Hospital reduces falls in hospital and at home
South Nassau Communities Hospital in Oceanside, NY, is reporting success with an aggressive approach to falls prevention.
In response to the need to decrease the number of falls in their elderly patients and the elderly in the communities they serve, South Nassau's Home Care Program and Department of Community Education initiated a falls prevention program in 2004. The program consists of a fall risk factor screening tool, medication review, a gait and balance assessment tool, a home safety assessment, recommendations for appropriate footwear, and a progressive home exercise program that addresses gait, strength, and balance deficits. The program has significantly reduced falls and fall-related injuries, says Nancy Helenek, RN, MSN, FABC, administrative director of care continuum.
Hospital leaders took action
The effort first began when hospital leaders realized that a high number of elderly patients were sustaining injuries in falls, says Helenek. A multidisciplinary team looked at the evidence-based risk factors for falls, the demographics of the hospital's elderly patient population, and the records from past falls. After synthesizing that information, the team put together a fall risk screening tool that was incorporated into the admissions process.
"That enabled us to assign high-, medium-, and low-risk factors to our patient population," Helenek says. "The admitting physicians were then educated on the risk factors, and anyone who was determined to be at high risk for falls would prompt us to initiate our fall prevention program."
Physical therapy a key
That fall prevention program begins with a visit from a physical therapist within 48 hours of admission. In addition, the program consists of a home safety assessment, a balance assessment, a footwear evaluation, and documented recommendations to the patient and caregivers. The patient receives an occupational therapy evaluation, if appropriate.
"We also provide lower extremity strengthening and balance exercises by the second visit from the therapist," Helenek says. "We then track these patients for the duration of the program to see if a fall has occurred."
The evidence-based program attempts to reduce the modifiable risk factors to decrease the person's risk for falls, says Francene Stauber, MD, PT, DPT, rehabilitation services supervisor.
"We have since identified and tracked 771 people from home care and the community screened to be at a high risk for falls. Of these, 39 have fallen with slight or no injury, and 10 have fallen with injury," Stauber says. "The program prevented falls in 93.6% of people participating in the SNCH Fall Prevention Program and prevented injury in 98.7%."
Stauber calls those results extremely encouraging, because the patients were not just a broad cross-section of all patients, but were only patients deemed to be at high risk for falling. The good results have prompted the hospital to start expanding the program beyond just those patients at highest risk for falling.
"No matter how much we expand the parameters and draw more patients into the program, we continue to see these strong results," Stauber says. "It is so encouraging that we have taken the program out into the community to address the fall risks that patients encounter in their own homes when they leave the hospital."
The hospital takes the program to senior citizen centers, senior housing, churches, libraries, and other locations where the team can educate seniors about risk factors and how to modify them. They also educate people about how physical therapy can lower the risk of falling.
Program modified over years
The risk assessment tools have been modified over the past five years as the fall prevention team gained a better understanding of the patient population and risk factors. Initially, the risk assessment considered patients age 75 or older to be at high risk for falls, awarding those patients one point that was factored into the other risk assessments to achieve a total score indicating overall risk. But then the fall prevention team realized that patients under 75 were falling at a high rate, so the cutoff age was lowered to 65.
"By doing that, we captured significantly more patients who were at risk for falling," Helenek says.
Stauber says the hospital team also tweaked the program to put more emphasis on polypharmacy as a risk factor. The initial assessment of the patient on admission includes a medication review and patient education by the nurse regarding how some medications can increase the risk of falling. Helenek points out that the cost of the South Nassau falls prevention program has been minimal, because most of the patients would have been part of the hospital's home care program anyway.
"Our staff are paid on a per-visit basis, and they would be visiting these patients anyway, so there is no real additional cost for that," she says. "There may be some additional costs involved for the patients who receive physical therapy but might not have if they hadn't been identified under this program, but there are cost savings that offset that. We see cost savings in decreased emergency department readmissions, decreased operating costs related to hip fractures, and savings from physical therapy not needed for fall rehabilitation."
South Nassau Communities Hospital in Oceanside, NY, is reporting success with an aggressive approach to falls prevention.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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