Archive December 2017 XVIII, No. 12

4 Keys to Prevent Patient Falls

Keep your patients from taking a tumble.

Brielle Gregory

Brielle Gregory, Associate Editor


falls risk HOLD ON If a patient appears to be a falls risk, designate a nurse to help her get dressed and make it safely to her ride home after surgery.

The OR staff at the Hospital of the University of Pennsylvania (HUP) in Philadelphia, Pa., knew they were having too many patient falls: 9 in 2014 and 12 in 2015, a disturbing rise they attributed to the rise in outpatient surgeries and the challenges of caring for ambulatory patients as opposed to bedridden inpatients.

"We needed to ask questions more applicable to the outpatient setting," says Ann Marie Morris, MSN, RN, CNOR, HUP's nurse manager of perioperative quality and safety. Ms. Morris says that although each of their patient falls happened away from the operating table, they had a few near misses with patients on the OR table, too. "As soon as you let your guard down, you end up with a fall," she says.

And the patient falls were affecting more than just the hospital's numbers. "I think the nurses felt helpless," says Michael Ham, MSN, RN, CCRN, CPAN, HUP's perioperative clinical practice leader. So the OR staff did a department-wide analysis of the falls to identify trends. Then, they consulted with academic health centers, met with the hospital-wide falls committee and spoke with physical therapists about what strategies they should implement to avoid patient falls in the outpatient setting.

After instilling those strategies, the hospital saw a 44% reduction in patient falls from 2015 to 2016, with only 7 patient falls. In 2017, that number dropped to 4. "We are constantly reinforcing and identifying how and where we can be more diligent," says Ms. Morris.

Here are the 4 key ways HUP lowered its patient falls, and how you can, too.

1 Ask 3 questions to determine the patient's fall risk.

During pre-op, first ask, "Have you fallen more than once in the past year or hurt yourself in a fall?" Next, "Do you feel you are at risk of falling?" And finally, "Do you have trouble dressing, grooming or bathing?" If the patient answers "yes" to any of those 3 questions, that helps indicate whether you might need to take extra precautions to prevent a fall. It's also important to consider the physiologic effects of anesthesthetic agents and preparation for surgery, including NPO requirements, and how those factors impact a patient's fall risk.

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