Preventing Falls in Hospitals

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The information in this toolkit is intended to assist service providers. and hospitals in developing falls prevention protocols This toolkit is. intended as a reference and not as a substitute for professional. judgment The opinions expressed in this document are those of the. authors and do not necessarily reflect the views of AHRQ No. statement in this toolkit should be construed as an official position of. AHRQ or the U S Department of Health and Human Services In. addition AHRQ or U S Department of Health and Human Services. endorsement of any derivative product may not be stated or implied. Preventing Falls in Hospitals,A Toolkit for Improving Quality of Care. Prepared for,Agency for Healthcare Research and Quality. 540 Gaither Road,Rockville MD 20850,www ahrq gov,Prepared by. RAND Corporation,Boston University School of Public Health. ECRI Institute,Contract No HHSA290201000017I TO 1,AHRQ Publication No 13 0015 EF.
January 2013,RAND Corporation, David A Ganz M D Ph D VA Greater Los Angeles Healthcare System University of. California at Los Angeles and RAND Corporation,Christina Huang M P H RAND Corporation. Debra Saliba M D M P H VA Greater Los Angeles Healthcare System UCLA JH Borun. Center for Gerontological Research and RAND Corporation. Victoria Shier M P A RAND Corporation,Boston University School of Public Health. Dan Berlowitz M D M P H Bedford VA Hospital and Boston University School of Public. Carol VanDeusen Lukas Ed D VA Boston Healthcare System and Boston University School of. Public Health,ECRI Institute,Kathryn Pelczarski B S. Karen Schoelles M D S M,Linda C Wallace M S N B S N.
Patricia Neumann R N M S, This document is in the public domain and may be used and reprinted without special. permission Citation of the source is appreciated,Suggested citation. Ganz DA Huang C Saliba D et al Preventing falls in hospitals a toolkit for improving quality. of care Prepared by RAND Corporation Boston University School of Public Health and ECRI. Institute under Contract No HHSA290201000017I TO 1 Rockville MD Agency for. Healthcare Research and Quality January 2013 AHRQ Publication No 13 0015 EF. Acknowledgments ix,Overview 1,The Problem of Falls 1. The Challenges of Fall Prevention 1,Toolkit Designed for Multiple Audiences 2. Implementation Guide Organized To Direct Hospitals Through the Change Process 3. Sections of the Guide 3,Adaptation of the Guide to Your Organization 3.
Improvement as Puzzle Pieces 4,1 Are you ready for this change 6. 1 1 Do organizational members understand why change is needed 6. 1 2 Is there urgency to change 8, 1 3 Does senior administrative leadership support this program 9. 1 4 Who will take ownership of this effort 11,1 5 What kinds of resources are needed 12. 1 6 What if you are not ready for full scale change 12. 1 7 Checklist for assessing readiness for change 13. 2 How will you manage change 14, 2 1 How can you set up the Implementation Team for success 15. 2 2 What needs to change and how do you need to redesign it 19. 2 3 How should goals and plans for change be developed 25. 2 4 Checklist for managing change 26, 3 Which fall prevention practices do you want to use 27.
3 1 Which fall prevention practices should you use 28. 3 2 What are universal fall precautions and how should they be implemented 30. 3 3 What is a standardized assessment of risk factors for falls and how should this. assessment be conducted 34, 3 4 How should identified risk factors be used for fall prevention care planning 38. 3 5 How should you assess and manage patients after a fall 46. 3 6 How can your hospital incorporate these practices into a fall prevention program 49. 3 7 What additional resources are available to identify best practices for fall prevention 51. 3 8 Checklist for best practices 51, 4 How do you implement the fall prevention program in your organization 52. 4 1 What roles and responsibilities will staff have in preventing falls 53. 4 2 What fall prevention practices go beyond the unit 59. 4 3 How do you put the new practices into operation 60. 4 4 Checklist for implementing best practices 67, 5 How do you measure fall rates and fall prevention practices 68. 5 1 How do you measure fall and fall related injury rates 69. 5 2 How do you measure fall prevention practices 77. 5 3 Checklist for measuring progress 80, 6 How do you sustain an effective fall prevention program 81. 6 1 Who will be responsible for sustaining active fall prevention efforts on. an ongoing basis 82, 6 2 How will you continue to monitor fall rates and fall prevention care processes 82.
