Jones 11 Fall Prevention Risk Reassessment using the Existing Fall Assessment Tool of the Methodist Hospital

1. Jones 11 Fall Prevention & Risk Reassessment using the Existing Fall Assessment Tool of the Methodist Hospital By: Pamela P. Pechon, BSN RN GRN-CAP Project December 19, 2007

2. Acknowledgement This project was made possible through the concerted efforts of Jones 11 night shift nurses & secretaries. Their cooperation in implementing the reassessments in addition to their busy routine was impeccable. Many thanks to Caroline Mascarenhas, Jones 11 Director for the information, directions, and generous advise needed in the study. Edna Cheng and Pablo Vasquez for the support and encouragement. Lastly, Ida Thomas and the UT professors who provided inputs and guidance in going forth with the study.

3. Introduction The high incidence of falls among the geriatric population in the hospital setting is alarming. Although a good fall assessment tool is in place patient safety remains at risk. Jones 11 is a geriatric acute/medical unit of the Methodist Hospital. It has 26-bed capacity with 5 double occupancy rooms and 16 private rooms. Rooms 13 & 14 are double bed-rooms but are smaller in size compared to the 3 other double-rooms. The private rooms are of good sizes with individual bathrooms.

4. Continuation The patients in Jones 11 comes from the Emergency room, from the doctor’s office, the ICU or from another unit within or from another hospital. From the month of January to the 2nd week of November,2007, there were a total of 31 fall incidents in the unit. 8 were considered with harm(skin tears, bumps, swollen knee and broken toenail). 15 of whom were males and 16 were females. Ages ranged from 21-95, 22 of whom were over age 60.

5. Cont’d Twenty of these incidents happened during the night between 11 pm – 7 am related to toileting, ages 65 and over, and other conditions as a result of new or change in medication.

6. Background On admission and every shift patients assessment is done including risks for falls based on functional screen and fall risk indicators in Method. Depending on how they scored they are then classified into one of these categories: low (1-10), medium (11-20) and high (>20). Interventions will then show the screen for the nurses to implement. PRN assessments may be done if patients condition change or after patient had an actual fall.

7. Purpose of the Study This study aims to: Identify patients based on low, medium or high fall risks Reassess patients based on risk indicators at scheduled intervals Document reassessments in Method at scheduled intervals Communicate fall risk effectively during shift change Identify patient acuity not only based on disease process and condition but as to fall and safety risk as well Fall risks should be considered in making nurses assignments Develop a unit –based fall reassessment protocol for Jones 11.

8. Scope of the study This study is limited only to: Jones 11 of the Methodist Hospital Pts aged 65 and above Night shift only Method documentation by nurses Dates –November 19- December 14,2007

9. Materials used The following were used to facilitate this project: A letter addressed to all night shift nurses regarding the purpose and their role in the implementation of the project, after approval from the unit director. Unit pagers were programmed to go off on scheduled times from 11 pm to 6 am to remind nurses that fall reassessment was due. Unit secretaries print out unit census report for each night starting November 19-December 14,2007. Background informations, statistics and reports were collected from unit director.

10. Procedure/Implementation In this study, fall re-assessments will be implemented as follows: Low Risk – at 11 pm and PRN (if pt was given a sleeping pill, new or change in medication, pain medication, etc) Medium Risk – at 11 pm and 3 am High Risk – at 11 pm, 1 am, 3 am & 5 am Documentation shall be reflected at specified times in Method from November 19 – December 14, 2007 at which time chart audits as to implementation will be done on a daily basis.

11. Data Collection Data was collected on a daily census basis, thus a patient may be counted twice or more depending on his length of hospital stay. Chart audits for fall scores and documentations in Method

12. Results From November 19-December 14, 2007, Jones 11 had a total of 575 patients. 163 of whom were males and 412 were females. 257 were ages 65 and over, 73 of whom were males and 184 were females. From these numbers 140 were classified under the medium risk, 33 under the high risk and 84 were on low risk. A patient may be classified at high risk at one point during the night and be classified medium or low at another time in the same night or vice-versa depending on the nurses’ judgement. Since the study was implemented the following results were arrived at: No fall incidents were documented. It was noted that if risk scores were not documented, a narrative observation or nurses notes were written in Method. It was noted that fall risks was communicated to the next shift during shift change report effectively. Fall risk was considered in determining patient acuity in the unit. Fall risk was considered in making nurse’s assignments.

13. Recommendations Patient safety is the essence of the nursing practice not only among the geriatric population but to all age groups in general. However, the special needs and considerations of the elderly urges the nurse and or caregivers to tailor need-based techniques . For the hospital nurse taking care of the elderly for the first time it may be difficult to identify the patients needs and degree of independence on the first day of hospital stay. The patient who has been independent all his life may not want to call for “help” as it has a bad connotation. Based on the results of this study, it is hereby recommended that scheduled reassessments done in this study be implemented continuously as a unit based protocol in Jones 11 of the Methodist Hospital .

14. Resources Method documentations Actual report from January – November,2007 PSN reports Fall Assessment Tool of the Methodist Hospital