involving all disciplines Multi-Disciplinary Rounds -Increases Awareness & Communication Environmental Rounds -Decrease External Risk Factors No Pass Zone -Involve Everyone - Answering Call Lights Multi-disciplinary rounds have proven effective for numerous safety and care initiatives, including reduction of falls. Multi-disciplinary rounds are usually specific to individual hospitals, however can involve the case manager, primary nurse and aide, physical therapy, attending physician, dietary, social worker, and other pertinent caregivers for the patient. Discussing the safety risks for the patient as a team can assist with awareness and interventions. Environmental rounds can reduce risk of patient and staff injuries by routinely checking on high risk areas, such as clutter in rooms or hallways, furniture is in working condition, flooring is secure, and there is adequate lighting. Implementing a hospital-wide program to ensure that call lights are answered promptly by hospital staff member close by is proving to increase patient safety and satisfaction. No Pass Zone is just one term used to signify patient areas of the hospital where all staff are held accountable to assist a patient as quickly as possible when summoned or need is identified. Training is typically done to non-clinical staff to address non-clinical needs and when to get assistance.

Patient and Family Engagement = Better Outcomes Research shows that when patients are engaged in their health care, it can lead to measurable improvements in safety and quality. Patient and family engagement is not a new or separate initiative. It is a critical part of what your hospital is already doing to improve quality and safety. Engaging patients and families through improved communication and other practices also has a positive effect on patient outcomes — specifically, emotional health, symptom resolution, functioning, pain control, physiologic measures, and comprehension of instructions.

Mr. Walt Demographic Information: 82 year old male Admitted with: Lower GI Bleed, r/o diverticula Social Situation: Lives at Assisted Living Facility, Family supportive Medications: Vitamins, low dose aspirin daily, famotidine, IV Fall History: Last admission was related to Fall w/injury 3 months ago Additional Observations: Mild dementia, uses walker, hard of hearing, Morse Fall Scale risk assessment at 47 (high risk falls) Let’s work through a case study together.

Mr. Walt Which interventions would you implement for all patients, including Mr. Walt? Communicate High Risk at Bedside Shift Report Shift/Safety Huddle Communication Hourly Rounding with P’s Action Patient Communication White Board Bed in Lowest Position/Call Bell in Reach Include Family in Care Plan Which interventions would you implement for all patients, including Mr. Walt? Communicate High Risk at Bedside Shift Report Shift/Safety Huddle Communication Hourly Rounding with P’s Action Patient Communication White Board Bed in Lowest Position/Call Bell in Reach Include Family in Care Plan

What other interventions would you Mr. Walt What other interventions would you implement for Mr. Walt? High Fall Risk Signage Fall Risk Armband Staying Within Arms Reach Bed and Chair Alarm PT/OT Consult What other interventions would you implement for Mr. Walt? High Fall Risk Signage Fall Risk Armband Staying Within Arms Reach Bed/Chair Alarm PT/OT Consult

What have we learned? Complete Fall Risk Assessment Design an Individualized Care Plan Some interventions discussed include: Bedside Shift Report Shift/Safety Huddles White Board Communication Purposeful Hourly Rounds Stay Within Arms Reach for Toileting Use Alarms, Signage, Armbands as Notification Devices PT/OT Consult Recap. What have we learned? Complete Fall Risk Assessment to Identify Fall Prevention Plan Design an Individualized Care Plan based on Fall Risk Some interventions discussed include: Bedside Shift Report Shift/Safety Huddles White Board Communication Purposeful Hourly Rounds Stay Within Arms Reach for Toileting Use Alarms, Signage, Armbands as Notification Devices Consult with PT/OT

Other presentations in this series Fall Risk Assessment Fall Prevention Interventions, Patient and Family Engagement Post-Fall Huddles and Analysis Two other presentations are available in this Fall Prevention Series. The Fall Risk Assessment presentation discusses the importance and basics of the Falls Risk Assessment. The Post-Fall Huddles and Analysis presentation will review the importance of continuous improvement through effective post-fall huddles and analysis to achieve and sustain zero patient falls on your unit. Brought to you by the Washington State Hospital Association

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