Fall prevention – where practice meets policy

Fall prevention & risk assessment

This week, we’re focusing on fall prevention, one of the many patient safety initiatives that healthcare organizations focus on for performance improvement.

The repercussions of a patient fall are grave. When a patient falls, it is an emotional experience for the patient, family, as well as the staff.  In addition, falls that are accompanied by injuries mean a longer length of stay, increased risk of mortality for those over age 65, and increased costs to the hospital.

When a patient is first admitted to the hospital, it is key to perform a fall risk assessment. One popular evidence-based risk assessment tool that we recommend is the Morse Fall Scale.  Once a fall risk assessment is completed, the primary care giver should be modifying the patient’s plan of care to include a fall prevention plan.  Some facilities use an algorithm, or a fall protocol, to help guide the implementation tools to prevent falls and/or injuries related to falls.

The discrepancy between policy and practice

When doing fall rounds, we’ve seen great fall prevention plans documented in the medical record. However, when we visit the patient’s room, we don’t always see evidence that the interventions were implemented. For example, say that at your hospital, patients who are screened as being a high risk for falls are mandated to have a falling leaf symbol on their door.  It goes without saying that if practice followed policy, then there should be a falling leaf symbol on the door of these patients.  Or what if the protocol is to place a rubber mat beside their bed? Then there should be a rubber mat beside these patients’ beds. Too often, the practice carried out in hospitals does not fit the policy or procedure that guides what should be done in that situation.

The discrepancy between practice and records

The other aspect of compliance with your fall policy is ensuring that the practice in place is what is documented in the records. This goes along with the old saying that “if it’s not documented, it’s not done”.  For example, if your hospital provides fall prevention education to the patient and family, be sure to document that in the chart or on the education record. Be sure to document whether you provide the education in person or via a handout. All of these details should be documented for your hospital’s records, for consistency, and for transparency.

Patient safety is a priority area that The Joint Commission will focus on during their survey. How have you involved the patient and family in their care and what education have you given them in terms of fall prevention?  The Joint Commission will be looking at active patient involvement in their care, which is one of the sub-processes of patient safety.

Forming a fall performance improvement team

Another sub process of patient safety is error reduction and prevention.  How are falls reported? Who reviews the fall events?  How is the data shared with leaders and with staff?  What assessments have been performed to identify factors that may contribute to falls?  My recommendation is to form a fall performance improvement (PI) team, a multidisciplinary group of folks passionate about understanding why and when patients fall in the organization. Include a clinical educator and patient safety expert, and recruit a physician champion for falls. The safety expert can perform rounds and let the educator know which pieces of the fall program/protocol need work. The educator can then modify the fall curriculum. Don’t be afraid of sharing the fall data with the staff – they are at the bedside and are key to preventing patient falls and fall related injuries. They need to see how their efforts in fall prevention are making (or not making) a difference.

All these pieces need to fall into place in order to ensure that practice meets policy when it comes to fall prevention.

Best regards,

Nicola Heslip | Policy & Patient Safety Specialist | PolicyMedical™

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