Kaiser Permanente, Northern California
Caritas in ActionHow Caring Science informs and inspires KP caregivers and affirms our commitment to provide our
patients and their families exceptional care
Caritas Consortium 2014
Patient Engagement for Falls Prevention Program
Honoring Health, Healing & Wholeness
Patient Engagement for Falls Prevention Program
Intent to Contribute Statement:
Examining fall events at Kaiser Permanente Santa Clara, (KP SCL) practices using only external approaches, such
as: yellow identification bracelets, signage on doors, floor pads, and alarms have not proven effective in reducing
the volume of falls. KP SCL desires to dramatically reduce the fall rate. Discovering new practices of patient
education was observed at the 2012 Caritas Consortium. Additionally, Northern California HEROES monthly
meeting had identified a best practice program called “No One Walks Alone” from KP San Diego Medical Center.
This program consisted of the following: universal fall precautions for all patients; alarms (bed and chair) for all
patients; all patients are accompanied when getting out of bed. KP SCL reviewed this best practice and added
several more elements to create an expanded “Falls Prevention Bundle”. Co-creating is described as the ability to
work with others to develop a healing environment for the physical and spiritual self who respects human
dignity. Patient engagement is critical in the success of collaboration with any prevention program. Using the
caring science to co-create a partnership with our patients allowed them to directly participate in their own
identification of risks about falling.
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… ContinuedWe augmented the current nurse centered Schmid Fall Risk Assessment and supplemented this risk assessment
with the Patient Partnership Agreement from KP San Diego. The Schmid Fall Assessment Tool was converted
specifically for patients who read and speak English at a reading level of fifth grade vetted through Health
Education, Compliance, Public Affairs, and reviewed with patients along with front line staff. The “Patient
Partnership Agreement” reviews the risks, informs the patients his/her role in fall prevention, what the nurse will
do for them and how to partner to prevent falls. A pilot was conducted on a high fall department and shared
among our Nurses, Unit Assistants, Patient Care Technicians, Physical Therapist, and Mobility Team. Of all of the
new strategies implemented, the single greatest impact came from the patient education bundle which directly
engaged the patient on the real risks of falls based on their assessment using the Schmid Fall Assessment and
Patient Partnership Agreement. Patients were surprised that they were at risk. Often times voicing their concern
that they don’t think they will fall. Reinforcement of the Patient Education Bundle upon admission, transfers in
and during Nursing Knowledge Exchange with monitoring equipped the staff and patient to co-create an
approach to stop falls beyond our pilot.
Patient Engagement for Falls Prevention Program
Inspired Contributor(s) : Kathy Ricossa
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Service Area: Santa Clara
Medical Center: SCL
Affiliation: PCS
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Year Shared: 2014
Venue: Caritas Consortium
Format: Poster
ID #: Q02
Keyword TAGs: Identifier
Consortium2014-June, Santa Clara, Poster, Patient Care Services, Adult Services
Education & Staff Dev, Hospital Initiatives, Patients/Families
Descriptor Mentoring/Empowering Others,
HEROES
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Patient Engagement for Falls Prevention Program
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Patient Engagement for Falls Prevention Program
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