pt falls

GundeRN · Nov 1, 2013

Look for a common denominator. How is staffing?

nurseprnRN, BSN, RN · Nov 1, 2013

Look for a common denominator. How is staffing?

Yep, the risk management people should be collecting the data on all factors. There are a lot of things that can contribute to fall risk. Here are a couple that are associated with falls in elders.

Are the patients receiving medications that predispose to falls? Recent research indicates that a huge number of SNF patients are getting drugs that are not indicated for elders or psychoactives for which there is no appropriate psych diagnosis.

Diuretics are also associated with falls because people feel they have to go to the bathroom and/or they are incontinent and slip/fall.

What time of day do these occur? Shift? Shift change? Staffing levels?

Lighting?

Footwear?

Orthopedic/neuro condition?

PT evals for safety being done?

allnurses Guide · Nov 1, 2013

There are many studies that show improved staffing decreases falls.

One found that fewer than 15 HPPD of direct care nursing predicted increased falls. Thisincluded licensed nurses and certified nursing assistants.[

QUOTE]"Data from the Military Nursing Outcomes Database (MilNOD) project demonstrate that inadequately staffed shifts can increase the likelihood of adverse events, such as falls with injury, medication errors, and needlestick injuries to nurses. Such evidence can be used to show that it takes not only the right number of nursing staff on every shift to ensure safe patient care, but also the right mix of expertise and experience."

Staffing Matters Every Shift: Staffing Mattersâ€"Every Shift : AJN The American Journal of Nursing

Nurse staffing and patient falls on acute care hospital units: Elsevier

Missed Nursing Care, Staffing, and Patient Falls: http://journals.lww.com/jncqjournal/Fulltext/2012/01000/Missed_Nursing_Care,_Staffing,_and_Patient_Falls.2.aspx

amoLucia · Nov 2, 2013

You state 21 falls in 10 months? That averages about 2 a month. While any fall is a problem, I'd need to see the numbers researched out further, particularly, shift, time & staffing level. And my next concern would be any particular med recently administered.

You really need to see the big picture for specific trends.

PS - what is 'sect'?

nurseprnRN, BSN, RN · Nov 4, 2013

I think "sect" is a typo for "ect," which is, of course, the wrong way to spell "etc.," for "et cetera," Latin for "and other things."

havehope · Nov 4, 2013

Although I am only a CNA I agree with what the other posters have said. Staffing is a main issue for our hospital. However, we try to do our best with what we can. On the even hour numbers (2,4,6,etc.) The CNA's are to do rounding and on the odd hour numbers (1,3,5,etc.) The nurses are to do rounding. I feel that is our main issue...individuals are charting that they have rounded when in fact they are not. Also, we have types of alarms that stand out when they go off. It doesn't sound like an IV pump or anything else on the floor, that way you know exactly what it is.

Also, when the person is very confused we tend to put those patients in the rooms directly from the nurses station.

amoLucia · Nov 4, 2013

Thanks, GrnTea. Makes sense.

Sarah922 · Nov 5, 2013

The unit that I work on has had zero falls since may.

I work on an orthopedic unit and out staffing is generally Nurses have 4-6 patients and Aides have 6-10 patients ( 10 is usually at night). I think one of the reasons we have decreased falls is because per out hospital protocol everyone gets a bed alarm at night, and we are very aggressive with chair alarms/bed alarms. When we hear a bed/chair alarm go off , we all go running into the room regardless if it's our pt or not. That might seem like a no-brained but I've been floated to other units where people hear the alarms but aren't very concerned because it's not their pt. We have even had patients say to their family members watch this, and stand up setting of the alarm just so we all run in there :no: . But collectively I think our staffing,hourly rounding,education and aggressive use of bed/chair alarms help us prevent falls.

Note: The unit is an Ortho/post op unit so we don't necessarily have many of the "confused" patients.. But we do encounter those who feel because it's elective surgery and they aren't "sick" that they don't need our assistance ambulating.

havehope · Nov 5, 2013

The unit that I work on has had zero falls since may.
I work on an orthopedic unit and out staffing is generally Nurses have 4-6 patients and Aides have 6-10 patients ( 10 is usually at night). I think one of the reasons we have decreased falls is because per out hospital protocol everyone gets a bed alarm at night, and we are very aggressive with chair alarms/bed alarms. When we hear a bed/chair alarm go off , we all go running into the room regardless if it's our pt or not. That might seem like a no-brained but I've been floated to other units where people hear the alarms but aren't very concerned because it's not their pt. We have even had patients say to their family members watch this, and stand up setting of the alarm just so we all run in there . But collectively I think our staffing,hourly rounding,education and aggressive use of bed/chair alarms help us prevent falls.
Note: The unit is an Ortho/post op unit so we don't necessarily have many of the "confused" patients.. But we do encounter those who feel because it's elective surgery and they aren't "sick" that they don't need our assistance ambulating.

This would be another reason for falls at my workplace. If it is someone else's patient, they don't bother…it gets very frustrating. Most of the time it is pure laziness.

patientsafetygeek · Nov 6, 2013

Bravo to your orthopedic unit! It sounds like there is a collective awareness on your unit of what needs to get done and I'll bet most staff are on board. I'm a firm believer in culture being the glue that brings all this together. There is so much variability from organization to organization, unit to unit, and sometimes even shift to shift. By culture I don't just mean unit culture (ex staff following protocols). While that is a biggie, how the organization is operated in terms of resources/staffing, etc, and leadership support play huge roles in the big picture of things.

There are numerous toolkits online...almost overwhelming. Focus on trusted sources such as AHRQ, Joint Commission, American Geriatrics Society, US Dept of VA, and the CDC has a STEADI toolkit that is great.

Infrastructure can be created with programs such as TeamSTEPPS and Comprehensive Unit-based Safety Program (CUSP), but this would be a huge undertaking and would need to be supported by leadership. Both can be accessed via AHRQ website.

Understand what your improvement process is at your facility (DMAIC, PDSA, other) so you can ask what needs improvement? How can we improve? How do we know improvements are working? You will need a team and unit champions.

Overall, falls prevention requires a multi-factorial approach that is standardized, yet also tailored to the needs of the patient. Patient/family centered approaches help even more, if possible. Assessment tools, assessment frequency protocols, attention to meds, rounding/huddle practices all enhance standard approaches to falls prevention (footwear, identification, call light, etc). From my experience, most falls are related to toileting and are unassisted. The link below is a nice presentation that was done by the National Patient Safety Foundation last February 2013. In there you will see the Joint Commission root cause on falls is related to assessments. Not just tools, but frequency and circumstance.

Good luck! And be sure to measure your outcomes...you may even identify that an intervention done for all patients that is really only applicable to a certain risk level.

http://www.npsf.org/wp-content/uploads/2013/03/PLS_1302_FallPrevention_LAG_MF.pdf

0.adamantite · Nov 7, 2013

I have see falls from malfunctioning bed alarms, leaving people in the bathroom alone who are fall risks, low hgb/narcotic induced dizziness, slipping and falling on spilled water/urine. I would look at the source.