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Train staff to prevent outpatient falls

Nurse Leader Weekly, September 12, 2005

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The JCAHO's National Patient Safety Goal on preventing falls applies to both outpatient and inpatient areas of hospitals, but your staff education should reflect the key differences between these two locations.

"Fall prevention in a diagnostic, therapeutic, or ambulatory setting is different from inpatient," says Corinne Haviley, RN, MSBSN, director of the department of radiology at Northwestern Memorial Hospital (NMH) in Chicago. "We don't spend as much time with patients as staff do on inpatient units. We may only see the patient for a few hours, which requires nursing and technical staff to assimilate patient information quickly."

NMH created and implemented a comprehensive fall-prevention program guided by two principles: All patients are at risk for falls, and everyone within the hospital has a role to play in fall prevention. The hospital's outpatient areas have tailored the program to suit the specific needs of their patients.

Precautions for falls

Some of the strict precautions for inpatients at risk of falling are the same as for outpatients. For example, staff assist patients who are on strict precautions to the bathroom, says Haviley. In addition, outpatient areas use cameras and intercoms to continually observe patients while they undergo treatment, such as magnetic resonance imaging. Standard precautions for all falls include

• providing the patient with orientation to the room, intercom system, call light use, and falls prevention and procedure
• placing the bed in a low position with wheels locked, side rails up, and curtain open so the patient can be monitored
• ensuring that the room is free of clutter and spills
• placing personal items within reach, including telephone and call light
• keeping the room well-lit, depending on the patient's needs 
• providing and documenting patient and family education about fall precautions as appropriate

After moderate sedation, all patients are placed on strict fall precautions. For these patients, staff must

• remain with the patient when assisting him or her to the bathroom
• offer assistance to the bathroom, commode, or use of bedpan continually while the patient is awake
• assess the patient's need for physical and occupational therapy consultation and discharge planning
• check on the patient hourly
• assess the need for one-on-one monitoring and arrange as needed

Use proper transfer equipment

Because of the procedures conducted in outpatient settings, transferring a patient there is different from doing so on an inpatient unit, says Haviley. Patients may go from wheelchair to procedure table to recovery and then exit.

For this reason, staff education drills down on proper transfer techniques, not just for bringing patients to and from a bed, but also for moving and positioning patients up and down or side to side on a table during a procedure, she says.

Source: This article is adapted from Competency Management Advisor, September 2005, HCPro, Inc.

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