Page 27 Complete Your CE Test Online - Click Here How do you put the new fall prevention program into action? The Agency for Healthcare Research and Quality recommend that the following items are clearly determined: ● ● Identify a process for putting new practices into day to day operation. ● ● Determine a system for pilot testing the new program. ● ● Provide education and training for implementing the new program. Acknowledge the way input from staff members have contributed to the program. Acknowledge the way this new program is expected to enhance safety and improve patient care. And remembers that ALL employees need education and training. Part of any fall prevention program must include a process for measuring fall rates and fall prevention practices. The Agency for Healthcare Research and Quality (2017b) recommends that during the course of fall prevention efforts, ongoing monitoring must be implemented as part of the fall prevent process. The agency’s recommendations for monitoring include that organizations regularly monitor an outcome indicator, such as falls per 1,000 occupied bed days, assessment of fall risk factors, or actions taken to reduce fall risks. In order to help establish a monitoring system, the agency recommends that organizations answer the following questions when establishing a monitoring system (Agency for Healthcare Research and Quality, 2017b): ● ● How are falls and fall-related injury rates measured? Falls are measured as falls per number of occupied bed days on a unit and/or an organization over a given period of days. ● ● How are fall prevention practices measured? Measuring falls is the overall indicator of how well a fall prevention program is working, it is imperative to assess the actual effectiveness of fall prevention practices. For example, an organization might monitor the performance of fall risk assessment within 24 hours of admission. Falls and assessment are two different factors that must be monitored in an ongoing manner. ● ● What should be done if data indicate that some fall prevention practices are not being implemented or are not effective? Review and revision are key to addressing this question. Organizations are cautioned not to look for someone to blame, but to evaluate existing systems and processes for flaws and inadequacies as well as barriers to implementing fall prevention strategies. Revisions must then be made as appropriate. In summary, when determining how to develop, review, or revise a fall prevention program, the Agency for Healthcare Research and Quality (2013d) recommends answering the following questions: ● ● What fall prevention practices should you use? ● ● Which universal fall precautions should be applied throughout the organization? ● ● How should a standardized assessment of fall risk factors be conducted? ● ● How should identified risk factors be used for fall prevention planning? ● ● How should you assess and manage patients after a fall? ● ● How can the organization incorporate these practices into a fall prevention program? Nursing consideration: All fall prevention programs must incorporate a process for managing patient falls. Who is responsible for immediate assessment? How can medical assistance be swiftly acquired? How will patients and families be told about the fall and how any resulting injuries are to be dealt with? Who will gather staff members involved in the fall for a debriefing? Debriefing is not to be used as a punishment or an accusation of wrong-doing. It is a tool to determine what happened, why it happened, and how its occurrence can be reduced in the future. Debriefing is also used to support staff members who are understandably distressed when a patient falls, especially if the patient is injured (Agency for Healthcare Research and Quality, 2013d). General fall prevention strategies There are a number of general fall prevention strategies that are components of most fall prevention programs. These may seem to be simple common sense, but failure to initiate these strategies can (and have) led to serious falls. Nursing consideration: The majority of research on falls to date has been done on falls in the inpatient setting. However, falls in the outpatient setting are just as big an issue. Fall prevention programs must be tailored to outpatient settings and quality improvement indicators developed to reduce safety hazards in these settings (Heung, Adamowski, Segal, & Malani, 2010). Here are some basic strategies for fall prevention in the healthcare setting and at home (Chu, 2017; Centers for Disease Control and Prevention, 2017): ● ● Encourage patients to undergo an assessment for fall risk factors. This should take place even if the patient has never fallen. Such an assessment can be done in the office practice setting, as well as the inpatient setting. ● ● Encourage patients to have appropriate preventive health examinations, such as vision evaluation and gait and balance evaluation. ● ● Teach patients about the side effects of any medications that can increase the likelihood of falls such as sleeping aids and antidepressants. A large number of medications can cause sleepiness, dizziness, and impaired coordination, all of which can contribute to falls. ● ● Encourage patients to have their Vitamin D levels checked, since insufficient Vitamin D levels have been linked to falls. ● ● Unless medically contraindicated, teach patients exercises that can improve muscle strength and coordination. ● ● Teach patients to reduce environmental hazards, such as scatter rugs, clutter, slippery floors, and inadequate lighting. A home assessment may be of great value to patients as they work to avoid falling. Additional lighting, railings on both sides of stairs, and grab bars inside and outside tubs and showers and next to the toilet are all good ways to reduce fall risk. In the inpatient setting, the following recommendations have been found to reduce fall risk (Chu, 2017; Centers for Disease Control and Prevention, 2017): ● ● Hurly rounding has been found to be an effective deterrent to falls. Research shows that hourly rounding makes patients feel safer and less apprehensive and can reduce falls. ● ● Good communication among healthcare professionals and between healthcare professionals and patients and families has been linked to a reduction in falls and other safety hazards. Some organizations use color-coded wristbands to indicate fall risk. ● ● Medication review is essential to safety. Staff members, patients, and families must be aware of what medications have been prescribed and potential side effects of these medications. For example, even though nursing assistants are not responsible for medication administration and evaluation, they should know which of their patients are taking medications that increase the risk of falling. Chu (20017) emphasizes the importance of education not only for patients, but also for staff members. She has identified the following education initiatives that should be provided to reduce the risk of falls during hospital stays: ● ● Post a fall risk alert sign in proximity to the patient’s bed and on the door as appropriate. Note that if the sign is on the door, the patient’s name should NOT be included in order to meet confidentiality mandates. ● ● Use bed alarms. Be sure that alarm fatigue has been addressed when developing the fall prevention program. ● ● Use color-coded identification bracelets so that the patient’s fall risk is clearly communicated with all employees. ● ● Perform hourly rounds. ● ● Educate patients and families about the patient’s risk for falling (including the risk at home). Teach patients and families how to make the home environment safer. ● ● Be sure that the call bell is within reach at all times and that patients know how to use it. In summary, fall assessment must be conducted on every patient. Assessments may vary depending on the patient population. The fall assessment tools used by the organization must be appropriate for use in each setting.