Fall Risk Screening in the ED

[RNintheER]

We have been told by our risk dept that due to a JC guideline we have to now screen every person who comes to the ED for a fall risk and reassess as needed......i.e. after giving narcotics, etc. This seems like it is going to be difficult to do. We can't do it in triage because we have to send a lot of people back to the lobby even though they might be categorized as a fall risk simply because we have no rooms avail. We are jam packed constantly. We are not a trauma center but a small 18 bed ED. Anyone care to share how their facility is doing this? Also, they said that the fall risk screening tool and interventions need to be the same throughout the facility. I don't get why ER has to implement the same things as medsurg.....its two different areas!

[I_LOVE_TRAUMA, RN]

We do this, but we have computer charting and it is just a check list. It's pretty easy, we do it with our hourly charting. It is a point system. It just asks you things like, fall in the last 6 months, medication that may contribute, mobilty impaired, sensation impaired, confusion, etc. (I can't remember any others right now). After you do the assessment, the pt. will be assigned a certain amount of points, and that tells you how at risk they are.

[mudd68]

It is a point system at my hospital also, similar to the Braden scale for skin risks. We implement interventions such as yellow booties on the patient, yellow sign outside or near the patients room, up to alarms and cloose observation. As far as the patients in the waiting room they are not included until they are assessed by an RN. ie, you cannot be held liable for a fall that occurs in the waiting room unless you had already admitted that patient and they made it back out to the waiting room without you noticing, and fell.

[RNintheER]

We have computerized charting as well. I am curious to know if your screening tool and interventions are the same as on the floor? And do you reassess after every pain medication???

[Aneroo, LPN]

We do this, but we have computer charting and it is just a check list. It's pretty easy, we do it with our hourly charting. It is a point system. It just asks you things like, fall in the last 6 months, medication that may contribute, mobilty impaired, sensation impaired, confusion, etc. (I can't remember any others right now). After you do the assessment, the pt. will be assigned a certain amount of points, and that tells you how at risk they are.

We did the same. It does not take long at all, and it automatically determines the fall risk. If they are a high fall risk, you do some quick education (here is your call light. Call me if you need to get up, I don't want you trying to get up by yourself, even to go to the bathroom, bed rails up, bed low, bed alarm on (if there is one, that's usually about the only difference b/t ER and floor fall risk stuff). They get a sign on the bed, door and a sticker on their bracelet.

We have computerized charting as well. I am curious to know if your screening tool and interventions are the same as on the floor? And do you reassess after every pain medication???

See above about interventions. It shouldn't be anything that isn't already being done.

You should reassess after pain meds, since that will increase their fall risk. Does it happen in the ER setting? Not all the time.

[canoehead, BSN, RN]

The most sensible approach I've seen is to say that everyone that comes to the ER is a fall risk until proven otherwise. So they ambulate with standby, and siderails are up with callbell, unless they've dome an ambulation successfully under supervision. So you write "Pt ambulated with steady gait to Rm 5" now they are OK, but give them a sedating med and they are a fall risk again until they walk steadily with supervision. If that's too complicated just call everyone a fall risk and be done with it. Patient's conditions are constantly changing in the ER, and they need constant reassessment of everything, not just fall risk. Make it as easy as you can.

[RNintheER]

I agree canoehead!!! We had considered this but risk mgmt said we had to implement the same interventions as on the floor.....which means a bed alarm/bed chirper on rooms out of direct (sight) observation. This is not practical in our ED. I think everyone who comes in the ED is a fall risk because they are placed on gurneys which are less stable and more narrow than beds!!! As well as the narcotics, and the reasons they came in....syncope, ALOC, pain, etc!!! Thanks!

[mmutk, BSN, RN, EMT-I]

We also have an electronic medical record we chart with and we do this on initial assesment and it generates a fall list score (either std or high risk)

Then we just checkbox the precautions i.e side rails up x2, bed in low postition, locked, family at bedside, toilet rounds, armband applied, ect...