Preventing Falls in Hospitals (Slide Presentation)
A Toolkit for Improving Quality of Care
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Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care
Agency for Healthcare Research & Quality
Toolkit: https://www.ahrq.gov/professionals/systems/long-term-care/resources/injuries/fallspx/index.html
William Spector, PhD
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What’s New?
- Falls Prevention Toolkit for Hospitals
- Web based design
- Evidence-based tools for falls prevention (35 tools)
- Guidance for multidisciplinary change team
- Focuses on overcoming the challenges associated with developing, implementing, and sustaining a fall prevention program
- Developed by RAND Corporation, ECRI Institute, and Boston University for AHRQ
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David Ganz, MD, PhD
RAND Corporation
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Purpose of this project
- Develop text and tools to guide implementation and maintenance of a hospital fall prevention program
- Audience: mid-level managers and clinicians
- Coverage: all stages of organizational change
- Reference for hospital teams at different levels of sophistication
- Approaches adaptable to local circumstances
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Toolkit/Resource Guide
- Six sections:
- Hospital readiness for change
- Managing change
- Choosing fall prevention practices
- Implementing best practices
- Measuring fall rates and fall prevention practices
- Program sustainability
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Inputs to toolkit
- Evidence review
- Expert panel
- In person meeting + follow-up conference call
- Hospital workgroup
- Self-assessment + follow-up phone call
- In-person meeting + monthly teleconferences
- Tool evaluation forms
- Site visits
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Hospital workgroup
- Six hospitals
- Vary on geography, safety net status, profit/non-profit, unionization, use of electronic health record
- Units selected for piloting:
- Medicine
- Neurology/neurosurgery
- Progressive care unit (telemetry/post-cath)
- Inpatient rehabilitation
- Geriatric psychiatry
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Kathryn M. Pelczarski
ECRI Institute
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Fall Prevention Tools
- Tailored with input from the pilot hospitals to ensure tools are:
- Realistically implementable
- Easy to use
- Broadly applicable in the acute care setting
- Highly relevant to addressing common challenges
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Relevant Tools
Flowchart showing the following text boxes: Challenges leads to Opportunity leads to Tools That Really Help
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Challenge
Image of Atlas holding the world on his shoulders. This depicts Atlas Syndrome (taking the burden on alone), which is unlikely to succeed.
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Opportunity
- An interdisciplinary approach
- Essential input from key stakeholders
- Harnessing the power of collaboration
- Securing support and resources
- Gaining buy-in
- Shared ownership
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Tool: Interdisciplinary Team (2A)
Part I: Team Members
Image of tool to list in table form the Position/Discipline, Names of Potential Implementation Team Members From Each Area, and Area of Expertise.
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Tool: Interdisciplinary Team (2A)
Part 3: Matrix of Applicable Tools by Role
Image of tool to list in matrix form the Position/Discipline and corresponding Tools and Resources. For example, for Nurse Manager, an X is noted for Tool 3E to show that it applies to that position.
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Tool: Action Plan (2F)
Improvement Objective: Implement standard fall prevention practices within 6 months
Image of tool in table form showing Key Interventions/Tasks, Steps To Complete Task and Tools to Use, Team Members Responsible for Task Completion, and Target Date for Completion.
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Tool: Managing Change Checklist (2G)
Image of checklist with several tasks checked off: Implementation Team composition, Team leader identified and in place, Members with necessary expertise/role identified and invited, Team agenda and charge clearly stated, and Current state of fall prevention practice and knowledge assessed.
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Tool: Managing Change Checklist (2G) continued
Image of checklist with additional tasks listed and Staff knowledge assessed checked off.
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Challenge
Inadequate Risk Assessments and Reassessments
Image of young man with clipboard and image of rubber stamp
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Opportunity
- Accurate and effective risk assessments
- Employing critical thinking and clinical judgment
- Consistency in approach
- Identifying and communicating risk at the earliest possible time
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Tools
- Morse Fall Scale (3H)
- STRATIFY Scale (3G)
- Medication Fall Risk Scale (3I)
- Orthostatic Vital Sign Measurement (3F)
- Delirium Evaluation Bundle (3J)
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Challenge
Inadequate and ineffective interventions
Morse Fall Score = 70
One set of interventions does not fit all
Over-reliance on bed exit alarms
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Opportunity
- Optimizing the effectiveness of interventions
- Tailoring interventions to address individual risk factors
- Assessing their effectiveness
- Modifying interventions, as appropriate
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Tool: Sample Care Plan (3M)
Image of tool showing columns for goal and action taken.
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Tool: Algorithm for Mobilizing Patients (3K)
Image of flowchart for mobilizing patients, including steps to take and inclusion and exclusion criteria.
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Challenge
Inconsistent or Ineffective rounds to address personal needs
Picture of patient lying in bed hooked up to an IV line. Pictures of items patient needs to reach: TV remote, eyeglasses, toilet, box of tissues.
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Opportunity
- Consistent and effective rounds to address a patient’s personal needs
- Purposeful rounding
- Standardized inclusion of key elements
- Optimizing safety during rounds
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Tool: Scheduled Rounding Protocol (3B)
Image of tool showing items in protocol, such as offering toileting assistance and checking that the bed is locked.
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Challenge
Unable to sustain falls prevention
Graph with on falls and falls with injury. A Falls Prevention Initiative took place in 2009. Falls and falls with injury decreased from 2008 to 2009 but increased in 2010 and 2011.
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Opportunity
- Continuous Improvement
- Identifying and addressing process challenges
- Improving compliance
- Learning from near falls and falls that do not involve harm, in addition to learning from falls with harm
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Tools
- Assessing Fall Prevention Care Processes (5B)
- Postfall Assessment for Root Cause Analysis (3O)
- Information to Include in Incident Reports (5A)
- Measuring Progress Checklist (5C)
- Sustainability Tool (6A)
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Tool Roadmap
Image of roadmap showing Section, Action Steps, Tool That Supports Action, and Who Should Use the Tool.
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Pilot Hospitals
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Charlton Memorial Hospital
Fall River, Massachusetts
Kendra Belken, PT, DPT
Physical Therapy Practice Specialist
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Falls Knowledge Test (2E)
- Employees with various job functions in the Rehab Unit completed the test
- Tool was revised based on our input to provide more clarity in instructions and question format
- Results helped us to target education to address gaps in staff knowledge
- Environmental safety
- Medications associated with risk of falls
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Assessing Fall Prevention Care Processes (5B)
- Tailored tool by grouping required information by location (e.g., environmental safety information in patient room, patient chart information at nurse’s station) --- reduced required audit time
- Added elements for patient room assessment (e.g., hourly rounding log complete)
- Helped monitor progress
- Plan to roll out this audit tool for use by fall prevention champions in all units
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Augusta Health
Fishersville, Virginia
Pat Benson, BSN, RN-BC
Nursing Quality Coordinator
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Environmental Safety Inspection List (3C)
- Added picture of typical patient room to show optimum environmental set-up corresponding to items on checklist
- Used by environmental services and nursing
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Environmental Safety Inspection List (3C)
- Audit identified problems with bed function & provided justification for implementing bed replacement plan
- Incorporated in Post-Fall Assessment for Root Cause Analysis Tool to investigate environmental safety issues that may have contributed to patient fall
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Thanks
