Falls Risk Assessment and Intervention in HMED

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Falls Risk Assessment and Intervention in HMED
WakeMed Emergency Services February 2006
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Why worry about Falls?

• Preventing falls is on JACHOs radar screen
  National Patient Safety Goal 8, Reduce the risk
  of patient harm resulting from falls.
• It is hospital policy Adult inpatients are
  assessed for falls risk daily using falls risk
  assessment tool on the nursing flowsheet.
• .falls are a leading cause of accidental
  death and a significant precipitator of hospital
  admissions in older individuals. (Ruchinskas,
  p.2)
• Patient falls constitute a major proportion of
  all incidents occurring in a hospital and can
  cause increased liability insurance for the
  hospital (Schmid, p. 202).

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Key factors associated with patient falls

• Impaired or decreased mobility
• Altered mentation
• Elimination
• Current medications
• Benodiazepines
• Anticonvulsants
• Antipsychotics
• History of previous fall(s) while hospitalized
• (Schmid,p. 205)

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What about WakeMed?

• 4.7 of patients coming to the ED present with a
  chief complaint of Fall.
• Very few patients have fallen in the ED over the
  course of the last year.
• Hospital-wide Falls Prevention policy in place.

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Fall prevention programs have demonstrated
significant effectiveness in reducing falls.
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Assess each patient for Falls Risk

• Use Schmid Tool in Triage
• A score gt3 indicates risk for falls
• Green star Icon will appear on Tracking board
• Re-assess on the nursing flowsheet
• Every 24 hours (standard time of 9am)
• After any change in condition

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Schmid Tool in HMED Triage, p. 1
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Schmid Tool in HMED Triage, p.2
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Schmid Tool in HMED Nursing Flows p. 1
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Schmid Tool in HMED Nursing Flows p. 2
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HMED Documentation for Falls when administering
high risk medications

• When documenting the administration of
• Anticonvulsants
• Benzodiazepines
• Antipsychotics
• Select any falls prevention intervention(s)
  deemed appropriate from the displayed list
• 2 side rails up
• Bed in low/locked position
• Call light within reach
• Door open if appropriate
• Family presence encouraged
• Pt/fam education
• Held in parent/caregivers arms (pediatrics)
• Green Star Icon will appear on Tracking Board

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Medication screen in HMED
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References

• http//www.jcipatientsafety.org/show.asp?durki117
  53(accessed on February 14, 2006)
• WakeMed Nursing Procedure and Policy Manual
  Falls Prevention Protocol, p. 1 (Accessed
  February 14, 2006 at http//wakemedweb.wakemed.org
  /SiteContent/DepartmentsFolder/Nursing20Administr
  ation20HomePage/120Nursing20Policies2020Proc
  edures/F/Falls20Prevention20Protocol.doc).
• Ruchinskas, R. (2003). Clinical Prediction of
  Falls in the Elderly. American Journal of
  Physical Medicine Rehabilitation 82(4), p.
  273-278.
• Schmid, N.A. (1990). Reducing patient falls A
  research-based comprehensive fall prevention
  program. Military Medicine 155(5), 202-207.