Fall Bundle No Harm Campaign Licensed Staff

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Amer i ca n Nurse Toda y - Best Pra cti ces for Fa l ls Reducti on : A Pra cti ca l Gu ide. I ssue Da te: Ma rch 2011 Vol. 6 No. 2.

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REPORTING of FALLS

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• Falls are reportable as a Sentinel Event per The Joint Commission and as endorsed by The National Quality Forum’s List of “Never Events”

• Individual State Statutes, e.g. California Senate Bill 1301• The Department of Health Care Services outlines the following:

– Section 2702 of the Affordable Care Act directs States to develop and implement a plan that withholds Medicaid payments to hospitals for provider-preventable conditions (PPC) as defined in the regulation

– In California the Department of Health Care Services (DHCS) has developed a State Plan Amendment (approved by CMS) to implement Section 2702

– Similar recommendations in Arizona and Nevada

– CMS elected to enforce compliance as of July 1, 2012 even though the federal law took effect July 1, 2011

Regulatory Agencies

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CMS requires reporting of Hospital Care-Acquired Conditions (HCACs ) only in inpatient acute care hospitals. Related to falls and trauma, this includes: • Fractures• Dislocations• Intracranial Injuries• Crushing Injuries• Burns• Electric shock

Reporting of Falls

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The Fall Bundle T-E-A-M

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Fall Bundle Every Patient Unit Processes

Toileting (Hourly Roundin

g)Documented

Teach

Back

Documented

Bed and/or

Chair

Alarms

Yellow

Wrist

Band & Booties, Doo

r Sign

, White

Board

Bed in

Lowest

Position

Gait Belt

Appropriate Use of

Restraints

Fall Mat

s

Fall Risk Assess

ment

Each

Shift

Injury

Assess

ment

Each

Shift

Fall

Matrix Components in

Place

Fall Huddles

SBAR or Ticket to

Ride Han

d Offs

Debriefing Form

After

Every

Fall

RCA Falls with Injury

Medication

s: Questio

n Necessit

y; Pharmacist Review

TToiletingTeaching

X X

EEnvironment

X X X X X X

AAssessment

X X X X X X X

MMedication

X

No Harm Campaign - Fall Bundle

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T-E-A-M

• T - Toileting (Hourly Rounding)– Round on patient/family every hour– Correct technique– Validation– Accountability

• T – Teaching (Patient and Family: Teach Back Model)– Patient and family education. Put a process in place that includes giving a Fall Handout/brochure, utilizing teach-back techniques to verify patient understanding and document education– Education and communication of falls, risk across departments and disciplines (including attending physicians) will be provided– Utilize the Q-Tube customized Fall Prevention Bundle Video. This is found either on the Q-Tube site or Patient Safety SharePoint under the Fall tab

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T-E-A-M

• E - Environmental– Bed Alarms/Chair Alarms– Floor Mat – ALL patients at high risk for falls (John Hopkins FRAT score > 13) shall have floor mat (new injury reduction intervention) and bed alarm (pre-existing fall risk reduction intervention) in place at all times.– Fall sign on door, yellow booties, and yellow magnet on patient’s board– Beds in lowest positions– Gain belts–Appropriate use of restraints

• A – Assessment– Fall Risk Assessment tools (this includes the preliminary medication review)– Fall Injury Assessment (ABCs)– Application of Fall Matrix – The matrix will be used as an adjunct to the assessment tools. It is divided into four grids. Each grid recommends basic fall prevention strategies determined by the patient’s fall risk assessment and fall injury assessment score

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T-E-A-M

• A - Assessment– Fall Huddles– Hand-off Methodologies (SBAR and Ticket to Ride)– Fall Debriefing Form (fall without injury)– RCA (Fall with injury)

• M – Medication– Secondary medication review. Involve pharmacists and prescribing providers with the goal of eliminating or replacing unnecessary drugs that increase the risk of falls or the severity of fall-related injury

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Fall Risk Assessment Tools (FRAT)FALL ASSESSMENT TOOL Fall Risk Factor Category Scoring not completed for the following reason(s) (check any that apply). Enter risk category (i.e. Low/High) based on box selected.

Complete paralysis, or completely immobilized. Implement basic safety (low fall risk) interventions. Patient has a history of more than one fall within 6 months before admission. Implement high fall risk

interventions throughout hospitalization. Patient has experienced a fall during this hospitalization. Implement high fall risk interventions throughout

hospitalization. CCOOMMPPLLEETTEE TTHHEE FFOOLLLLOOWWIINNGG AANNDD CCAALLCCUULLAATTEE FFAALLLL RRIISSKK SSCCOORREE.. IIFF NNOO BBOOXX IISS CCHHEECCKKEEDD,, SSCCOORREE FFOORR CCAATTEEGGOORRYY IISS 00..