6 3 What types of ongoing organizational support do you need to keep the new. practices in place 83,6 4 How can you reinforce the desired results 84. 6 5 Summary 87,7 Tools and Resources 89, Appendix Bibliography of Studies Implementing Fall Prevention Practices 185. Who Should Use The, Section Action Steps Tool That Supports Action Tool. Overview Enlist support of senior leaders Tool A Introduction and Overview for Senior manager. Stakeholders,Section 1 Are you ready for this change. 1 1 Assess the culture of safety in your Tool 1A Hospital Survey on Patient Safety Culture All interdisciplinary. hospital team members, 1 2 Evaluate current organizational Tool 1B Stakeholder Analysis Implementation Team.
attention to falls leader, 1 3 Assess and develop leadership Tool 1C Leadership Support Assessment Implementation Team. support for the fall prevention leader,program Tool 1D Business Case Form. 1 5 Identify resources that are available Tool 1E Resource Needs Assessment Implementation Team. and resources that are needed leader, 1 7 Assess your progress on completing Tool 1F Organizational Readiness Checklist Implementation Team. readiness for change activities leader,Section 2 How will you manage change. 2 1 Identify your Implementation Team Tool 2A Interdisciplinary Team Implementation Team. 2 2 Assess the current status of fall Tool 2B Quality Improvement Process Implementation Team. prevention activities in your leader individuals, hospital Tool 2C Current Process Analysis designated by the.
Tool 2D Assessing Current Fall Prevention Policies Implementation Team. and Practices leader, Determine staff knowledge about Tool 2E Fall Knowledge Test Staff nurses and. fall prevention nursing assistants, 2 3 Set goals for improvement based on Tool 2F Action Plan Implementation Team. outcomes and processes leader with quality,improvement safety ris. Who should use the, Section Action Steps Tool That Supports Action tool. 2 4 Assess your progress on completing Tool 2G Managing Change Checklist Implementation Team. the managing change activities leader, Section 3 Which fall prevention practices do you want to use.
3 1 Identify how fall prevention care Tool 3A Master Clinical Pathway for Inpatient Falls Quality. processes connect to one another improvement safety ris. k manager staff,nurses nursing,assistants, 3 2 Implement universal fall Tool 3B Scheduled Rounding Protocol Unit manager staff. precautions nurses nursing, Tool 3C Tool Covering Environmental Safety at the assistants facility. Bedside engineer hospital,employee who enters,Tool 3D Hazard Report Form patient rooms. Tool 3E Clinical Pathway for Safe Patient Handling. 3 3 Identify important risk factors for Tool 3F Orthostatic Vital Sign Measurement Staff nurses. falls in your patients pharmacist nursing, Tool 3G STRATIFY Scale for Identifying Fall Risk assistants. Tool 3H Morse Fall Scale for Identifying Fall Risk. Tool 3I Medication Fall Risk Scale and Evaluation, 3 4 Use identified fall risk factors to Tool 3J Delirium Evaluation Bundle Digit Span Educators staff nurses.
implement fall prevention care Short Portable Mental Status Questionnaire and physicians nurse. planning Confusion Assessment Method practitioners physician. assistants nursing, Tool 3K Algorithm for Mobilizing Patients assistants. Tool 3L Patient and Family Education,Tool 3M Sample Care Plan. 3 5 Assess and manage patients after a Tool 3N Postfall Assessment Clinical Review Staff nurses and. fall physicians,Tool 3O Postfall Assessment for Root Cause. Who should use the, Section Action Steps Tool That Supports Action tool. 3 8 Assess your progress on completing Tool 3P Best Practices Checklist Implementation Team. the best practices activities Leader, Section 4 How do you implement the fall prevention program in your organization.
4 1 Assign staff roles and Tool 4A Assigning Responsibilities for Using Best Implementation Team. responsibilities for tasks identified Practices Leader Unit manager. in set of best practices,Tool 4B Staff Roles, 4 3 Assess current staff education Tool 4C Assessing Staff Education and Training Implementation Team. practices and facilitate integration Leader,of new knowledge on fall. prevention into existing or new, 4 4 Assess your progress on Tool 4D Implementing Best Practices Checklist Implementation Team. implementing best practices Leader,activities, Section 5 How do you measure fall rates and fall prevention practices. 5 1 Collect the right data to learn about Tool 5A Information To Include in Incident Reports Quality. falls fall related injuries and their improvement risk. causes manager information,systems staff, 5 2 Measure fall prevention practices Tool 5B Assessing Fall Prevention Care Processes Unit manager and unit.
