Accreditation

Gear up for the JCAHO's proposed patient fall goal

Accreditation Connection, May 10, 2004

Take a hard look at patients' risk for falling and get ready to create a comprehensive fall-reduction program next year, as a proposed National Patient Safety Goal for 2005 would require hospitals to reduce the risk of patient harm resulting from falls. The draft goals are posted at www.jcaho.org, the JCAHO's Web site.

And the JCAHO is not the only healthcare organization that is closely tracking this patient safety issue. Patient falls are often cited as the second most-frequent cause of harm for patients, topped only by medication errors, says Amanda Borgsdorf, MHSA, coordinator of the Madison (WI) Patient Safety Collaborative.

Research literature suggests that 2%-4% of all patients fall, and between 2%-6% of those falls result in serious injury, such as fracture.

Those involved with fall-prevention programs at the Madison Patient Safety Collaborative and the Pella (IA) Regional Health Center, say a successful fall-prevention program does the following:

  • Analyzes how and where falls happen
  • Targets the units where falls are most frequent
  • Varies program elements to fit patients' needs
  • Ensures that reporting the circumstances of patient falls is nonpunitive
  • Assesses every patient
  • Reeducates staff periodically

The Madison Collaborative, composed of three medical groups and four hospitals-Meriter Hospital, St. Marys Hospital Medical Center, University of Wisconsin Hospital and Clinics, and William S. Middleton Veterans Administration Hospital-began a collective fall-prevention program in 2001.

Patient falls reduced by half during pilot

The collaborative formed a fall-prevention committee, that included a nurse from each of the five units, a pharmacist, a physician, and a physical therapist, says Myra G. Enloe, patient-safety officer at the University of Wisconsin Hospital and Clinics.

During the pilot program, the team saw the number of falls drop by 51% on the five target units across the four hospitals, she says.

The group considered the pilot a success, Enloe says, although fall rates did rise slightly in 2002. The collaborative has since finished the pilot program of initial interventions and is rolling out fall-prevention components throughout the hospitals.

Each hospital in the collaborative uses risk assessments that note confusion, depression, using the bathroom, and dizziness, as high-risk factors, Enloe says. See a sample fall risk assessment and scoring tool in the PDF of this issue.

Avoid sleeping pills

Certain medications, such as those that aid sleep, increase the risk of falls. The collaborative tried to reduce the use of sleeping aids, offering instead natural sleep inducers, such as warm herbal tea, ear plugs, a warm blanket, or a brief massage, Enloe says.

If the patient is still awake and requesting assistance 30 minutes later, caregivers offer an over-the-counter medication to relieve minor pain that might interfere with sleep. If another 30 minutes pass, they may provide a low dose of sleep medication that is not generally associated with falls, she says.

Forty-four percent of the patients fell asleep after receiving warm tea or another preliminary intervention, Borgsdorf says. Another 44% fell asleep after receiving a nonprescription pain killer, she says. More important, the group's efforts reduced sleeping-pill use from 24% to 4%. Among the patients who fell during the pilot, none had received a sleeping aid, she says.

The safety committee had to continue fall-prevention education, Borgsdorf says; otherwise, they found that the program would slip off the busy staff's radar.

The program is promoted among the staff by one-to-one interactions and through a half-day inservice training involving a nurse, known as a "unit champion," from each of the targeted units.

 

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