Inpatient Falls Prevention

1. Inpatient Falls Prevention By Nursing Performance Improvement Restraint/Fall Liaison Committee & Judy Mc Hugh, Nursing Performance Improvement Coordinator

2. Opportunity Statement Patient falls hold a potential for increased morbidity, mortality and economic loss to the institution on a problem that is largely preventable. By reducing patient falls we reduce the risk of patient injury. While the LUHS fall rate range of 2.20 - 2.52 remains below the University HealthSystem Consortium rate of 2.79, there is an ongoing need to reexamine the LUHS fall rate. Our goal is to continue to look at more fall prevention and interventions.

3. Most Likely Cause Inpatient falls are multi-factorial Patient Decreased Sensorium • Mobility such as muscle weakness, gait and balance disorders, impaired physical mobility, and poor transfer/lift technique. • Confusion, disorientation or alcohol or drug withdrawal. • Medication usage, which included sedatives, sleepers, diuretics or cardiac medication.

4. Most Likely Cause Inpatient falls are multi-factorial Environment • Elimination needs, which meant getting to the bathroom for: urgency, diarrhea and incontinence. • Room Clutter • Wet Floors

5. Most Likely Cause Inpatient falls are multi-factorial People • Lack of Fall Prevention Knowledge Materials • Restraint use • Commodes • Bed alarms not available • Broken bed brakes

6. Solutions Implemented • Implemented a Hospital-wide Level II Fall Prevention Program • Developed an annual fall prevention and restraint application competency designed for direct caregivers • Employee Newsletter “Heartbeat” • CPR/Restraint Application Marathon • Fall Prevention Inservice.

7. Solutions Implemented • Targeted high fall nursing units • Piloted equipment • Educated staff on the fall prevention program • Produced and distributed monthly Fall Assessment and Intervention QI Newsletter • Utilized Patient Observer- High risk fallers were in visual contact and within 5 feet of patient

8. Solutions Implemented • Developed Fall/Restraint Reduction RN Liaison Role. These nurses became an expert for their unit. • Implemented a New Bed Alarm System for high-fall nursing units • Initiated Fall Nurse Documentation Quarterly Audit

9. Recommendations for Further Study or Action • Evaluate potential environmental fall risk factors • Continue Quarterly Fall assessment audits • Evaluate new equipment for fall reduction and injury reduction

10. Recommendations for Further Study or Action • Nurse Call Integration for New HillRom Bed with alarm • Hospital-wide Education for New HillRom Bed Alarm Program • Incorporate fall risk factors and history of fall into the Electronic Medical Record EPIC

11. Falls Environment People Wet floorsBed Bedroom Lack of knowledge High Acuity Unavailable sitters Water Clutter Elimination Relatives Urine Broken brakes Fall Risk Factors IV Poles Chairs Ambulating Commode Bathroom Unassisted Patient & Restraint Application Staff Ancillary MD Nursing Materials Decreased Sensorium Medical DX Restraint Use Broken Bed Commodes Gait/ Imbalance/Impaired Mobility Age > 65 Medications Vision Bed Alarms Not Available Old prescriptions SedationNarcotics Cardiac DrugsSleepers Seizure Meds