Fall and Harm Prevention

A Top Safety Priority

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Currently our fall prevention goals at HMC are to: 1) Increase awareness of patients: a) at risk for falls b) at risk for harm by falls 2) Conduct fall risk assessments on a regular basis and communicate perceptions of risk to all members of the health care team. 3) Emphasize that everyone has a role to play in preventing falls and injuries from falls. 4) Decrease inpatient fall rates by 20% or greater; decrease the number of patients experiencing recurrent falls; and reduce the number of serious injuries that result from falls. 5) Encourage communication between disciplines regarding fall risk and shared responsibility for fall prevention.

Patterns of falls at HarborviewPatterns of falls at Harborview

• 1-2 falls per day, on average, inpatient • Falls with injury: 17%• Falls with serious injury: <1%• Repeat (>1) fallers: ~20%• Percent of falls that are witnessed: 77%

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COMMUNICATE FALL RISK TO ALL PROVIDERS Visual Fall Alerts : Yellow armbands and blankets, Falling Person & Fall Plan on white board, discuss fall and harm risk and prevention plan at hand-off.

AUDIBLE ALERTSBed exit alarms, sitter select

Reduce HarmLow Beds, Floor Mats and increased observation ie chart in room, patient at front desk, sitter

Educate patient and familyProvide written and verbal information, use teach back, document fall prevention education in the detailed assessment

Standardize hourly rounding

HMC CARES about Fall Prevention

Why do people fall?Why do people fall?

People of all ages can fall.There are many risk factors for falls.Intrinsic Risk Factors

Risk factors that are due to the patient’s internal (cognitive or physical) conditions

Extrinsic Risk FactorsRisk factors that are external to the patient

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Intrinsic risk factorsIntrinsic risk factors

• History of falling• Lower body weakness• Balance problems• Gait disturbance• Postural hypotension• Altered mental status (delirium,

dementia)• Incontinence or urgency (bowel,

bladder) • Alcohol or drug intoxication• Sensory impairments (vision, hearing)

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Medications are a major extrinsic risk Medications are a major extrinsic risk factor for falls. Another factor is the factor for falls. Another factor is the environment.environment.

Medications that cause sedation, dizziness, confusion (impair alertness and alertness and judgmentjudgment)

Medications that cause postural hypotension (lead to dizziness or syncopedizziness or syncope)

Medications that stimulate bowel or bladder function (lead to hurrying out of hurrying out of bedbed)

Medications that impair balance (alter alter coordination and gaitcoordination and gait)

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How can we prevent fallsHow can we prevent falls??

• Risk and harm assessment• Universal fall preventions for all

patients at all times• Visual Cues• Communicate fall risk with all

providers• Utilize the fall prevention orders for

patients at risk

Adhere to Universal Fall prevention guidelines for all patients

• Keep bed in lowest position• Keep equipment that patient may need within

reach• Ensure call light is within reach • Ensure that patients access to eyeglasses,

hearing aids, walker or cane • Encourage non-skid footwear• Maintain clutter free environment and alert staff

of any spills.• If patient is newly admitted to unit or post-op or

post procedure, regardless of fall risk place bed alarm for 24 hours.

AND

Conduct Hourly RoundingConduct Hourly Rounding

AIDETPrompted toiletingAssess and treat painRepositionCheck for environmental hazardsPlace personal items within reach

There is evidence to indicate that hourlyrounding decreases falls in the hospital.

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Visual Cues Visual Cues •Yellow blankets, socks, and arm bands identify those at high risk of falls while hospitalized.•On the white boards , the “falling man” icons indicate fall risk.•Do not throw the yellow blankets in the laundry!

