Inpatient Fall Reduction and Prevention

1. Inpatient Fall Reduction and Prevention Lallie Kemp Medical Center University Medical Center

2. background • Operational impacts to hospitals • Length of stay • Costs associated with additional tests • Litigation • Typical fall rate • 3-4 falls per 1000 patient days • CDC reports 3rd most common cause of unintentional injury and death across all age groups • Joint Commission reports most common category of incidents reported • Nurses play a key role in prevention

3. Problem --- Analysis of Fall Data University Medical Center

4. Problem --- Need to improve staff ENGAGEMENT Promote Desire to Improve Create Culture of Safety LALLIE KEMP Medical Center Improve Staff Attitudes Create Competition Improve Morale

5. Engage Nursing Staff Opportunities for Improvement University Medical Center

6. Opportunities for Improvement LALLIE KEMP Medical Center

7. Interventions • Identify those at risk • Modify the environment • Relocation of patients • Addition of a Bedside Companion • Use of bed exit alarms • Increased assessment for specific population • Elimination schedules • Family involvement • Non-skid socks University Medical Center

8. Hourly rounding (3P’s – pain, potty, position) Enhancing communication Bed side reporting Patient companion handoff tool Revision of In-house Transfer form to SBAR format Addition of Handoff communication Continuing Education to annual Nursing Education training Focused education of nursing assistant staff as bedside companions Nursing Skills fair education for all staff Medication alerts for nursing staff in pyxis/MAR Interventions University Medical Center

9. Track, trend, and interview all staff involved in occurrences Assign education module to all staff involved with patient fall Team Huddle Establish Fall Prevention Liaison on each unit Place graphical data on each unit showing progress Doctors in-serviced on fall prevention and charts reviewed for correct activities Patients and family members educated on call lights and fall prevention Family members encouraged to stay with patients Interventions LALLIE KEMP Medical Center

10. Hourly check off form for high risk patients Non-slip socks utilized by all patients Non-slip coating placed in showers Rolling chairs removed from all patient care areas Educate staff on fall prevention New bed alarms purchased Staff educated on proper use of bed alarms Damaged equipment (BSCC’s) replaced Interventions Lallie KEMP Medical Center

11. results • Steady decline in fall events since 2010 (average of 3.5 falls/month). • In 2011 we had an average of 2.2 fall events per month (average of 1500 patient days/ month). • Consistent with the literature, one single intervention has not consistently prevented fall events across all settings. • Combined interventions were most successful to provide the safest environment for our patients. • Injuries requiring additional tests or treatment where limited. • Patients experiencing a fall event had an average length of stay of 11-15 days. This is in comparison to the hospital overall average length of stay of 4.5 days. University Medical Center

12. Results # Falls per month University Medical Center

13. Inpatient Fall incidents 2009-2011 University Medical Center 3.2 3.5

14. results • Results better than expected • Falls decreased from 19 the preceding year to 1 for the following year • Fall rate decreased from 3.3 falls per 1000 patient days to 0.22 falls per 1000 patient days or a reduction of 95% • Serious falls decreased from 2 the preceding year to 0 the following year • Repeat falls decreased from 2 to 0 LALLIE KEMP Medical Center

15. Results Lallie Kemp Medical Center

16. Inpatient Fall Reduction and Prevention Lallie Kemp Medical Center University Medical Center Questions