Transcript Document

Fall and Harm
Prevention
A Top Safety Priority
7/18/2015
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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 Harborview
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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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HMC CARES about Fall Prevention
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 ALERTS
Bed exit alarms, sitter select
Reduce Harm
Low Beds, Floor Mats and increased observation ie chart in
room, patient at front desk, sitter
Educate patient and family
Provide written and verbal information, use teach back,
document fall prevention education in the detailed assessment
Standardize hourly rounding
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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 Factors
Risk factors that are external to the patient
Why do people fall?
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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)
Intrinsic risk factors
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Medications that cause sedation,
dizziness, confusion (impair alertness and
judgment)
 Medications that cause postural
hypotension (lead to dizziness or syncope)
 Medications that stimulate bowel or
bladder function (lead to hurrying out of
bed)
 Medications that impair balance (alter
coordination and gait)
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Medications are a major extrinsic risk factor
for falls. Another factor is the environment.
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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
How can we prevent falls?
Adhere to Universal Fall prevention guidelines
for all patients
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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.
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AIDET
Prompted toileting
Assess and treat pain
Reposition
Check for environmental hazards
Place personal items within reach
There is evidence to indicate that hourly
rounding decreases falls in the hospital.
Conduct Hourly Rounding
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!
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Assessment 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:
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• the patient returns to unit post-op or
post procedure
• the patient transfers from ICU to
acute care.
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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
Plan of Care
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Fall Documentation Includes
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Daily fall risk assessment (Morse Fall Scale) daily
and whenever patient condition changes i.e. postop, transfer to/from acute care/ICU/post-fall
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Inclusion of fall precautions into the IView
precautions tab
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Selection of interventions: will flow to Patient
Plan summary
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Documentation of the Evaluation of the Plan in the
daily note
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Education provided to patients and families
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Detailed Assessment band
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Information for patients and families
about fall prevention.
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Inpatient and outpatient materials
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Materials on “Falls and
anticoagulation”
Patient Education on Falls
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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
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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 incontinence
Known sensory impairment (vision or
hearing difficulties)
In ETOH or drug withdrawal
Frail Elder
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Increased Risk of HARM from Falls
 Craniectomy (no cranial bone)
 Currently on therapeutic anticoagulation or at high risk for bleeding
(e.g. low platelet count)
 History of osteoporosis, bony
metastasis or other conditions
causing fragile bones.
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• 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
Communicate fall risk information to rest of
team
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The provider order set
(page one):
•Focuses on 3 key
modifiable fall risk factors
found in hospitalized
persons:
1) Postural dizziness
2) Lower body
weakness
3) 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
prevention
checklist (page
two)
Focuses on:
Patient and
family
education.
Documentation
Delirium
prevention Bed
selection
Equipment
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Patient activity alarms
Floor mats
Low bed
Broda Chair
Mattress on the floor
Pocket talkers
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Low bed and floor mats
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Broda 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
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What to do after a fall
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Check for injuries and notify the physician
about the fall.
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Use safe patient handling to move the patient
off the floor, call the lift team to assist if
needed.
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Check that all the interventions were in place
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Debrief: review the fall the patient and staff
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Revise the plan if needed
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Complete a PSN report
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Talk to the family about the fall
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Document event in medical record
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A more detailed post-fall template in
ORCA is coming in 2012.
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Will be used for documentation
purposes and to help guide the
process of assessment and patient
handling after a fall event.
Post- fall assessment
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Next Steps
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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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Resources
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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 Prevention
If you have any suggestions or questions email:
[email protected]
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Thank you for joining our
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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