Clearly define what constitutes a patient fall (Ganz 2013, Miake-Lye 2013, Registered Nurses Association of Ontario).
Leaders must also accept, that with clearer definitions of patient falls, there will most likely be an increase in falls in the early days of the program. High-reliability organizations understand that this is not a reflection of staff negligence, but of better data collection policies.
Define Type of falls.
- Physiological (anticipated). Most in-hospital falls belong to this category. These are falls that occur in patients who have risk factors for falls that can be identified in advance, such as altered mental status, abnormal gait, frequent toileting needs, or high-risk medications
- Physiological (unanticipated). These are falls that occur in a patient who is otherwise at low fall risk, because of an event whose timing could not be anticipated, such as a seizure, stroke, or syncopal episode.
- Accidental. These falls occur in otherwise low-risk patients due to an environmental hazard. Improving environmental safety will help reduce fall risk in these patients but is helpful for all patients
Categorize falls with injury.
- No apparent injury
- Minor: Bruises or abrasions as a result of the fall
- Moderates: an injury that causes tube or line displacement, a fracture, or a laceration that requires repair.
- Major: injury that requires surgery or a move to intensive care unit for monitoring a life-threatening injury.
- Death.
Develop a multidisciplinary team to create, implement, and sustain fall prevention and protection from injury initiatives. This team should include, but is not limited to, Executive Sponsor, Environmental Manager, Risk Manager, Physical Therapist, Occupational Therapist, Medical Doctor, Unit Manager, Frontline Nursing staff, Certified Nursing Assistant. Efforts should be made to get as many representatives from all shifts.
Gain consistent data collection processes. Without reliable data metrics a facility cannot reliably compare before and after initiative validity.
- Falls per 1,000 patient days is the most reliable metric.
- Falls with injury per 1,000 patient days should also be noted.
Review Fall Assessment tools being utilized. The tool should have clarity on the purpose for the outcomes desired from the tool. Is the tool being used to triage or screen for the likelihood of a fall? Do you have tools to evaluate patients for muscle strength, gait, and other contributing factors? Competency assessment of clinicians who utilize the tool should be done on an on-going base to ensure accuracy and knowledge application of the tools.
Review Fall Prevention and Protection from Injury Interventions.
- Institutions should be utilizing not only ambulation equipment but visual cues to indicate high risk fall patients for staff members. Color coded gowns, wrist bands, socks, external magnets and other visual cueing notifies those trained in fall prevention and protection from injury that a patient is at risk, and thus requires greater monitoring.
- Utilize appropriate interventions for individuals specific fall risk factors. Patients that have difficulty with toileting will require different interventions, then if a patient's risk factors are due to culprit medications.
Review Environmental Risk Factors.
The following provisions should be followed to avoid environmental risk factors:
- Beds kept in the lowest position.
- Glare reduction windows in place.
- Polarized windows decrease glare.
- Tinted mylar shades can eliminate glare without loss of ambient light.
- Translucent light filtering pleated shades or sheer draperies eliminate glare without loss of ambient light.
- No gloss flooring should be utilized.
- Handrails should be in the room, walkways and bathrooms. They should be easy to identify with a coloring different from the wall they are attached to assist those who are visually impaired or have low vision.
- All ambulation and patient transferring equipment should be serviced and inspected within the manufacturer's guidelines.
Create staff teaching for new fall prevention and protection from injury initiatives.
- These should be run by the fall champions, and encourage feedback from the staff for possible process improvements.
Create patient and visitor education.
- Patient and visitor education is a vital component to any multifactorial fall prevention and protection from injury initiative.
Create a post fall huddle initiative.
- Post fall huddles should initially include guidelines on how to care for a patient that has fallen.
- Once the immediate medical concerns of the fall have been addressed, a non-punitive root cause analysis should be performed. There are two different types of root cause analyses: aggregate and individual. Organizations should consider having both processes in place to assure maximum learning and improvement. Highly reliable institutions create a safe environment for staff members to report any potential patient safety concerns. Without this safe reporter environment, true root causes will never be found, thus creating negative patient safety outcomes indefinitely.
Re-Evaluate
- The multidisciplinary committee should meet on a predetermined basis to review fall prevention and protection from injury initiatives for areas of improvement.
Technology Plan