Preventing Inpatient Falls

1. Preventing Inpatient Falls J. McAllister, SN University of South Florida College of Nursing Quality Improvement Project

2. Purpose • Decrease the number of inpatient falls on the 5 South Trauma Floor through the use of evidence based practice. • Increase the use of fall assessment tools • Implement the appropriate use of fall prevention equipment (i.e. bed alarms, chair alarms) through the use of daily auditing tools • Increase staff knowledge on fall prevention and risk

3. Background • 700,000 to 1 million inpatient falls occur every year • 30 to 51 percent of these falls result in injury • Falls account for 70% of all inpatient injuries • More than half of report falls occur due to bladder/bowel urgency • Risk for falls is significantly increased over the age of 65 • Centers for Medicare & Medicaid Services do not cover the costs of inpatient falls that result in injury • National average cost of fall related injury: $13,316 per patient • National average additional hospitalization days: 6.3- 12 days (Moin, 2012); (World Health Organization)

4. Background (Moin, 2012)

5. Bayfront Fall Statistics 2014 BMC Total Hospital Falls 2014

6. Bayfront Fall Statistics 2014 Total BMC Falls per Unit, 2014

7. Bayfront Fall Statistics 2014 Total BMC Falls per Patient Day compared to 2014 Target Goals

8. Implementation and Methods • Cause and Effect Analysis (Fishbone Diagram) • Patient Fall Assessments • Bed Alarm Use Audit • Implementing Standard Fall Prevention Interventions

9. Cause and Effect Analysis

10. Fall Risk Assessment • Many fall risk assessment tools are available • Hendrich I & II, Johns Hopkins, Morse, STRATIFY, etc. • There is no definite consensus to which tool is the best • These tools predict patient susceptibility to falls but do not prevent falls • Assessments should be performed upon admission, with transfer to a new unit, after a fall occurs, with change in patient condition and after a procedure is performed. (National Guideline Clearinghouse)

11. Fall Risk Assessments • Fall risk assessments should be thorough and occur continuously during treatment • Assessments should include: • Age • Level of consciousness • Need for an ambulatory aid • Characteristics of patient gait • Balance • Blood pressure • Use of tethering devices and devices that limit mobility • Fall history • Medications • Continence status • Presence of hearing or visual impairments • Predisposing diseases or conditions (Ohio Public Health Association)

12. Fall Risk Assessment

13. Fall Risk Assessment Cont.

14. Bed Alarm Audit Adapted from http://www.unmc.edu/patient-safety/images/Fall_Risk_Audit_Tool_Example_2.docx.

15. Implementing Standard Fall Prevention Precautions • Orient patient to the environment • Make sure call light is within reach • Personal Items within reach • Bed is is locked and in lowest position • Provide non-slip footwear and a fall risk arm band • Turn lights on when getting patient out of bed • Remove all clutter • Provide scheduled toileting while patient is awake (Q2 hours • Provide assistive device during ambulation or transfer (walker, cane, etc.) • Use bed/chair alarms if necessary • Place signage outside the door indicating risk • Ensure all walking surfaces are dry • Perform needs assessment during hourly rounding. (Gardener & Feil, 2013)

16. The 4 P’s of Hourly Rounding • The 4 P’s • Position • Pain • Personal Needs • Placement • This can result in • A reduction in falls • An Increased patient and staff satisfaction • A decrease in call light use (Gardener & Feil, 2013)

17. Measuring Outcomes • Outcomes of these implementations can be analyzed through the use of incident reports reported after a fall • Incident reports collect data on contributing factors to the fall such as time of day, location, activity and incontinence • Incidence of fall can be calculated from this data using this formula: Number of Patient Falls ____________________ X 1,000 Number of Patient Bed Days • This formula can be used to calculate falls for the entire hospital or unit specific falls and can be used to evaluate the effectiveness of fall prevention techniques. (Quigley, Neily, Watson, Wright, & Strobel, 2007)

18. Process Improvement • Taking necessary measures to prevent falls is a team effort. • RNs • Assess fall risk during patient admission according to facility guidelines • Implement standard prevention precautions • Be knowledgeable about the potential risks of certain medications and conditions relating to falls • Educate other staff members about appropriate prevention of falls • Educate the patient about preventing falls at home • Communicate the needs of the patient to the physician and physical/occupational therapy • PCTs • Answer call lights as swiftly as possible • Implement standard prevention precautions within scope of practice • Perform a Bed Alarm Audit during shift change with oncoming PCT • Communicate patient needs with the RN

19. Process Improvement • Falls can be reduced by 21% when appropriate interventions such as: • Medication adjustment • Treating underlying causes • Scheduled toileting/mobilization • Gait training • The use of standard fall precautions are implemented (National Institute of Health)

20. Limitations • Fall precautions, assessment tools and equipment cannot be appropriately implemented when there is a storage of staff • Lack of staff puts patients at risk because of increased patient-to-nurse ratio • Leads to lengthened response times • Staff non-compliance with precautions, assessment tools and equipment • Facility deficit in the tools necessary to prevent falls

21. References Gardener, L. A., & Feil, M. (2013, February 28). Falls: Risk assessment, prevention and measurement. National Patient Safety Foundation. Retrieved April 7, 2014, from http://www.npsf.org/wp-content/uploads/2013/03/PLS_1302_FallPrevention_LAG_MF.pdf Fall Risk Assessment. (n.d.). Ohio Public Health Association. Retrieved April 7, 2014, from http://www.ohiopha.org/admin/uploads/documents/Fall%20Risk%20Assessment-CMS%200512.pdf Masica, A., Richter, K., Haydar, Z., & Convery, P. (n.d.). Linking Joint Commission inpatient core measures and National Patient Safety Goals with evidence. National Institute of Health. Retrieved April 7, 2014, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2666853/#B6 Moin, L. C. (2012).Preventing Patient Falls in a Hospital Setting: A Persistent Problem. Xtrawise: a publication for the medical community, 14.4. Retrieved April 6, 2014, from http://www.sizewise.net/getattachment/70b1fddf-ca54-4126-8a73-fe272744d109/patient_falls.aspx National Guideline Clearinghouse | Prevention of falls (acute care). Health care protocol.. Retrieved April 7, 2014, from http://www.guideline.gov/content.aspx?id=36906&search=fall+prevention Quigley, P., Neily, J., Watson, M., Wright, M., & Strobel, K. (2007, May 2). Measuring Fall Program Outcomes. <i>Measuring Fall Program Outcomes</i>. Retrieved April 7, 2014, from http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No2May07/ArticlePreviousTopic/MeasuringFallProgramOutcomes.html What are the main risk factors for falls amongst older people and what are the most effective interventions to prevent these falls. (n.d.). World Health Organization: Europe. Retrieved April 7, 2014, from http://www.euro.who.int/__data/assets/pdf_file/0018/74700/E82552.pdf