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Hospital improves falls prevention

Nurse Leader Weekly, March 18, 2005

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Assessing and addressing patients' risks for falls is a 2005 National Patient Safety Goal, but some acute care hospitals have been working on falls prevention for years. One hospital shares its successful prevention tactics.

Northwestern Memorial Hospital (NMH) in Chicago developed a comprehensive falls prevention program guided by two principles:

1. All patients are at risk for falls
2. Everyone within the hospital has a role to play in fall prevention

All employees can prevent falls
"Traditional approaches to fall prevention charge nursing with the overall responsibility," says Stephanie Kitt, RN, MSN, director of quality at NMH. "But we can only improve if everyone is aware that all patients are at risk for falls and that a collaborative effort is needed to help."

Hospitals should educate anyone who has contact with patients, including housekeepers, food service staff, transporters, physicians, physical therapists, and family members, says Carol Payson, RN, MSN, interim director of surgical patient care.

All patients are at risk
"All patients are at risk for falls, regardless of age," says Payson. Staff at NMH use a fall risk assessment tool that categorizes patients as either on standard or strict precautions for falls.

All patients are considered on standard precautions, which include interventions such as making sure that call bells and trays are within patients' reach.

Patients are put on strict precautions based on an assessment of factors, including medications, mobility, history of falls, mental status, diagnoses, and symptoms, as well as environmental factors such as the number of intravenous lines and other equipment in place for the patient's care, says Payson.

Sign on to prevent falls
NMH posts a sign to the door of each patient on strict precautions. The sign reads simply, "Please help prevent falls" and lists the following five interventions:

1. Put bed in low position
2. Keep room free of clutter
3. Have personal items and call light within reach
4. Maintain adequate lighting
5. Call for help if assistance is needed

Family members are encouraged to ask care providers about the sign, says Payson. "This way, we can educate them as to how we all can help their family member be safe."

Conduct frequent patient rounding
Patients often fall because they are trying to get somewhere or reach something, says Kitt. To prevent these incidents before they occur, the hospital developed a patient rounding program.

Nurses, certified registered nurse assistants, or patient care technicians check on these patients at least once per hour and ask them whether they have any personal needs, such as going to the bathroom.

Update risk assessments often
Staff update patients' fall risk assessments every 24 hours or as a change occurs-for example, when patients return from surgery or are transferred to a different level of care, says Payson.

Source: Adapted from Briefings on Patient Safety (March 2005), published by HCPro, Inc.

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