Fall Risk Assessment and Intervention Nursing Practice Changes and Jeff Chart Updates

1. Fall Risk Assessment and InterventionNursing Practice Changes and Jeff Chart Updates Tentative Go Live Date September XX, 2012

2. Falls and Injury from FallsA Nursing Sensitive Indicator The prevention of falls and injury from falls in patients who are hospitalized are indicators of high quality bedside nursing care given on a particular unit or at a hospital. Recognizing who is at risk and implementing appropriate interventions aimed at minimizing the risk is part of professional nursing practice at TJUHs, Inc.

3. Why we needed a New Fall Risk Tool Background: Morse Falls Risk Tool was not meeting our needs; screens for Fall Risk and did not assess WHY patient is at risk It did not predict all of our falls Some of our patients scored not at risk (< 50) experienced a fall Often incomplete/inaccurate documentation

4. Jefferson Fall Risk Assessment and Intervention Tool Goal: To improve patient outcomes (decrease falls and injury from falls) through targeted interventions based on assessment

5. Jefferson Fall Risk Assessment and Intervention Tool (cont) What is different? • Goes beyond screening – assesses WHY a patient is at risk for fall • No “points”/numerical values assigned to a risk factor • If you assess a patient to be at risk to fall due to any risk factor – then they are at risk • Supports clinical judgment and decision making – re: selecting fall prevention interventions based on the specific risk factor(s)

6. Timeline

7. Fall Risk Assessment • Hx of falls prior or during hospitalization • Altered mobility/gait disturbances • Altered elimination • Altered balance/risk for dizziness • Equipment • Altered mental status &/or behavior risk • Risk of injury

8. Fall Prevention Interventions

9. Assessment Assess Fall Risk factors through: • Observation of patient • Interview (completion of Nursing Admission Assessment) • Review of the Physician History & Physical

10. Falls Tab Added to Assessments

11. Assessment - Complete Fall Risk Assessment in Jeff Chart.

12. InterventionImplement and document General Safety interventions for ALL patients.

13. InterventionImplement and document General Fall Prevention Interventions for ALL pts with any risk for falls

14. Interventions - SpecificSelect appropriate interventions based on patient risk factors and individualized assessment.

15. Case Study A 35 year old female is being admitted for wheezing and shortness of breath. PMH: Hypertension and asthma Admission orders include: • Inhalers • Prednisone 40mg PO • Hydrochlorothiazide 12.5mg PO What are the Falls Risk Factors for this patient? What Fall Prevention measures would you implement and document for this patient?

16. Fall Risk Assessment

17. Interventions General Safety Interventions only • Sensory items within reach • Call bell within reach • Non-skid footwear • Night Light • Level 2 Bed Alarm at night • Bed in low position/locked • Pt/Family teaching • Hourly rounding

18. Case Study An 82 year old female was admitted 5 days ago, S/P fall at home. • PMH: Hx of falls, has generalized weakness, uses cane to ambulate, has diabetes with neuropathy in hands and feet, is HOH, and takes Coumadin for chronic atrial fibrillation • Two days ago patient spiked a fever to 101.3F and became confused; found to have a UTI • Current orders include: • IV fluids Pain Medications Oxygen at 2 liters • Antibiotics PT/OT consult What are the Falls Risk Factors for this patient? What Fall Prevention measures would you implement and document for this patient?

19. Fall Risk Assessment

20. Interventions General Safety Interventions General Fall Prevention Interventions Specific Fall Prevention Interventions

21. Key Points • Falls Risk Assessment and Intervention is a professional nursing role and responsibility • Complete every shift, after a change in condition or after a fall, and upon transfer to another unit. • No “point” values are assigned to risk factors • Having any risk factor makes the patient at risk for falling • Tailor your interventions to the patient’s assessment • Communicate patient’s fall risk and interventions via handoff, huddles, IPOC, and Teletracking.

22. Fall Prevention is a Nurse-Sensitive Indicator of Quality As a professional nurse providing direct care, you are in a position to make a difference in patient outcomes. Your assessments and thoughtful planning will minimize the risks for patients at risk for falls and injury from falls