Fall PreventionAn Evidence-Based Practice Project

Alvernia UniversitySpring 2016

Timothy Espersen, SNALVEmily DeCampo, SNALV Briana Austin, SNALVAmanda Bozzelli, SNALV

Learning Objectives

Compare and contrast individual versus multi-component nursing interventions to decrease inpatient falls.

Discuss nursing interventions that can be implemented without a provider’s order.

Describe the nurse’s role in decreasing inpatient falls of hospitalized clients.

Evaluate effective nursing interventions to help decrease inpatient fall rates.

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Background/Problem

“Falls are associated with increased health care use, including increased length of stay and higher rates of dis- charge from hospitals into long-term care facilities. Even a fall that does not cause an injury can trigger a fear of falling, anxiety, distress, depression, and reduced physical activity." (Miake-Lye, Hempel, Ganz, & Shekelle, 2013)

“Falls are a leading cause of nonfatal injuries and trauma-related hospitalizations in the United States, and have been linked directly with the quality of nursing care in the hospital setting. In this literature review, multiple studies are summarized that found rounding decreased falls per 1,000 patient days.” (Hicks, 2015)

“Falls are a patient safety priority among hospital inpatients. The creation of a Patient Safety Team engaged frontline staff in patient safety and falls prevention. This intervention decreased the fall rate from 1.90 to 0.69 falls per 1,000 occupied bed days.” (Christiansen, Feider, Godlock 2016)

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Clinical Significance

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MONTH AVERAGE FALLS PER

MONTH

GOAL BASELINE

JULY 2015 2.5 1.8 3.35AUGUST 2015 1.1 1.8 3.35SEPTEMBER

20151.19 1.8 3.35

OCTOBER 2015 4.75 1.8 3.35NOVEMBER

20152.3 1.8 3.35

DECEMBER 2015

3.79 1.8 3.35

Good Samaritan HospitalTelemetry Unit- 3S

3S Unit: Inpatient Fall Rate

Clinical Significance

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MONTH FALLS PER 1000 PATIENTS

GOAL BASELINE STATE

OCTOBER 2015 2.5 1.8 2.11 1.8

NOVEMBER 2015 2.1 1.8 2.11 1.8

DECEMBER 2015 1.9 1.8 2.11 1.8

Good Samaritan HospitalHospital Wide Inpatient Fall Rate (falls per 1000

patient days)

PICO

P= Adult and geriatric hospitalized population I= Individual nursing interventions C= A multicomponent fall prevention program O= Decreasing inpatient falls

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PICO Question

In the adult and geriatric population, what is the effectiveness of individual nursing interventions versus a multicomponent fall prevention program to decrease inpatient hospital unit falls?

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Literature Reviewed

Search Engines UsedEBSCOhost- Health, CINAHL, OVID, PubMed, Cochrane Library, JBI

Date Range Used2011-2016

Search LimitersNot PediatricsNot Neonates/InfantsNot articles older than 2011

Keywords Usedfall prevention, fall prevention interventions, fall prevention prpgrams, nursing interventions, nurse’s

role, decreasing falls, hospitalized clients, adult clients, adult patients, geriatric clients, geriatric patients, adult and geriatric population, inpatient falls, decreasing falls, decreasing inpatient falls, fall risk, bed alarms, bed alarm use, patient education, staff education, nursing involvement

Articles Reviewed18 articles reviewed8 articles selected for inclusion

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Literature Review: Levels of Evidence

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Level Of Evidence Number of Articles found

Summary of Findings

Level I 5 Data found through review of multiple studies reveals that a multi-intervention approach can lead to decreased inpatient falls and help prevent further complications of patients.

Level II 2 Individualized targeted multiple fall interventions should be implemented in the acute care setting in addition to fall prevention strategies that are already in place

Level III 0 N/ALevel IV 1 There is some data that shows correlation

between the use of low-low beds and decreasing inpatient falls. A randomized controlled trial is required to give additional evidence.

Fall Risk Safety Letter-Good Samaritan Hospital

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-Letter presented to patients and their families upon admission if patient is found to be at a high risk for falls

Current Practice-Fall Prevention Policy/Practice Change (February 2016)- Good Samaritan Hospital

Effective immediately, if a patient “refuses” a part of the fall prevention protocol (including the use of the BED ALARM), the following steps must be followed:1.RN must educate the patient on the safety measures associated with intervention. If the patient still refuses, the RN must communicate the refusal to the Charge Nurse

2.The Charge nurse must meet with the patient and explain to the patient the need for the safety intervention. If the patient still refuses, the Charge Nurse must communicate the refusal to the NM (nurse manage), ANM (assistant nurse manager), or Supervisor

3.The NM, ANM, or Supervisor must meet with the patient and explain the need for the safety intervention. If the patient still refuses, a 1:1 sitter must be arranged to keep the patient safe.

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Fall risk Interventions- Special bracelet to alert staff of the patient being at a high risk for falls.- A sign placed above the patients bed to encourage staff members to assist with

the patients safety- Patients instructed to use they call light when they want to get out of bed- Patients are asked to wear nonslip, footwear, and will be provided if needed- Patients will be periodically checked on to provide assistance with toileting and

positioning- Keep some of the side rails up to prevent the patient from accidentally falling out

of bed.-Alarms may be used to assist with patients safety -Patients will have a fall risk rating placed outside their door to alert staff of the

level of assistance that may be needed to ambulate

For patients identified as a high fall risk by the nurse, receives a Fall Risk Safety Letter regarding the interventions that will be put into place to help prevent the patient from falling during the inpatient stay.

