Hospitals that have had the most success with reducing patient falls share two common traits: They take the time to measure and analyze specific contributing factors that led to falls and they also have a culture that supports “zero falls,” finds a new report released by the American Hospital Association's Health Research & Educational Trust.
“Successful organizations developed a culture of pride and ownership about having zero falls, and preventing falls became a mission that resonated on each participating unit or throughout the entire hospital,” said the report (.pdf), “Preventing Patient Falls: A Systematic Approach from the Joint Commission Center for Transforming Healthcare Project .
The report looks at the results of five organizations that followed Joint Commission recommendations and took a robust approach to fall prevention. The approach incorporates tools from Lean Six Sigma and change management methodologies to reduce falls with injury in inpatient units. Collectively the five hospitals reduced patient falls with injury by 62 percent and patient fall rates by 35 percent. Based on those results, the report states that a typical 200-bed hospital that followed the approach could expect 72 fewer injuries and avoid $1 million in costs.
The five hospitals that participated in the program are featured in the report and share their best practices to successfully reduce patient falls. Here are a few of their strategies:
A unit-wide educational effort for staff and patients and “Call, Don’t Fall” campaign at an inpatient unit at the Bassett Medical Center, 180-bed, acute care inpatient teaching hospital in Cooperstown, New York, helped lead to a 43 percent reduction of falls.
The campaign focused on human factors--such as patients who are reluctant to ask for help with toileting and staff who wanted to protect the patient’s right to privacy so didn’t proactively assist with toileting--that the organization found commonly led to falls. The organization created signs in patient rooms and common areas reminding patients to call for help before getting out of bed, purchased chair seat alarms that alert staff when patients get off the toilet and has patients at risk for falls wear special gowns, nonskid sockets and lap blankets. Furthermore, the fall prevention team has two daily huddles to identify patients at high-risk of falls and then makes sure nurses help these patients with toileting every two hours. The result is a significant reduction in falls, especially during the night.
Baylor Scott & White Medical Center-Garland, a 113-bed hospital in Texas, developed interventions to improve communication and use of call lights to notify nurses that patients need help with toileting. Part of the problem was that older male patients didn’t feel comfortable asking young female nurses for help with toileting so nurses were advised that if they preferred, they could have a male staff member assist them.
The organization also revised its educational materials and printed them in English, Spanish and Vietnamese with vocabulary at a third-grade reading level. Upon admission, a nurse discusses a patient acknowledgement form with the patient that provides a checklist that encourages patients to use their walkers, canes or braces and handrails in their rooms, bathroom and hallway.
Like Bassett and Baylor, Kaiser Permanente Zion Medical Center in San Diego found that many patients were embarrassed to ask for help or put a higher priority on privacy than on safety. The 414-bed teaching hospital focused its fall prevention efforts in the medical center’s stroke telemetry unit by creating a culture that reinforced a “no one walks alone” approach. Every patient in the unit is considered a fall risk, regardless of age, and as a result bed alarms are set in every room so all patients must be assisted each and every time they leave their bed for any reason.
The fall prevention team conducts hourly rounding when patients are offered bathroom assistance and help repositioning themselves. Unit huddles take place at the beginning of each shift and two hours later to review any changes and observations.
Standardized fall safety messages were developed to help prevent falls with injury among high-risk older patients at Memorial Hermann Memorial City’s cardiology unit. The fall prevention team at the 444-bed hospital in southeast Texas standardized visual cues on the unit, created a post-fall huddle tool and meetings and leader rounding and hourly rounding.
The interventions led to a decrease of fall rates by 50 percent during the study period. The team said it credits the success of the program to three factors: robust process improvement, safety culture and leadership commitment.
A video monitoring system was one of the interventions used by Wake Forest Baptist Medical Center, a 1,004-bed academic medical center in Winston-Salem, North Carolina. Prior to the installation of the equipment, patients identified at high-risk for falls would need a sitter, which was often difficult to schedule. The equipment allowed a video technician to monitor up to eight patients from the nurse’s station at all times. If the technician notices that a patient is trying to get out a bed, he or she places a phone call to a staff nurse and pages all staff on the floor. Patients who were monitored had a 16 percent reduction in falls and a 41 percent reduction in falls with injury.