Assessment of fall risk and harm riskAssessment of fall risk and harm risk• Morse fall risk assessment is to be

done every day• Scores greater than 50 indicate

fall risk.• Patients must to be reassessed

for fall risk when condition or level of care changes. For example reassessment is indicated when: • the patient returns to unit post-op or

post procedure• the patient transfers from ICU to

acute care. 12

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Go to Ad Hoc to pull up the Morse Fall

scale if Morse needs to be re-scored

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Interventions will flow into the Interventions will flow into the Plan of CarePlan of Care

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Fall Documentation IncludesFall Documentation Includes• Daily fall risk assessment (Morse Fall Scale) daily

and whenever patient condition changes i.e. post-op, transfer to/from acute care/ICU/post-fall

• Inclusion of fall precautions into the IView precautions tab

• Selection of interventions: will flow to Patient Plan summary

• Documentation of the Evaluation of the Plan in the daily note

• Education provided to patients and families

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Detailed Assessment bandDetailed Assessment band04/21/23 18

Patient Education on FallsPatient Education on Falls

• Information for patients and families about fall prevention.

• Inpatient and outpatient materials

• Materials on “Falls and anticoagulation”

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NEW: Fall Prevention Order Set Utilize these orders for patients

with:A High Morse Fall Scale score

(>50) and/or one or more risk factors for harm.

The Provider order set is on the first page

Nursing interventions are on second page.

Increased Risk of Falls

•A report of falls at home in the admission assessment or a history of falling in the hospital.Known or suspected dementia or evidence of confusion and /or delirium (disoriented, somnolent, agitated or day/night reversal)Bowel or bladder incontinenceKnown sensory impairment (vision or hearing difficulties) In ETOH or drug withdrawalFrail Elder

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Increased Risk of HARM from Falls

Craniectomy (no cranial bone)Currently on therapeutic anti-coagulation or at high risk for bleeding (e.g. low platelet count)History of osteoporosis, bony metastasis or other conditions causing fragile bones.

Communicate fall risk information to rest of Communicate fall risk information to rest of teamteam

• Prompt MDs to complete Fall Prevention Orders for patients at high risk of falling (first page of order set).

• Implement nursing-driven interventions (second page of order set) for high risk patients, and keep copy of plan in patient’s Kardex

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The provider order set (page one):

•Focuses on 3 key modifiable fall risk factors

found in hospitalized persons:

1) Postural dizziness2) Lower body

weakness3) Altered mental status (delirium

/dementia)•Engages relevant

healthcare professionals (including clinical

pharmacists) for each risk factor present

•Prompts documentation of plan for fall prevention in

medical record.

The nursing fall The nursing fall prevention prevention checklist (page checklist (page two)two)Focuses on:Focuses on:Patient and Patient and family family education.education.DocumentationDocumentationDelirium Delirium prevention Bed prevention Bed selectionselection

EquipmentEquipment Patient activity alarmsFloor matsLow bedBroda ChairMattress on the floorPocket talkers

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Low bed and floor matsLow bed and floor mats

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Broda ChairBroda Chair

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• Patients who need direct supervision• Comes with a tray for meals etc.• Seat tilts to reduce sliding• Call the lift team for mechanical lift• Footrest can removed• Wipe down with Sani-Wipe between patients• Keep pieces together

What to do after a fallWhat to do after a fall• Check for injuries and notify the physician about the fall.

• Use safe patient handling to move the patient

off the floor, call the lift team to assist if needed.

• Check that all the interventions were in place

• Debrief: review the fall the patient and staff

• Revise the plan if needed

• Complete a PSN report

• Talk to the family about the fall

• Document event in medical record

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Post- fall assessment Post- fall assessment

A more detailed post-fall template in ORCA is coming in 2012.

Will be used for documentation purposes and to help guide the process of assessment and patient handling after a fall event.

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Next Steps Next Steps

• Be proactive, look for yellow armbands.• Think about patient safety every time

you interact with a patient • Double check for safety

• Bed down• Patient has call light and knows how to use

it• Patients at risk for falling are toileted

regularly.

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ResourcesResources

• Charge Nurse• Nurse Manager• Clinical Education• Falls Committee (SOFT = Safer

Outcomes from Falls Team) Members

• Fall Prevention Website

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Search the intranet for Fall or Fall PreventionIf you have any suggestions or questions email:

fallhmc@uw.edu

Thank you for joining our Thank you for joining our Fall Prevention team!!Fall Prevention team!!

Maintaining safety in the hospital is everyone’s job. Identifying patients at risk for falls is key to preventing falls. We can effectively intervene, reduce falls and prevent

harm.

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