fall prevention - weeblysarahsalvadorelevel3portfolio.weebly.com/uploads/2/...review the uc health...
TRANSCRIPT
Fall
Prevention
Purpose and Objectives
Purpose:
Review the UC Health Fall Prevention Program.
Objectives:
1. Present evidence about patient safety and falls.
2. Review the UC Health Fall Prevention Policy and
Fall Risk Assessment Tool.
3. Identify current interventions to prevent falls.
4. Take a post-test to verify knowledge competency.
Evidence
• Of all falls, up to 45.2 % occurred during toileting with majority
occurring on the way from the chair/bed to the bathroom (Tzeng
H.M., 2010)
• Individualized and targeted fall prevention strategies in addition
to universal fall prevention interventions work better than
universal interventions alone (Ang et al, 2011)
Regulatory Requirements
• Reducing falls: a UCH Critical Success Factor!
• Magnet re-designation requires inpatient fall rates to be at or
below the median of comparison hospitals
• Falls with major injury are a CMS hospital acquired condition
(HAC). Hospital acquired falls w/injury will impact
reimbursement
– Major injury = fracture, surgery, casting or traction; inter-
cranial injury; internal injuries such as burns, electric shock
or crushing.
• UCH must work hard to keep our fall rate below the national
benchmarks.
– UCH Hospital Goal starting July 1st, 2013 = 2.79
– UHC Consortium Inpatient Benchmark = 3.17
Mrs. Smith (fictitious name) came to UCH with a stroke
and at the time of the expected date of discharge had
accrued expenses of $24,099.
On the day of discharge, she fell and broke her hip. The
additional costs associated with this fall are as follows:
Surgical expenses: $15, 214
Rehab recovery: $24, 005
Total Additional Expenses: $39, 313
Original expenses: $24,099
New Total expenses: $63,412
Instead of going home, Mrs. Smith went to a
nursing home. Her health outcomes are now
uncertain.
Preventing Patient Falls Fall Definitions and
Assessment
What is a Patient Fall? A patient fall is an unplanned descent to the floor with
or without injury. Assisting the patient to the floor is a fall.
What is a Near Miss Fall? A near miss fall is when the patient begins to fall but
does not reach the floor. The patient is assisted to the chair or bed without injury.
What is an Intentional Fall?
Patient falls on purpose or falsely claims to have fallen.
When a patient falls back into bed or into a chair, it is not considered a fall. Click here to review the policy.
Nursing
Fall Prevention Activities
• At UC Health the Fall Risk
Assessment Tool is used across
services and systems.
• This tool was created by Poudre
Valley Hospital and implemented
system wide due to their resounding
success in preventing falls.
• This tool is based on patient
symptoms and gait disturbances.
When to Assess Patient Fall Risk
Inpatient Assessment
• Assess and rate the patient fall risk on admissions and at the
start of each shift.
• Assess and re-rate fall risk if the patient’s condition changes.
This change in condition may include such examples as a newly
ordered medication or altered mental status.
• Reassess immediately after a fall and 24 hours post fall to
ensure there are no delayed injuries.
Ambulatory/Outpatient/Procedural Areas Fall Assessment
• Use the same Fall Risk Assessment Tool as inpatient areas.
• Fall Prevention Interventions will adhere to specific area’s guidelines on Fall Prevention.
Fall Risk
Assessment Tool
This shows the tool and
the different colors
indicate which patient
characteristics correlate
with each fall risk level.
The next slide will show
what the assessment
looks like in EPIC.
Inpatient Fall Assessment Tool
PROPERTIES
On passing, 'Finish' button: Goes to Next Slide
On failing, 'Finish' button: Goes to Next Slide
Allow user to leave quiz: After user has completed quiz
User may view slides after quiz: At any time
User may attempt quiz: Unlimited times
13
Falls Interventions
Low Fall Risk Interventions
Green
• Side rails raised x2 or x3 (x1 for beds with 2 long side
rails)
• Low bed position, brakes on, call light in reach
• Remove obstacles
• Glasses/hearing aids in reach as appropriate
• Assess the patient at a minimum of 1 time per shift
• WARNING!
“Not capable of bed exit” makes the patient automatically a
low risk. Use this very cautiously (i.e. end of life,
quadriplegic, pharmaceutically paralyzed)
Moderate Fall Risk Interventions
Yellow
All of the Low Risk interventions PLUS:
• Check patient every 2 hours
• Offer/encourage toilet every 1-2 hours as appropriate
• Assess for use of standing/transfer devices
High Fall Risk Interventions
Red
All of Low and Moderate interventions PLUS:
• Institute fall-alert marker on door jamb and chart (on bed in ED)
• Place colored fall-alert socks on patient unless contraindicated
(e.g. risk of skin breakdown-heel, excessive swelling-lower
extremity, or cause pain/discomfort)
• 3 side rails raised with bed alarm
• Chair alarm when up in chair
• Remain within reach of the patient when in chair or Check on
bed without alarm (including when in bathroom)
• Check on patient every hour
• Gait belt or up with standby assist
• Additional fall risk interventions as appropriate/available
High Fall Risk Interventions
Side Rail Use in Fall Prevention
All high risk fall patients must have 3 side rails raised with a bed alarm.
