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Winter 2014
UMMC Falls Prevention Program – A Review of the Past and a Look into the Future Luizalice Lima, MS, BSN, RN-BC, Professional Development Coordinator Clinical Practice & Professional Development, Falls Committee Facilitator
The University of Maryland Medical Center continues to be fully committed to improving patient safety, particularly as it pertains to reducing falls. During the fiscal year 2013, there were 321 falls with 83 injuries.1 Preventing patient falls is challenging for every unit. Many organization-wide and unit-based initiatives have been implemented during the past year to reduce the incidence of falls. In October 2012, the fall prevention program (“falls bundle”) was launched hospital wide adopting the best practices developed by the Vascular Progressive Care Unit-C5E. Its objectives were standardization of fall prevention approach, enhancement of knowledge related to contributing factors and prevention measures, nurturing of a sense of pride and ownership in falls prevention, and achievement of excellence in patient satisfaction scores for staff responsiveness to call lights. The program achieved most of these objectives; however, call light response time and ownership in falls prevention are still the focus of our attention and efforts. During the last fiscal year, the Falls Committee deployed many initiatives. The focus was to provide real time data to unit leadership and fall champions so that immediate action could occur. This data provided valuable insight into the circumstances of each fall, identification of prevention interventions in place (or not) before a fall, as well as monthly fall rates. In addition, members of the committee performed monthly audits on different items, such as the last time hourly caring rounds were performed, use of bed/chair alarms, patient/family education about falls, use of non-skid socks, and the use of yellow bracelets on high and critical risk patients. It is clear that improvements in patient/family education about falls and the use of appropriate alarms is needed. The committee created the quarterly flyer, “Facts about UMMC Falls Events." The flyer included NDNQI quarterly fall rates, examined trends based on post-fall huddles forms received, and recommended actions. In July 2013, the Office of Clinical Practice and Professional Development started to provide a monthly report based on RL Solutions to leadership and champions with unit-specific data in the form of graphs and tables. Additionally, the Falls Committee submitted a weekly analysis of all falls with recommendations for staff education and practice changes to managers and champions.
Call Don’t Fall
Following up on the most recent recommendations from The Joint Commission mock survey conducted in May of 2013, the committee started reviewing the falls policy2 and the Morse electronic form. The committee performed an extensive review of the literature to obtain best practices to support changes. These changes are (refer to policy for full content): 1. Update of the NDNQI 2013 fall definitions: assisted fall, unassisted fall, physiological fall, suspected intentional fall, baby/child drop, developmental fall, and fall during play. 2. Nurses, independently of unit location and patient population, will document appropriate fall prevention interventions on the electronic medical record (Morse electronic form). 3. Further clarification of the meaning of the Morse tool subscales was included to foster standard interpretation and greater inter-rater reliability. 4. Simplification of risk levels from three levels (standard, high, and critical) to two levels (standard and high). 5. Manipulation of the Morse scoring system to adapt levels to specific high-risk populations3. Patients in ICUs, the Adult ED, procedural areas performing moderate sedation or anesthesia, and behavioral health units will always obtain a high-risk score. See example screen shots at right from EMR. 6. Addition of interventions to standard and high-risk precautions. 7. Development of an ambulatory services and pediatric fall assessment policy on attachments A & B respectively. In the future, the Falls Committee plans on concentrating on the best prevention interventions and modes of available technologies corresponding to the patient’s fall risk score and condition (gait, mental status, etc.). As identified by data analysis, staff is very conservative in implementing interventions. Other areas of concentrated efforts by the committee are the engagement of patients and families in fall prevention and improving the utilization of current resources, such as the Intranet fall prevention handouts (in English and Spanish), and the fall prevention video on the on-demand system titled as “Your Care – Speak Up”4. continued on page 9.