POINTS

AGE (SINGLE-SELECT) 60 – 69 years (1 point) 70 – 79 years (2 points) 80 years (3 points)

FALL HISTORY (SINGLE-SELECT) One fall within 6 months before admission (5 points)

ELIMINATION, BOWEL AND URINE (SINGLE-SELECT) Incontinence (2 points) Urgency or frequency (2 points) Urgency/frequency and incontinence (4 points)

MEDICATIONS: IINNCCLLUUDDEESS PPCCAA//OOPPIIAATTEESS,, AANNTTII--CCOONNVVUULLSSAANNTTSS,, AANNTTII--HHYYPPEERRTTEENNSSIIVVEESS,, DDIIUURREETTIICCSS,, HHYYPPNNOOTTIICCSS,, LLAAXXAATTIIVVEESS,, SSEEDDAATTIIVVEESS,, AANNDD PPSSYYCCHHOOTTRROOPPIICCSS (SINGLE-SELECT)

On 1 high fall risk drug (3 point) On 2 or more high fall risk drugs (5 points) Sedated procedure within past 24 hours (7 points)

PATIENT CARE EQUIPMENT:: AANNYY EEQQUUIIPPMMEENNTT TTHHAATT TTEETTHHEERRSS PPAATTIIEENNTT,, EE..GG..,, IIVV IINNFFUUSSIIOONN,, CCHHEESSTT TTUUBBEE,, IINNDDWWEELLLLIINNGG CCAATTHHEETTEERRSS,, SSCCDDSS,, EETTCC)) (SINGLE-SELECT)

One present (1 point) Two present (2 points) 3 or more present (3 points)

MOBILITY ((MMUULLTTII--SSEELLEECCTT,, CCHHOOOOSSEE AALLLL TTHHAATT AAPPPPLLYY AANNDD AADDDD PPOOIINNTTSS TTOOGGEETTHHEERR)) Requires assistance or supervision for mobility, transfer, or ambulation (2 points) Unsteady gait (2 points) Visual or auditory impairment affecting mobility (2 points)

COGNITION ((MMUULLTTII--SSEELLEECCTT,, CCHHOOOOSSEE AALLLL TTHHAATT AAPPPPLLYY AANNDD AADDDD PPOOIINNTTSS TTOOGGEETTHHEERR)) Altered awareness of immediate physical environment (1 point) Impulsive (2 points) Lack of understanding of one’s physical and cognitive limitations (4 points)

*Moderate risk = 6-13 Total Points, High risk > 13 Total Points Total Points

The Johns Hopkins Hospital © 2006 This tool was created by John Hopkins Hospital. Permission for use has been granted to Methodist Hospital.

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Assessment Tool Target Patients When To UseJohns Hopkins Fall Risk Assessment Tool

All Adults Admission, Shift Change, Transfer between

Departments, Patient Status or Treatment

ChangesLittle Schmidy Pediatric Fall Risk Assessment Tool

Under 18 Same as Above

Fall Risk Assessment Tools

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Assessment Tools – Johns Hopkins Fall Risk

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Assessment Tools – Johns Hopkins Fall Risk

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Assessment Tools – Johns Hopkins Fall Risk

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Assessment Tools – Johns Hopkins Fall Risk

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Assessment Tools – Little Schmidy Fall Risk Assessment

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Assessment Tools – Little Schmidy Fall Risk Assessment

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Injury Risk Assessment

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A: Age >65 years

B: Bones susceptible to fracture

C: Coagulopathies/risk for bleed

S: Surgery (postoperative)

Note: Use of critical thinking and clinical judgment should be used to override the result of any fall assessment tool assessment.

Injury Assessment Tool (ABC’s)

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CHSB is implementing strategies to identify patients who are high risk for falls and ways to prevent incidence/injuries related to falls.

Every employee must be aware of the following strategies:

1. Use of YELLOW booties

2. Use of YELLOW armband

3. Use of YELLOW gown

4. Use of YELLOW magnet on patient’s board

5. Use of hip protectors

6. Use of bed alarms

7. Use of floor mats

Implementation Strategies

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Implementation Strategies

1. Use of YELLOW booties

3. Use of YELLOW gown

2. Use of YELLOW armband

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Implementation Strategies

5. Use of hip protectors 7. Use of floor mats

6. Use of bed alarms4. Use of yellow magnet on patient’s board

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Post Fall Debriefing Tool

Thank You

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Please complete the Post Test after reviewing the module