• The 4th side rail is considered a restraint and would require a
restraint order if used. May be used with specialty mattresses for
safety (not requiring a restraint order).
• You must follow the policies: “Fall Prevention” and “Physical
Restraint Non-behavioral”
Beds and Fall Strategies Look, Listen, Feel to make sure properly alarmed
(for med/surg beds)
Look:
Green light means the bed
alarm is set, bed is low, locked
and both side rails up
Yellow light means the bed
alarm is set but 1 of the other
parameters is not set
Listen:
One solid beep, bed alarm is
set!
Feel:
Zero bed and weigh each new
patient
Key Points about Patient Falls
• Keeping patients safe requires vigilance and teamwork. Work
closely with patient, family and inter-professional team to maintain
successful surveillance.
• Educate the patient and family. Keep them informed about the
patient’s fall rating. Engage them in helping prevent injury.
Review room signage.
• Learn ALL components of the Fall Prevention Program and
policy. Your patient’s safety depends on it!
• When in doubt of risk, rate patient higher not lower to rate patient
risk. May use “RN-Increased Risk Level”.
21
Key Points about Patient Falls EPIC auto calculates the fall risk based on the fall assessment form. This
then directs interventions, but it is up to the nurse to ensure high fall risk
interventions are in place! EPIC populates moderate and high fall risk
banners for patients on their patient summary tab (see screen shot).
22
Preventing Patient Falls
Strategies to Prevent Falls
• Keep patient environment free of clutter; clean up spills with the
assistance of Environmental Services
• Report any equipment issues impacting falls to Anytime,
Anywhere (88351)
• Use bed or chair alarm. Check bed
alarm system connection to head wall by
pushing the nurse call button on bed rail
• Familiarize yourself with equipment in use
in your area (bed alarms, chair alarms)
…..continued
Strategies to Prevent Falls, Continued
On inpatient services, 35% to 40% of falls relate to toileting.
• Implement toileting checks during hourly rounds, schedule toileting
to prevent falls!
• Use commodes
• If the patient is a high risk for falling,
remain within arms reach of patient in bathroom;
this is not considered a fall prevention
intervention----it is nursing protocol and the
patient cannot refuse
• Complete and document hourly rounding on all high fall risk
patients
Check out the Fall Prevention Resources website!
From the HUB home page, click on the Departments and Services
tab. Then click on the Champions / Committees link and lastly the
Fall Prevention Champions link.
Many helpful
resources
relating to fall
prevention
may be found
here under the
“Resources
and Documents”
link.
Medical Surgical Units
EBP Intervention: Purposeful
Hourly Rounding
UCH implementing on Medical Surgical Units
5 P’s of Purposeful Hourly Rounding (on all patients) (see next
slide)
Rounding helps prevent falls, improve patient satisfaction,
decrease call light frequency, decrease skin breakdown and
improve pain control
………continued
27
Purposeful Hourly Rounding, continued
5 Ps of Purposeful Hourly Rounding
• Pain: address pain scale
• Potty: ask patient if he/she needs to go to the bathroom
• Position: complete turning or ask patient if he/she is comfortable
• Personal Needs: make sure bedside table & all belongings are
within reach. Ensure call light is with patient.
• Presence: let patient know you are available & have time.
Hourly rounding is expected on every patient (per service excellence)
but documentation of safety checks/hourly rounding is based on fall
risk
Medications and Fall Risk
• It is known that certain medications and interactions between
multiple medications can increase patient fall risk.
• RN must assess patient fall risk as it relates to prescribed
medications. An RN can order a pharmacy consult for pharmacy
staff medication review at any time and is required to order one
after any patient fall.
• Partner with your physicians to discuss medications and fall
risks!
Post Fall Actions It is critical to assess any patient who falls, regardless of inpatient or
outpatient setting
• Do not move patient until it is safe.
• Take vital signs.
• Call the MD or LIP provider; ensure F/U tests ordered and completed
as indicated.
• Reassess patient frequently for changing condition.
• Inform family as soon as possible.
• Provide comfort and support to patient.
• Complete PSN
• Analyze cause of fall to prevent 2nd fall; post fall huddle with debriefing
form
• Reassess patient in 24 hours to assure there are no lingering effects
from patient fall.
