Close the loop: Create fall-reporting process
Retrospective look may lead to improvement
Comprehensive Home Health Services of Mesquite, TX, decided its complaint reporting process needed to be changed so the agency could better track how many patients had falls at home.
The hospital-based agency developed a tool for reporting falls that included details such as whether a fall was witnessed by anyone. The tool also enables the agency to keep track of a patient’s age and whether the patient uses assistive devices. "This is so we can generate some data to develop into our safety education program," says Patti O’Connell, RNC, QI director of Comprehensive Home Health Services, which conducts 5,500 visits a month in northeastern Texas.
O’Connell says the tool also will help the agency track how many patients are referred to a physical therapist and whether that affects the number of falls.
Eventually, the agency will have collected enough data to help it improve quality through both education and making policy changes, O’Connell adds.
Here’s a look at the agency’s tool:
Patient Fall Reporting Process
Purpose: To establish a uniform information collecting and reporting system for tracking and assessing patient and staff needs related to safety, specifically patient falls.
Goal: To identify and meet client safety needs.
1. All patients are assessed at admission and on an ongoing basis for safety and fall potential within the home. Any staff member identifying a patient with a fall risk will document "FALL RISK" on the front of the patient’s home chart and on the visit note for the patient’s medical record. Nursing will document the fall risk potential in the Safety and Musculo-Skeletal sections. The staff member is also responsible for notifying the Case Manager, as soon as possible, so that appropriate intervention with physician and staff notification can be implemented.
2. All patient falls, witnessed or unwitnessed, are to be immediately reported to the Case Manager. The staff member witnessing or receiving the report of a fall will be responsible for documenting the fall account on the visit or communication note.
3. When a home health aide or non-nursing discipline reports a fall to the Case Manager, the Case Manager will be responsible for following up with the patient and physician regarding whether a SN visit for assessment related to the fall needs to be scheduled.
4. The staff member witnessing or receiving the report of a fall is responsible for completing an Occurrence Report. The following information needs to be included on the report:
a. Date/time of fall . . . Date of the report
b. Events leading to fall, e.g., patient got out of bed to use bathroom in middle of night, did not use walker, lost balance, and fell into standing bird cage and then onto floor.
c. Description of all injuries assess for loss of consciousness, change in mobility or ROM function, level of function, mental status, pain, tissue, joint, bone injury.
d. Assess for needed intervention emergency treatment, wound care, increased need for supervision, SN observation and assessment due to injury, therapy referral, etc. Assess for need to change acuity level.
e. Document physician notification for ALL injury or suspected injury falls and for repeated falls. Document patient needs identified to physician and for orders received.
f. Document recommendation, patient/caregiver education implemented, and responses.
g. If patient is sent to ER/physician, document follow up diagnosis, treatment received, any new orders/meds.
5. The Occurrence Report is to be turned in to the Case Manager and an IOF will be completed. The IOF and Occurrence Report are immediately forwarded to the QI department for review.
6. The QI department will promptly review the IOF and Occurrence Report for completeness and forward to the Director of Professional Services for review.
7. The director will forward, as appropriate, the IOF and Occurrence Report to the Administrator for review. The Director will then forward the forms to the hospital Quality & Risk Management Department.
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