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Tentative Go Live Date September XX, 2012

This document discusses Jefferson Hospital's implementation of a new fall risk assessment tool and intervention program. The previous tool was not adequately assessing why patients fell or predicting all falls. The new tool goes beyond screening to evaluate specific fall risk factors and match interventions. It was trialed in 2011 and 2012. The document provides examples of assessing a low and high fall risk patient and selecting appropriate safety and fall prevention interventions. It emphasizes fall prevention is a nursing quality indicator and nurses can improve outcomes through thorough assessments and tailored care planning.

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Kimberly Joy Gregorio
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32 views

Tentative Go Live Date September XX, 2012

This document discusses Jefferson Hospital's implementation of a new fall risk assessment tool and intervention program. The previous tool was not adequately assessing why patients fell or predicting all falls. The new tool goes beyond screening to evaluate specific fall risk factors and match interventions. It was trialed in 2011 and 2012. The document provides examples of assessing a low and high fall risk patient and selecting appropriate safety and fall prevention interventions. It emphasizes fall prevention is a nursing quality indicator and nurses can improve outcomes through thorough assessments and tailored care planning.

Uploaded by

Kimberly Joy Gregorio
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Tentative Go Live Date

September XX, 2012


Falls and Injury from Falls
A Nursing Sensitive Indicator
The prevention of falls and injury from falls in patients
who are hospitalized are indicators of high quality
bedside nursing care given on a particular unit or at a
hospital.

Recognizing who is at risk and implementing


appropriate interventions aimed at minimizing the risk
is part of professional nursing practice at TJUHs, Inc.
Why we needed a New Fall Risk Tool
Background:
Morse Falls Risk Tool was not meeting our needs;
screens for Fall Risk and did not assess WHY patient
is at risk

It did not predict all of our falls

Some of our patients scored not at risk (< 50)


experienced a fall

Often incomplete/inaccurate documentation


Jefferson Fall Risk Assessment
and Intervention Tool
Goal:
To improve patient outcomes (decrease falls
and injury from falls) through targeted
interventions based on assessment
Jefferson Fall Risk Assessment and
Intervention Tool (cont)
What is different?
 Goes beyond screening – assesses WHY a patient
is at risk for fall
 No “points”/numerical values assigned to a risk
factor
 If you assess a patient to be at risk to fall due to any
risk factor – then they are at risk
 Supports clinical judgment and decision making –
re: selecting fall prevention interventions based on
the specific risk factor(s)
Timeline
Summer Spring 2012
2011 All units on all
FRG SN Fall 2011 campuses trialed
identified new Fall Risk
FRG SN or
Assessment and
Fall
WHY their designee from pilot
patients fell – Intervention Tool. 2012
units trialed the Go
what put them assessment Fall Interdisciplinary
at risk? Live!
criteria and Committee
provided feedback provided feedback.

Summer 2011 Winter 2012 Summer


Fall Task Force Task force identified 2012
created a Fall specific
interventions to Jeff Chart
Risk Assessment match risk factors Training and
Tool based on a based on literature Education
literature review and best practices
and the Jefferson
specific risk
factors identified
by Fall Resource
Group
Fall Risk Assessment
 Hx of falls prior or during hospitalization
 Altered mobility/gait disturbances
 Altered elimination
 Altered balance/risk for dizziness
 Equipment
 Altered mental status &/or behavior risk
 Risk of injury
Fall Prevention Interventions
Specific Fall
Prevention
Interventions

General Fall Prevention


Interventions
(all pts at risk for Falls –
regardless of why)

General Safety Interventions


(all pts – regardless of fall risk)
Assessment
Assess Fall Risk factors through:

 Observation of patient

 Interview (completion of Nursing Admission


Assessment)

 Review of the Physician History & Physical


Falls Tab Added to Assessments
Assessment - Complete Fall Risk
Assessment in Jeff Chart.
Intervention
Implement and document General
Safety interventions for ALL patients.
Intervention
Implement and document General Fall
Prevention Interventions for ALL pts
with any risk for falls
Interventions - Specific
Select appropriate interventions based on patient
risk factors and individualized assessment.
Case Study
A 35 year old female is being admitted for wheezing and
shortness of breath.

PMH: Hypertension and asthma


Admission orders include:
 Inhalers
 Prednisone 40mg PO
 Hydrochlorothiazide 12.5mg PO

What are the Falls Risk Factors for this patient?


What Fall Prevention measures would you implement
and document for this patient?
Fall Risk Assessment
Risk Assessment Criteria Assessment

Hx of falls prior or during No risk


hospitalization
Altered mobility/gait disturbances No risk

Altered elimination No risk; has been on HCTZ

Altered balance/risk for dizziness No risk

Equipment No risk
Altered mental status &/or No risk
behavior risk
Risk of injury No risk
Interventions
General Safety Interventions only
 Sensory items within reach
 Call bell within reach
 Non-skid footwear
 Night Light
 Level 2 Bed Alarm at night
 Bed in low position/locked
 Pt/Family teaching
 Hourly rounding
Case Study
An 82 year old female was admitted 5 days ago, S/P fall at
home.
 PMH: Hx of falls, has generalized weakness, uses cane to
ambulate, has diabetes with neuropathy in hands and feet, is
HOH, and takes Coumadin for chronic atrial fibrillation
 Two days ago patient spiked a fever to 101.3F and became
confused; found to have a UTI
 Current orders include:
 IV fluids Pain Medications Oxygen at 2 liters
 Antibiotics PT/OT consult

What are the Falls Risk Factors for this patient?


What Fall Prevention measures would you implement
and document for this patient?
Fall Risk Assessment
Risk Assessment Criteria Assessment – from H & P, nursing
assessment, PT/OT assessment
Hx of falls prior of during Hx of falls
hospitalization
Altered mobility/gait disturbance Generalized weakness; hx of DM
with neuropathy
Altered elimination Admitted for UTI

Altered balance/risk for dizziness Uses cane for balance to walk

Equipment IV pole; Oxygen therapy


Altered mental status &/or Confusion; HOH; Pain medication
behavior risk
Risk of injury Coumadin with therapeutic INR
Interventions
General Safety Interventions
General Fall Prevention Interventions
Specific Fall Prevention Interventions
Altered mobility Assist with transfers/ambulation

Altered elimination Toilet q1 hour; stay with pt.


Bedside commode
Altered balance/risk for dizziness Ambulate with cane at all times

Equipment Assist with IV pole & Oxygen tubing

Altered mental status &/or behavior Room close to Nurse’s station


risk Self-releasing seat belt in chair
Risk of injury Low bed
Key Points
 Falls Risk Assessment and Intervention is a
professional nursing role and responsibility
 Complete every shift, after a change in condition or
after a fall, and upon transfer to another unit.
 No “point” values are assigned to risk factors
 Having any risk factor makes the patient at risk for
falling
 Tailor your interventions to the patient’s assessment
 Communicate patient’s fall risk and interventions
via handoff, huddles, IPOC, and Teletracking.
Fall Prevention is a Nurse-
Sensitive Indicator of Quality

 As a professional nurse providing direct care,


you are in a position to make a difference in
patient outcomes.

 Your assessments and thoughtful planning will


minimize the risks for patients at risk for falls and
injury from falls

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