Intervention Title:
Assessing Risk and Designing Tools to Reduce Falls – Seton Family of Hospitals, Austin, Texas

Goal:
Significantly reduce patient falls and injuries resulting from falls.

Innovation:
Staff developed a risk assessment protocol, identifying populations at risk and using prevention tools such as alerts and patient-care rounding.

Result:
Falls and injuries from falls have decreased, and staff is consistently meeting its goal of just two falls per 1,000 patient days.

Institution:
Seton Family of Hospitals
1601 Rio Grande #300
Austin, TX 78701
P: (512) 324-8925

From the experts:
“By providing a multidimensional prevention program, we have been able to significantly reduce patient falls and injuries. We have learned that accurately conducting risk assessment is the first step to successful prevention. Our staff now has pride in keeping a record of little to no falls.”

Nikki Rivers R.N., M.B.A.
Senior Director of Nursing, Seton Family of Hospitals

Profile:
The SetonFamily of Hospitals, a not-for-profit organization, is the leading provider of health care services in Central Texas, serving an 11-county population of 1.7 million.

Clinical areas affected:

• Medical surgical units

Staff involved:

• Nurses
• Physicians
• Quality department

Timeline:
Staff spent six months hardwiring the assessment tool, three months implementing the alerts and six to eight months implementing rounding.

Contact:
Mary A. Viney, R.N., M.S.N., C.N.A.A.-B.C.
Vice President Nursing Systems Network Accreditation
P: (512) 324-8925
mviney@seton.org

Innovation implementation:
Evaluation at Seton showed that patients were not being properly assessed for risk of falls. The hospital had been utilizing the Hendrich fall assessment tool to determine if patients could stand from a sitting position without using their hands, but many staff members conducting the tests were making assumptions about patients instead of actually observing. Scoring was not being done accurately, so staff was re-educated on how to properly score a patient through live demonstrations. By providing information on how to assess patients for falls, more patients were found to be at risk. Additionally, a new system allowed staff to segment their hospital population into three risk categories for falls—at risk, high risk and very high risk. Risk assessment is now conducted on admission and every 24 hours.

To alert providers and hospital staff to patients at risk, several alerts were put in place. Orange identification bracelets, red socks on patients and orange flags outside patient doors were all used to designate a patient at risk. These alerts also helped educate patients' families about the risks of falling, particularly when going from bed to bathroom. Since some patients at risk for falls still need to be mobile but require assistance, staff members were trained to assist these patients in ambulation instead of immediately having them sit down.

The higher-risk populations receive a visit from a staff member every two hours during rounds. Clinical assistants are assigned to make rounds to these patients and provide nutrition or assistance to the restroom. Patients at very high risk receive rounding every hour. By implementing a multipronged intervention, patients, caregivers and families have all become part of a team to prevent falls.

Advice and lessons learned:

1. Educate the entire care team. Make sure enough time is spent with team members from transportation, housekeeping and physical therapy who work with patients to ensure everyone is aware of fall alerts and understands them.
2. Don't underestimate the number of patients at risk. Education showed more patients at risk, and simple things like turning bed alarms back on after therapy must be reinforced.
3. Measurement is very important to the process and outcome. Talk to caregivers immediately after a fall to get key information about what led to the fall and how to prevent future falls.

Cost/benefit estimate:
Staff consistently meet the goal of two falls per 1,000 patient days. Staff maintained an injury rate of 0.1 per 1,000 patient days from November 2007 to January 2008.