5 3 Assess your progress on measuring Tool 5C Measuring Progress Checklist Implementation Team. progress activities Leader, Section 6 How do you sustain an effective fall prevention program. 6 3 Identify factors need to sustain your Tool 6A Sustainability Tool Implementation Team. fall prevention efforts Leader,Acknowledgments, William Spector Ph D Senior Social Scientist at AHRQ acted as project officer for this task. order to develop a toolkit Rhona Limcangco Ph D Health Analyst at AHRQ provided. additional support in carrying out the project, The development of this toolkit was facilitated by the assistance of quality improvement teams at. six medical centers, Joyce Dolin Jena Reilly and Kendra Belkin at Charlton Memorial Hospital Fall River. Jerry Lockett Clover Irving Wiggins and Mariely Maldonado at Florida Hospital East. Orlando Orlando FL, Martha Syms Kelley Williams and Kaye McMullin at St Mary s Regional Medical.
Center Enid OK, Myka Whitman Emmet Polster and Amanda Mahaffee at Northwest Texas Hospital. Amarillo TX, Linda Gehring Marie Cicerone and Sarah Knuckles at Temple University Hospital. Philadelphia PA and, Pat Benson Michele Davis and Terry Bryan at Augusta Health Fishersville VA. We thank them for their valuable contributions, We also thank the authors of the evidence review that provided background information for this. toolkit Susanne Hempel Ph D Sydne Newberry Ph D Zhen Wang Ph D Paul G Shekelle. M D Ph D Roberta Shanman M S Breanne Johnsen and Tanja Perry. We thank Walid Gellad M D our internal peer reviewer as part of RAND s quality assurance. process for his constructive and detailed comments. We thank our technical expert panel Katherine Berg PT Ph D Sharon K Inouye M D. M P H Suzan N Kucukarslan R Ph Ph D Dale M Needham M D Ph D Julia B Neily. R N M S M P H Patricia Quigley A R N P Ph D Laurence Rubenstein M D M P H. Blair L Sadler J D Stephanie Studenski M D M P H and Catherine Cait Walsh R N. M S N for their advice on this document, We also thank Andrew Bernard M D and colleagues at University of Kentucky Medical Center.
and UK Healthcare Cynthia J Brown M D M S P H Patricia C Dykes D N Sc R N. F A A N F A C M I Anne M Drolet M S A N P B C C C R N Victoria Fraser M D. Terry Haines Ph D Frances Healey R N Ph D Serena Koh R N Ph D David Oliver M B. B Chir D G M D M E M H M M D M Sc M A F R C P and Ronald I Shorr M D. M S for sharing their advice and materials,The Problem of Falls. Each year somewhere between 700 000 and 1 000 000 people in the United States fall in the. hospital i A patient fall is defined as an unplanned descent to the floor with or without injury to. the patient ii A fall may result in fractures lacerations or internal bleeding leading to increased. health care utilization Research shows that close to one third of falls can be prevented iii As of. 2008 the Centers for Medicare Medicaid Services CMS does not reimburse hospitals for. certain types of traumatic injuries that occur while a patient is in the hospitaliv many of these. injuries could occur after a fall, Staff in acute care hospitals have a complex and potentially conflicting set of goals when treating. patients Hospital personnel need to treat the problem that prompted the patient s admission. keep the patient safe and help the patient to maintain or recover physical and mental function. Thus fall prevention must be balanced against other priorities Fall prevention involves. managing a patient s underlying fall risk factors e g problems with walking and transfers. medication side effects confusion frequent toileting needs and optimizing the hospital s. physical design and environment A number of practices have been shown to reduce the. occurrence of falls but these practices are not used systematically in all hospitals. The Challenges of Fall Prevention, Fall prevention requires an interdisciplinary approach to care Some parts of fall prevention c. Preventing Falls in Hospitals Checklist for assessing readiness for change How can your hospital incorporate these practices into a fall prevention program

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