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The JCAHO to clamp down on patient falls in 2005

Nurse Leader Weekly, May 14, 2004

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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.

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.
 
Pella (IA) Regional Health Center, including a hospital, family-health centers, and a nursing home with an Alzheimer's unit, reduced patient falls with its program, says Barbara Braafhart, RN, Pella's risk manager.

Pella tailored its programs to their patient populations, designing one for long-term care patients, another for acute-care.

Most falls are related to toileting because patients don't want to wait for assistance, Braafhart says. The hospital has implemented a "stay with me" program, putting a laminated sign in the patient's bathroom to alert staff to remain with the patient even during toileting.

Long-term care residents are assessed for falls upon admission and reassessed quarterly, says Mary Jo Foster, RN, the nursing director of long-term care for Pella. They develop a fall-prevention program based on the needs of each high-risk resident, she says. Patients in acute care are assessed and placed in one of three levels.

When a patient falls, the staff completes a fall flow sheet that includes how the patient fell, who found the patient, and the time the patient was found, says Foster. The sheet calls for other information, including the patient's vital signs, levels of pain and consciousness, and evidence of cuts or bruises.

The safety committee pieces together the circumstances surrounding the accident, noting information such as when the nurse assistant last saw the resident, whether there were hazards such as a wet floor, when the patient last went to the bathroom, and whether the patient is incontinent. The staff report the fall to the patient's physician immediately if the patient was injured or within eight hours if there was no injury. Pella also notifies the patient's family within the same time frames.

The flow sheet is placed on the bedside clipboard and three follow ups are performed at eight-hour intervals. Staff members make a report to the fall-prevention committee that analyzes falls for causes and preventions, Foster says.

Because the program is nonpunitive, employees have been forthright about the circumstances behind falls, she says.

- Adapted from Briefings on Patient Safety, published by HCPro, Inc., May 2004

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