'I'm not fallin' for that' reduces patient falls
Reducing falls is a constant worry for hospitals, and sometimes it seems there are no new ideas. But many health care providers are finding the most success with an approach that includes a wide range of efforts, everything from special equipment and monitoring systems to making sure every employee is empowered to prevent falls.
That all-encompassing approach has cut the incidence of falls in half at Briarwood Healthcare Center, a part of Friendship Village of Schaumburg in Illinois, a continuing care retirement center. The nursing home's fall prevention program was developed when Rebecca Johnson, senior vice president of human resources and quality improvement, was launching a new quality initiative program called "Friendship Village's Spirit of Excellence." Johnson asked risk manager Helene Corcoran to participate in evaluating a pilot falls prevention tool kit that was available from their insurance carrier.
Lynn Blakemore, the nursing home's administrator, was looking at the facility's fall data and wanting to control the number of repeat falls and related injuries. Finally, Barbara Lopiccolo, the nursing director, wanted Johnson to write a formal fall prevention program. They all approached Valerie Bare, RN, certified restorative nurse and rehabilitation coordinator, for help. That's when she realized that all the different parties were working toward the same goal.
So Bare suggested that they pull all the related projects together. The different perspectives should boost the chance of success, she thought.
"As a nurse, we have a scientific way of looking at things. We identify problems, establish time- limited measurable goals, and finally identify interventions," Bare says. "Rebecca explained that the quality improvement realm also had scientific methods to approach challenges as well. We then talked about how we would structure the project."
Varied members on team
Bare says the composition of the team is critical. In addition to Corcoran, the risk manager, the team includes a housekeeper, certified nursing assistant, a staff nurse, the director of social services, MDS coordinator, therapy program manager, the director of nursing, assistant director of nursing, and Johnson, the senior vice president of human resources and quality improvement. Bare serves as the team leader.
The varied makeup of the team helped establish the project's importance and create a sense of ownership for all the staff, Bare says. It also promoted a wide range of ideas leading to creative solutions, she says.
The fall prevention team came up with a program called "I'm Not Fallin' for That." The name was meant to be catchy and memorable, Bare says. Friendship Village used the catchphrase on posters throughout the facility and in educational sessions for all staff.
"In our pilot program, we showed pictures to the staff of various dangerous situations for high-risk residents, such as trying to get out of bed unassisted, or going to the washroom by themselves. The pictures of those situations had the phrase, "I'm Not Fallin' for That" stamped across them. The idea was to cement in the staff's brains, at a glance, what was dangerous, so that as they passed the residents in their workdays if they saw dangerous situations they could identify them."
The team also provided staff with a process for intervention, beginning with approaching the resident and securing their safety. The hospital also uses a two-tiered wristband system that identifies those with the pieces in place to be at risk for falls and those who have distinguished themselves already by falling, maybe more than once.
"We had tried some other methods before like the 'Falling Star' symbols on beds or doorways, but the problem with that is that the resident changes rooms and the signage doesn't always get updated. And the signs don't help when the resident is in the dining room or in therapy," Lopiccolo says. "But the wristband is always with the resident. Everyone knows at a glance that this person is high risk."
Empowerment is key
But most important, Bare says, is the empowerment of all staff to intervene in dangerous situations. Staff at Briarwood understand that preventing falls is the job of every employee, not just nurses, she says.
"We also have a Good Samaritan-type clause in place that allows anyone to intervene to prevent a fall, with the promise that we're never going to tell you that's not your job or you shouldn't get involved," Bare says. "As a result, we have had housekeepers, painters, and dishwashers prevent falls."
Corcoran says one important decision was to focus first on the nursing home portion of Friendship Village, excluding the assisted living and independent living facilities. The nursing home residents faced the highest risk, so the team decided to focus there first and then expand the program once all the kinks were worked out.
Over a period of three months, the incidence of falls decreased 50%, Bare says. Also, the number of injuries related to falls fell by 50%, she says.
"We had a decline in every area in which we collect data and measure falls," Bare says. "Whether you look at the number of falls or the injuries resulting from those falls, the numbers decreased across the board."
Risk manager plays key role
Corcoran credits the multidisciplinary composition of the team, and Bare's leadership, for much of the success. Without the right team members and leadership, it will be difficult to achieve the all-important buy-in from the facility staff, she says.
The risk manager should play a substantial role in any fall prevention effort, Corcoran says.
"My experience as a nurse came into play, but I [also was there] to provide immediate answers to legal questions about the things we should or shouldn't do related to confidentiality, for instance," she says. "That helped the team move on efficiently, without having to wait for an answer from me, and I didn't have to wonder if the team's work was going to lead to a breach of confidentiality or requirements for reporting."
Sources
For more information on preventing falls, contact:
- Valerie Bare, RN, Certified Restorative Nurse and Rehabilitation Coordinator, Briarwood Healthcare Center, Schaumburg, IL. Telephone: (847) 755-2020. E-mail: [email protected].
- Helene Corcoran, Risk Manager, Briarwood Healthcare Center, Schaumburg, IL. Telephone: (847) 755-2020. E-mail: [email protected].
- Rebecca Johnson, Senior Vice President, Human Resources and Quality Improvement, Briarwood Healthcare Center, Schaumburg, IL. Telephone: (847) 755-2020. E-mail: [email protected].
- Barbara Lopiccolo, Nursing Director, Briarwood Healthcare Center, Schaumburg, IL. Telephone: (847) 755-2020. E-mail: [email protected].
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