Falls Risk Guide
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) 2005 National Patient Safety Goals requires hospitals to assess and periodically reassess each patient's risk for falling. At Methodist Hospital the total number of reported falls in 2005 was 197 and it is increasing every year, Out of these 80 had reported injuries, 3 had root cause analysis (RCA) completed and 1 was a reportable event. Through RCA we identified that our current falls assessment tool did not accurately capture patients at risk for falls, therefore we had missed opportunities to prevent falls. Further more we did not have many visuals alerting staff that the patient is a falls risk and the visible interventions that correspond with that specific risk.
According to a study supported by the Agency for Healthcare Research and Quality , many falls in hospital happen when the patient is alone or involved in elimination-related activities (for example, walking to or from the bathroom or bedside commode, reaching for toilet tissue, or exiting a soiled bed).
Researchers at the Washington University School of Medicine in St. Louis interviewed all patients at one hospital who fell over a 13-week period and/or their family members and nurses. They also reviewed adverse event reports and medical records to identify the circumstances and patient characteristics involved in the first fall of the 183 patients who fell during the study period. The results of their study revealed that the average age of patients who fell was 63.4 years, but ages ranged from 17 to 96 years. Their study showed that 85% of falls occur in the patient's room, 79 % of falls occurred when the patients were not assisted, 59 % during the evening/overnight and 19 % while walking. Nearly half (44 percent) of patients were confused or disoriented at the time they fell.
In 81% of the patients general muscle weakness was very prevalent, 39% had diabetes, 36% had urinary frequency and 38% had lower extremity problems. Most of the patients who fell were on sedatives that could have contributed to a fall. Falls due to elimination-related activities increased the risk of fall-related injury; the patient was left alone after being assisted to the bathroom or commode. Many patients who fell did not use assistive devices that they regularly used at home.
Falls in the hospital affect nearly everyone and falls prevention programs are necessary to prevent hospital falls and reduce fall injury rates. Falls Prevention Process
• RN/ LPN to complete the Falls Risk Tool on all patients on admission, daily & PRN • RN/LPN to obtain a Falls Risk Score based on their assessment/observation: * Low Risk 0-5
* Moderate Risk 6 - 13
* High Risk > 13
• RN/LPN applies an ORANGE falls risk arm band if the patient is a Falls Risk • RN/LPN posts a “YELLOW” falling star visual if patient “MODERATE FALLS RISK” • RN/LPN posts a “RED” falling star visual if patient is “ HIGH FALLS RISK” • The HUC puts the “FALLS RISK” sticker on the patient’s chart & KARDEX- nursing needs to verify that this is done. • The NA helps to ensure that the above prevention process remains in place for those patients who are at risk of falls and alerts RN/LPN when the FALLS RISK arm band, falling star, or sticker may be missing. • Follow the Falls Risk Interventions posted in patient room .
FALLS RISK INTERVENTIONS
|LOW FALLS RISK |MODERATE FALL RISK |HIGH FALL RISK | |Fall risk score = 0-5 points |Fall risk score = 6-13 points |Fall risk score = > 13 points...