Post Fall Huddle
Fall Huddle debriefing immediately after a fall or by end of the shift
• Acts as a way for teams to debrief and analyze fall
• Look at ways to prevent the fall from happening again
• Fall Huddle Debriefing Form helps ensure that all post fall
actions are completed
Fall Huddle Form
Fall Huddle/Debriefing Form Perform Huddle in Pt’s room with Pt’s input!
Unit: _______Room#______ Date/Time of fall: ________ Patient Sticker
Primary RN_______________________
Diagnosis:_________________________
Situation Staff Present for Huddle: ______________________________________________________________________
Who fell? How did it happen? __________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Pt States: ____________________________________________________________________________________
Vital Signs/Pain Level: ________________________________________________________________________
Was the Fall Assisted by staff? Yes No Injury Level: No Harm Minor Moderate Severe
Injury Location/locations:______________________________________________________________________
***How would you prevent this fall from happening in the future?____________________________________
Fall Prevention Strategies in Place at Time of the Fall
Last Documented Fall Score: New Fall Score:
Was the Pt. scored appropriately? Yes No If no,_______________________________________________
Was the Pt. CAM/CAM ICU + per charting? Yes No Is the Pt. CAM/CAM ICU + now? Yes No
Hourly rounding completed. Yes No If no,__________________________________________________
-When was the last time staff was in the room? _________________________________________________
-When was the last time the patient was toileted?_______________________________________________
-Was the unit fully staffed with CNA’s? Yes No If no, CNA: Pt ratio: ___________________________
List ALL High Fall Risk medications the Pt. received in the last six hours:_____________________________
____________________________________________________________________________________________
Red/High Risk Interventions
(if red prior to fall) If not in place explain:
Bed/Chair Alarm ON. Yes No If no,____________________________________________
-If bed/chair alarm on was it functioning appropriately? Yes No, What type of bed? Old New
-Did alarm ring through the call bell system? Yes No
-If NO to either, contact Mechanic on Duty 8-4845 or Engineering 8-8351.
Red Socks on. Yes No If no,____________________________________________
Red Sticker on door/chart. Yes No If no,____________________________________________
Toilet with assistance. Yes No If no,____________________________________________
3rd
SR up. Yes No If no,____________________________________________
4th
SR up. Circle one: Safety/Rest Yes No If no,____________________________________________
Environmental Adjustment Yes No If no,____________________________________________
Pharmacy Consult Yes No If no,____________________________________________
Sitter Yes No If no,____________________________________________
Post Fall Task List What New Intervention(s) are in place to prevent future falls? _____________________________________
Complete PSN
MD called to see pt
Document Fall under Clinician Communication
Reassess Fall NIC, automatic 16 points
Place pt sticker on this form
Order “IP Consult to Pharmacy” in EPIC (RN to put in order).
Fax this form to Risk Management 40457
Inform Patients Family of fall within 6 hours of fall
Ensure this form is delivered to unit Fall Champion or placed in unit Fall Notebook
ON OFF HOURS (weekends and nights): page Hospital Manager (Business hours) page Unit Manager. (Form Revised 1/28/13 NH)
Post Fall Actions, continued
• If, despite all best efforts, a patient fall happens, the RN or other
provider must report the fall using the Patient Safety Net database
• Each item on the form must be filled out completely to provide
accurate information to departments managing fall data; if PT/OT
involved, include this in the narrative
• Document the fall in EPIC under Notes → New Note → Types →
Significant Event.
• Any fall resulting in serious injury or death should be called
immediately to Professional Risk Management at ext. 4-7475
(4RISK), in addition to completing the PSN report
• Transport orders, including Ticket to Ride, in
EPIC must include fall risk information
• Document Patient/Family education in EPIC
• Always use a gait belt when mobilizing
patient for the first time. Gait belt use is
encouraged with all high fall risk patients
• Document assessment and interventions
accurately
• If you believe your patient needs a sitter,
consult with the charge RN
Patients fall at UCH because:
• Inconsistency in charting/ shift report that pt. previously
fell
• Bed alarm not turned on or not plugged into call system
• Patient cognitive status changes; does not follow instructions
• Medication interactions that are not detected or known to increase
risk for falling
• Assuming patient mobility is better than reality
• Toileting, toileting, toileting! Patient may need schedule,
commode, support and presence to prevent falling
References
• Ang, E., Mordiffi, S.Z., & Wong, H.B. (2011). Evaluating the use of a
targeted multiple intervention strategy in reducing patient falls in an
acute care hospital: a randomized controlled trial. Journal of
Advanced Nursing. 67(9). P. 1984-1992.
• Tzeng, H.M. (2010). Understanding the prevalence of inpatient falls
associated with toileting in adult acute care settings. J Nurse Care
Qual. 25(1). P.22-30.
36
You may now take the test for this self-
learning module. Please exit the course
using the “exit’ tab in the upper R corner
of the screen. Once you exit the module,
you will be able to access the test. You
must complete the test with 100% correct
to receive credit.