Through a hospitalwide initiative, Community Medical Center in Toms River, N.J., has decreased patient falls by 30% within a year. The initiative, called a three-ingredient recipe for success, consists of three parts education, assessment and intervention.
Each patient presents a unique combination of safety risks that could result in a painful, life-changing fall. Nurses understand the importance of reducing falls, but as patient advocates also respect the importance of patients independence.
Confronted with the challenge of balancing safety and independence in 2010, the center was able to reduce fall risk by using the three-step model. The 592-bed hospital found success by having the three parts operate as a single, simultaneous process to reduce falls.
The project began by examining patient demographics. The immediate neighborhood attracts elderly retirees, and 73% of the in-patient population at the medical center are older than 65. Comorbid conditions that predispose elderly patients to falls are common at the medical center. For example, often patients are on multiple medications, such as antidepressants and benzodiazepines, which are associated with increased risk for falls.
An Administrative Falls Team set the goal for falls reduction at 30%. The team, which included nursing, pharmacy, risk management, physical therapy and administration, read the research and found that falls have multiple factors, such as frailty, illness, medications and the environment. Thus, the three main ingredients of the falls prevention recipe education, assessment and intervention were born.
Ingredient 1: EducationStanding, from left, are Kimberly Ashworth, RN; Marion Murray, RN, director of patient care; Patricia Checchia, RN; Sandra Verga, RN, assistant director of patient care; Christine Schulz, RN; and Cora Ramos, RN. Seated, from left, are nursing assistants Melissa Colon, CNA, and Elisa Lugo, CNA.
Administrative Director of Nursing Christine Dodds, RN, BSN, MSHA, led the individualized training required of all direct caregivers. Transporters, dieticians, physical therapists, risk managers, rehabilitation personnel, nurses and nursing assistants had specialized preparation for their roles in falls prevention. Nurses focused on assessing a patients fall potential and the impact of poly-pharmacy. They were taught how and when to use the bed alarms and to evaluate patients rooms for hazardous clutter.
The team realized patients and families also needed education. To meet that need, the medical oncology unit made a Welcome to 4B flyer explaining the risk factors specific to oncology patients. The handout, The Partnership for Safety, also was created to invite patients and families to partner with staff to decrease falls.
Caregivers were taught to look for yellow, whether it was yellow stickers on armbands, patients in yellow slippers or yellow star magnets on door frames. Yellow signaled Caution. Patient at Risk. Even hospital volunteers did their part by knitting yellow lap blankets for the patients. When the data showed that the falls rate was declining, staff nurses presented a Falls Fair to share their achievements with all employees.
Ingredient 2: AssessmentAnn Coogan, RN, left, and Donna Velardi, RN, of Community Medical Center, teach staff how to be Fall Savers.
A modified Hendrich II Risk Predictor was the assessment form used on all new admissions by RNs as part of patients initial screening. Regularly scheduled falls assessments occurred every day. Each identified fall risk had particular interventions that had to be activated as part of the patients plan of care. The new clinical policy and procedure defined the process, including the responsibilities of each department.
At a daily morning meeting led by Dodds, any fall or near-miss event was reviewed in detail. This process was repeated again in the evening. Any serious change in a patients risk was shared immediately with staff. This critical exchange of information promoted quick preventive action.
Ingredient 3: Intervention
A major falls risk factor is toileting. Interventions to counteract the problem were immediate and included offering frequent toileting, providing a bedside commode, removing obstructive furniture en route to the toilet and the use of bed alarms. The single most effective intervention, however, was frequent observation. There is no substitute for having staff make hourly rounds to intervene and prevent a fall before it happens.
The three-ingredient recipe continues to reduce the falls rate. Units have begun to have friendly inter-unit competitions to see which one can reach 45 days without a fall first. A celebration is hosted for the winning unit.