Hospital cuts injuries with 'falls cart'
Sometimes the most effective strategies for those problems that plague every health care facility are not high tech and don't require a highly paid consultant. Sometimes the solution can be deceptively simple such as creating a "falls cart" to keep essential fall reduction tools handy for both patients and caregivers.
Another idea is to create one in a special inpatient room where patients at the highest risk for falls can receive special attention.
Both strategies are in use at Caritas Norwood (MA) Hospital, a 264-bed acute care facility where risk manager Lynn Worley, JD, RN, CPHRN, says it has been a simple and inexpensive strategy for improving patient safety. A falls cart or designated room will be only one part of a comprehensive fall reduction plan, she says, but they are good examples of how seemingly basic suggestions from frontline clinicians can make a difference.
"Much of what we're doing to reduce falls was developed by working with the nurses who are out there every day working with these patients, listening to what they told us would work, in addition to consulting the literature and best practices," she says. "We now have a learning packet on our online network that has become an assigned competency for all of our nurses."
Mary McDougall, MSN, MPH, APRN, BC, a clinical nurse specialist at Caritas Norwood, was involved in developing the falls cart along with other aspects of the hospital's fall reduction program. She says the falls cart is part of a program that includes ongoing education for the staff about fall risks and the changes that come with aging. The hospital also created a high-risk fall room by remodeling an existing four-bed room.
One bed was removed so that there would be more space to move around, and the room was fitted with additional railings and hand holds throughout. Special care is devoted to avoiding any tripping or fall hazards in the room. The hospital uses common criteria for determining fall risk when assigning patients to the room. The typical patient assigned to the fall prevention room is more than 80 years old, with a history of falling, a history of confusion, and multiple medications.
The room is used only for female patients now, but there are plans to create another room for male patients at risk of falling. The room has been in use for only a few months, but there have been no falls in the room so far.
"Having this room doesn't mean that we don't practice fall prevention everywhere else in the hospital, but for this room we cherry-pick the patients who are at highest risk," McDougall says. "The room is staffed with a dedicated nurse's aide who has been through a special falls prevention program. In addition to that aide, the rest of the staff know to be extra vigilant with these patients."
McDougall says the team at Caritas Norwood is focusing more lately on diabetic patients, because recent literature shows that they are at increased risk of falls, even aside from any additional risk factors they may have. Their diabetes can lead to foot and circulation problems that impair walking, and difficulties with maintaining blood sugar levels also can make them unsteady.
"I teach our people to look for these patients who have these factors that make them a high risk for falls. They're on the lookout now, and we identify patients at risk. We sort of wave the red flag over these patients and make sure everyone knows there is a higher risk with this individual," McDougall says. "We can know ahead of time which patients are more likely to fall."
Worley says a retrospective review of falls data at the hospital confirmed that, in some cases, the patient's blood sugar level was one cause of the fall.
The falls carts are a particularly good idea when measured against the negligible cost and minimal work required, Worley says. McDougall explains that the falls carts are common rolling carts, the type used in many ways throughout any hospital, that are kept stocked with items that can help prevent falls. The items include Velcro belts and "busy aprons" for elderly patients who need something to occupy their hands, skin sleeves for intravenous lines, gait belts, minimal restraint devices, and various activities to keep patients busy.
"One cart is kept in the falls prevention room, and there are two more that are available on the units as needed," McDougall says. "It's a simple idea but it works."
Sources
For more information on the fall prevention strategies at Caritas Norwood, contact:
- Mary McDougall, MSN, MPH, APRN, BC, Clinical Nurse Specialist, Caritas Norwood (MA) Hospital. Telephone: (781) 769-2950. E-mail: [email protected].
- Lynn Worley, JD, RN, CPHRN, Risk Manager, Caritas Norwood (MA) Hospital. Telephone: (781) 278-6304. E-mail: [email protected].
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