Patient falls: What works to prevent them?

[UPSBossman]

I've been trying to solve the problem of falls since I started in healthcare a year ago. I quickly decided to approach the problem differently from the rest of my health system, assuming that falls can not be eliminated, so we should try to lessen the ill effects when they do happen. I came up with a proposal that would install a reactive, minimally deflective floor in the patient's room. In English, a floor that absorbs the impact of a fall (instead of the patient) but does not distort when you walk on it or roll a bed over it (not a tripping hazard nor does it make it hard to roll anything on it.) The floor did not absorb fluids, and was anti-microbial. The brass decided it was too expensive, and the project died on the table.

Unable to leave it alone, I'm again trying to figure out a solution. I want my new proposal to include fall prevention tactics as well. Online searches have been very generic: "Education and family involvement" is apparently the solution, but this doesn't work for my purposes.

I'm curious if any of you would be willing to share with me fall prevention tactics that work. Is there anything you've seen done that actually had a positive impact on the patient? Strategies or a technique that have reduced the severity or frequency of patient falls in your experience?

Thanks in advance for any help you can give me on this!

[Asystole RN]

unfortunately there is no one single intervention that will solve such a complex problem. there are assessment tools available to help at least identify those at risk and implement interventions.

from the ihi

bay pines vamc fall protocol.pdf

bay pines vamc falls algorithm a

bay pines vamc fall algorithm b

from personal experience it appears that a lack of staffing is a major contributor of falls however i must disclose that i that i have not personally researched the topic. with some degree of accuracy i am able to identify those who are most likely to fall using preset fall risk assessments. what i am not able to do however is actually monitor those patients as closely as needed.

what may be helpful is to look at a cost/benefit analysis of hiring staff at a lower wage to more consistently monitor patients. my initial impression would be that it is less expensive hiring sitters than to suffer the cost of a single fall. $8 an hour is not much money considering the cost of a fx repair, increased hospital stay, or wrongful death settlement.

[casi, ASN, RN]

My facility is starting to go alarm free. For fall risks we try to meet their needs. If we have someone trying to crawls out of bed because they have to go to the bathroom, we'll put them on a toileting schedule. If they are voiding frequently we'll explore the idea of urinary retention and/or UTI.

Another thing that we do is we try to keep the doors to the fall risk's room open someowhat. We are trying to teach all staff (housekeeping maintance, nursing, nutrition) to look left and right and peak into rooms when they walk downs the halls to make sure residents are safe. If residents are not safe and they are non-nursing personnel they are suppose to sit with the resident and get help.

[Ayvah, RN]

We also have crash mats that we put on the floor - but in my experience they are just another trip hazard for both the patient and the nurse - yes I can be a klutz too.

Agreed! I have had 2 patient falls specifically because of those mats. Got to be careful with those.

[gentlegiver, ASN, LPN, RN]

Duct tape works... but again those pesky regulations get in the way! Seriously, the better staffing to patient ratios so that thier needs can be met and no-one is left waiting for long periods of time while thier CNA's & Nurses are caring for other patients.

[gentlegiver, ASN, LPN, RN]

If residents are not safe and they are non-nursing personnel they are suppose to sit with the resident and get help.

How do they sit with the resident and get help at the same time?? Aside from ringing the call bell and hoping the staff is not too busy to rush in, I can see them losing alot of time sitting and waitting. I found most falls occure during the time when the staff is busiest, at 7am when getting everyone out of bed, they all want up at the same time and to go to the bathroom immediately when up, about halfway between getting up and lunch, after each meal, right about shift change and just before bed. Again I think the best option would be better staffing, you can't toilet everyone at the same time and when you have 4 CNA's for 58 patients and 2 Nurses who are trying to complete a med pass and treatments it's a perfect setup for falls.