Center reduces falls with lift champion, ergonomics
A comprehensive program of education and changes in procedures has virtually eliminated falls at a surgery center in California. The leaders of the effort say their experience shows that reducing falls requires an approach that touches on all aspects of the problem.
The effort began in March 2006, with staff training started in June. There has been no patient fall in the year since the program began, says Jeanne Linda, RHIT, CPMSM, CPHQ, director of medical staff services/quality review at San Leandro (CA) Surgery Center. The falls at the surgery center never were higher than typically found in other surgery centers, but recent nationwide efforts at improving patient safety spurred staff at the center to look for ways to reduce injuries from falling, she says.
"Additionally, at the same time the staff was learning to reduce patient falls, they were also learning to protect themselves and avoid back injuries," Linda says. "Some of the resources we provided, like the transfer belts, helped make them more comfortable and confident that they could move patients without hurting themselves."
There has been no employee back injury since the program began, Linda says. She worked closely with Carol Bowen, RN, director of the center's post-anesthesia care unit (PACU) to investigate past falls at the facility and determine what might learned from them.
The investigation revealed a few intriguing points:
- New staff were involved with some of the falls. Was there a lack of orientation?
- All of the patients had a nerve block. Was there a lack education regarding numbness and difficulty in moving?
- All of the falls occurred in the PACU. Did the staff have the right training and tools? Were they communicating adequately with other team members?
Linda notes that leadership was involved in the investigation and supported the effort, including providing time and resources for those involved. "One of the things we realized was that we were not providing uniform training for all our staff on fall prevention. So leadership said maybe's time to go outside the organization to bring someone in to train the staff," she says. "Adding an ergonomic specialist from outside was a big part of the program."
Ergonomic specialist called in
This is what the surgery center did to reduce falls:
- An ergonomic specialist was hired to train all clinical staff in appropriate patient transfer. The training included classroom work on anatomy, body mechanics, safe transfer methods, and related topics. The specialist also conducted a hands-on lab where staff could practice safe transfers. (See box below for some of the fall prevention tips taught to the surgery center staff.)
Fall prevention tips help
keep post-op patients safeThese are some of the key fall prevention tips taught to the staff at San Leandro (CA) Surgery Center:
- Keep bed side rails up at all times. Never leave a patient unassisted with side rails down.
- Do not leave a patient unattended while dressing.
- Assume every patient will be weak and numb.
- To use a wheelchair, start with the wheelchair near the patient. Assist the patient directly to the wheelchair, position yourself in front of the patient, placing a hand in the axillary area, and guide the patient to a standing position. Then pivot to a sitting position in the wheelchair.
- Remember that moving a patient always will be more difficult than moving materials of a similar weight and size. The body is heavy, awkward, and delicate.
- Be prepared for the center of gravity to change during the handling activity.
Staff were required to pass a competency examination in the appropriate skills. Training all of the staff took two days.
- Transfer aids were purchased for use by all staff. These included gait and transfer belts, transfer boards, slide boards, slippery sheets, and mechanical lifts.
- A "lift champion" was appointed to support staff in appropriate lift and transfer techniques. Bowen is one of the two lift champions; the other is in the operating room unit. The lift champion serves as a trainer during the clinical staff orientation process and mentors existing clinical staff. The champion also observes clinical staff during the patient transfer process and assists when necessary.
- Staff were encouraged to use "active communication" to prevent falls. With active communication, staff never hesitate to ask for assistance from team members and explains to the patient what he or she should do to assist.
- Discharge instructions were amended to include education to patients when nerve blocks have been administered. The warning begins with "You may have a block. This will cause numbness on the surgery side. Do not weight-bear until the block has fully worn off." The instructions are reviewed with the patient preoperatively and postoperatively, and then again with the patient's family member or other caregiver after discharge.
- The surgery center initiated a "Caught Being Good" program to recognize staff members who use proper techniques for avoiding falls. Any staff member can report someone performing well, or leaders like Linda and Bowen can catch them in the act. That person's name and sometimes a photo is posted on the "Caught Being Good" bulletin board with praise for following proper procedures in fall prevention.
"It's a small thing, but people think it's fun," Linda says. "It's a little way to let them know we've noticed they're doing the right thing, and we appreciate it."
Sources
For more information on the San Leandro effort to reduce falls, contact:
- Carol Bowen, RN, PACU Director, San Leandro Surgery Center, 15035 E. 14th St., San Leandro, CA 94578. Telephone: (510) 276-2800. E-mail: [email protected].
- Jeanne Linda, RHIT, CPMSM, CPHQ, Director, Medical Staff Services/Quality Review, San Leandro Surgery Center. E-mail: [email protected].
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