Current Practice-Fall Prevention Policy/Practice Change (February 2016)- Good Samaritan Hospital

Post Fall Assessment Document- Good Samaritan Hospital- Form to be completed by the

primary nurse of a patient after an inpatient fall

- Form helps to identify the possible root cause of the fall and may be able to help prevent future falls due to the same cause

Summary of Evidence

The use of low-low beds did decrease the rate of falls, but decreased the level of injuries that occurred with the falls

Patient education related to their disease process and their increased risk for falls decreased the rate of falls

Hourly rounding showed promising effects on decreasing patient fall rates

Include interventions such as a toileting schedule, medication review, and a post fall conference in a multicomponent fall prevention program

Open communication and staff education have a positive influence in decreasing falls

Exercise interventions and vitamin D/calcium supplementation may show reduction in the number of falls

Summary of Evidence- Cont…

Single versus Multiple intervention fall prevention approaches The use of using only one fall prevention intervention has shown to help to

decrease inpatient falls, but as the literature suggests, multiple fall interventions put into place based on the client have proved to be more effective.

Data found through review of multiple studies reveals that a multi-intervention approach can lead to decreased inpatient falls and help prevent further complications of patients.

Integrating Evidence into Practice

When implementing nursing interventions to prevent falls, a multi-fasciated approach should be taken and should be individualized based on client need.

Continue to monitor patients that are high fall risks to determine if more interventions need to be applied and whether or not the initial interventions are effective.

How to Integrate the Evidence Into Practice Continue with previous fall prevention measures (bed/chair alarms, signs and

bracelets, 1:1 sitter, instructed to use call bell when patient wants to get out of bed, wearing nonslip footwear, keeping side rails up)

Add specific client education about how to client’s disease process makes them at an increased risk to fall without assistance to increase the patient’s knowledge about their risks and decrease patients ambulating out of bed without calling for assistance

Implement the use of low-low beds to decrease injuries during a fall Keep open communication with team members Provide a toileting schedule for patients whose bowel and bladder habits are

impaired by their disease process Review medications with patients when appropriate (patients without

cognitive impairment) to decrease their incidence of falls

Post-Activity Test

1. List 2-3 nursing interventions that contribute to decreasing inpatient falls.

2. True or False: Multifaceted fall prevention programs do not show any benefit versus single interventions in decreasing inpatient falls.

3. True or False: Nursing interventions, like placing a patient on a bed alarm, require and MD order.

4. Continuous Re-evaluation of nursing interventions that have been implemented is necessary for determining effectiveness and improving patient outcomes. (True or False?)

5. Explain the importance of decreasing inpatient falls, and what effects falls can have on a patients hospital stay.

6. True or False: Continuous re-evaluation of RN interventions put into place to prevent falls is key to preventing inpatient falls.

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Resources Ang, E., Mordiffi, S. Z., & Wong, H. B. (2011). Evaluating the use of a targeted multiple intervention strategy in reducing

patient falls in an acute care hospital: A randomized controlled trial. Journal of Advanced Nursing, 67(9), 1984-1992. Retrieved March, 2016.

Barker, A., Kamar, J., Tyndall, T., & Hill, K. (2012). Reducing serious fall-related injuries in acute hospitals: Are low-low beds a critical success factor? Journal of Advanced Nursing, 69(1), 112-121. Retrieved February, 2016.

Choi, Y., Lawler, E., Boenecke, C. A., Ponatoski, E. R., & Zimring, C. M. (2011). Developing a multi-systemic fall prevention model, incorporating the physical environment, the care process and technology: A systematic review. Journal of Advanced Nursing, 67(12), 2501-2524. Retrieved February, 2016

Darlene, H. (2015). Can rounding reduce patient falls in acute care? An integrative literature review. MEDSURG Nursing, 24(1), 51-55. Retrieved February 25, 2016.

Graham, B. C. (2012). Examining Evidence-Based Interventions to Prevent Inpatient Falls. MEDSURG Nursing, 21(5), 267-270. Retrieved March 5, 2016.

Godlock, G., Christiansen, M., & Feider, L. (2016). Implementation of an evidence-based patient safety team to prevent falls in inpatient medical units. MEDSURG Nursing, 25(1), 17-23. Retrieved February 28, 16.

Godlock, G., Christiansen, M., & Feider, L. (2016). Implementation of an evidence-based patient safety team to prevent falls in inpatient medical units. MEDSURG Nursing, 25(1), 17-23. Retrieved February 28, 16.

Guo, J., Tsai, Y., Liao, J., Tu, H., & Huang, C. (2013). Interventions to reduce the number of falls among older adults with/without cognitive impairment: An exploratory meta-analysis. International Journal of Geriatric Psychiatry, 29(7), 661-669. Retrieved March, 2016

Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient Fall Prevention Programs as a Patient Safety Strategy. Annals of Internal Medicine,158(5; Part 2), 390-396. Retrieved February, 2016

Shorr, R. I., Chandler, A. M., Mion, L. C., Waters, T. M., Liu, M., Daniels, M. J., . . . Miller, S. T. (2012). Effects of an Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients. Annals of Internal Medicine Ann Intern Med,157(10), 692-699. Retrieved February, 2016. 1

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