Preventing Patient Falls in the Hospital Setting

[RNJoInMI]

Looking for safe and effective methods or techniques to reduce the number of patient falls on our PM&R unit. Can anyone share what policies/procedures your institution has in place for preventing falls?

I am an RN at a Rehabilitation Hospital on a Physical Medicine and Rehabilitation Unit. The average age of our patients is approx. 67 years old. The primary admitting diagnoses are Debility/Abnormal Gait/De-conditioning/Functional Deficits secondary to CVA/MI/Cancer/Amputation/MVA/ etc... with multiple stable and unstable co-morbidities. Recently, despite our best efforts, we have had an increase in patient falls. I am doing online research to see if there are effective methods we are NOT already using that could reduce our number of patient falls. Unfortunately, all the research I have collected suggests methods that we already have in place.

We use a risk assessment tool with every admission, update it electronically every shift, those at moderate to maximum risk get fall alert bracelets, fall risk signs at the bedside and at the room door, are rounded q 1 hr, clock voided/toileted q 2 hr, have call light, tray table, phone and water within reach, non-skid slipper socks that are colored coded to represent fall risk, side rails x 3, and the patient is reminded frequently to call for assistance before attempting to get out of bed, when needed we use bed and chair alarms and employ patient sitters as a last resort. Still, we have falls. Some of the patients that have fallen are very confused, others have stated that they thought they could get up on their own, others have said they did not want to burden a nurse with a minor task/request.

We are very lucky to have patient ratios of 1RN:5-7 patients and 1CENA:7 patients. Staffing does not really seem to be a factor in the number of falls, however the falls do occur more often on the afternoon and midnight shifts when the patients are in their rooms. During the day the patients are with SLP/PT/OT/RT for 3-5 hours x 5-6 days a week and monitored 1:1.

Does anyone have any creative ideas/solutions they can suggest to help reduce our patient fall numbers? I would be very appreciative if you could share what has worked at your hospital?