11.25
Hdl Handle:
http://hdl.handle.net/10755/162669
Type:
Presentation
Title:
Preventing Falls in the Emergency Department: A Program that Works
Abstract:
Preventing Falls in the Emergency Department: A Program that Works
Conference Sponsor:Emergency Nurses Association
Conference Year:2007
Author:Rosenthal, Anna, RN, MS
P.I. Institution Name:Stony Brook University Medical Center
Title:Nurse Manager ? Emergency Department
Contact Address:Nicolls Rd., Stony Brook, NY, 11794, USA
Contact Telephone:(631) 444-6972
Co-Authors: Eileen Dowdy, RN
[Clinical Poster] Clinical Topic: Falls represent the leading cause of accidental death in people age 65 and older and are a common occurrence among hospital patients of all ages. The busy, fast-paced emergency department (ED) creates an especially high-risk area for falls, yet little research exists on preventing falls in the emergency department. In 2005, this Level I trauma center with 75,000 visits a year recorded an average of 1.3 falls per month for all ED patients, 31% of which resulted in patient injury. We found this statistic unsatisfactory and, in 2006, ED nurses and other ED staff, along with representatives from risk management and quality management formed a multidisciplinary team to identify best strategies to reduce falls in our ED. Our goal was to achieve a fall rate of zero within 12 months.

Implementation: In early 2006, after studying alternative approaches, a task force of physicians, registered nurses, clinical assistants, and nursing station clerks choose to adapt the Hendrich II Fall Risk Model for use in triage. This widely used, evidence-based fall risk assessment had already proven itself effective in the hospital's in-patient areas. Patients are assessed for the presence of risk factors, including confusion, depression, altered elimination, dizziness, use of anticoagulants or benzodiazepines, and gender. Each risk factor is assigned weighted risk points. For example, four points are assigned if the patient seems confused, one point is assigned if the patient is male, and so on. If risk factors add up to a score of five or greater, fall precautions are implemented. Safety watch sitters are assigned to any patient with a score of five or greater who also seems agitated, confused, or is uncooperative. For all "at-risk" patients, triage nurses check the "fall risk" box on the ED record and identify patients with an orange wrist band. An orange sign also is placed on the stretcher side rail, which reads: "Patient is at risk for falls. Please keep side rails in the up position." High-risk patients are placed on 1:1 observation or on a safety watch, as appropriate, and patients and family members are educated on the importance of these measures to keep patients safe. All personnel who interact with ED patients, including nurses, clinical assistants, transporters, physicians, physician assistants, residents, and radiology technicians attended a one-hour-training session with ED educators to familiarize them with the new system, and the training is now incorporated into orientation for all new ED personnel. To foster compliance, staff receives monthly updates on their individual performance. Staff members that do not comply are reeducated about the importance of the program. An ED quality improvement coordinator evaluates fall data monthly to determine opportunities for improvement. The results of these assessments are reviewed at monthly staff meetings and posted on the staff quality improvement board.

Outcomes: The implementation of the program and education process itself has resulted in heightened staff awareness of fall prevention. Since the program's inception in February 2006 to evaluation of data in April 2007, ED falls have decreased from 1.3 falls per month to an average of 0.2 falls per month, for an overall decline of 85%. Of the falls that did occur, none have resulted in patient injury. Prior to the program's implementation, staff members unfamiliar with a patient were unable to know if the patient was at risk for a fall. Now, the bright orange signs at bedside alert everyone that the patient is a fall risk. Some staff nurses expressed skepticism about adapting an in-patient assessment for use in the emergency department, but were willing to comply once they realized it took only seconds to complete the assessment. To move closer to the goal of zero falls, a check box was added to the triage record, marked "fall precautions" to remind nurses to place patients on fall precautions. To date, nurses report satisfaction with the program and helping keep their patients safe by preventing falls. High-risk patients express feeling safer having a sitter assigned to them, and their family members feel reassured knowing a companion is available to sit with them after visiting hours.

Recommendations: Emergency departments that have not yet done so should assess the incidence of patient falls in their department and take measures to correct any problems. By implementing a few simple changes, emergency departments can significantly cut the risk of falls and unnecessary injuries to their patients. Indeed, creating a safe patient environment begins in triage, with early identification of at-risk patients and setting in place appropriate measures based on evidence based procedures that work.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titlePreventing Falls in the Emergency Department: A Program that Worksen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162669-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Preventing Falls in the Emergency Department: A Program that Works</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2007</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Rosenthal, Anna, RN, MS</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Stony Brook University Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Nurse Manager ? Emergency Department</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">Nicolls Rd., Stony Brook, NY, 11794, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(631) 444-6972</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">anna.rosenthal@sunysb.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value"> Eileen Dowdy, RN</td></tr><tr><td colspan="2" class="item-abstract">[Clinical Poster] Clinical Topic: Falls represent the leading cause of accidental death in people age 65 and older and are a common occurrence among hospital patients of all ages. The busy, fast-paced emergency department (ED) creates an especially high-risk area for falls, yet little research exists on preventing falls in the emergency department. In 2005, this Level I trauma center with 75,000 visits a year recorded an average of 1.3 falls per month for all ED patients, 31% of which resulted in patient injury. We found this statistic unsatisfactory and, in 2006, ED nurses and other ED staff, along with representatives from risk management and quality management formed a multidisciplinary team to identify best strategies to reduce falls in our ED. Our goal was to achieve a fall rate of zero within 12 months. <br/><br/>Implementation: In early 2006, after studying alternative approaches, a task force of physicians, registered nurses, clinical assistants, and nursing station clerks choose to adapt the Hendrich II Fall Risk Model for use in triage. This widely used, evidence-based fall risk assessment had already proven itself effective in the hospital's in-patient areas. Patients are assessed for the presence of risk factors, including confusion, depression, altered elimination, dizziness, use of anticoagulants or benzodiazepines, and gender. Each risk factor is assigned weighted risk points. For example, four points are assigned if the patient seems confused, one point is assigned if the patient is male, and so on. If risk factors add up to a score of five or greater, fall precautions are implemented. Safety watch sitters are assigned to any patient with a score of five or greater who also seems agitated, confused, or is uncooperative. For all &quot;at-risk&quot; patients, triage nurses check the &quot;fall risk&quot; box on the ED record and identify patients with an orange wrist band. An orange sign also is placed on the stretcher side rail, which reads: &quot;Patient is at risk for falls. Please keep side rails in the up position.&quot; High-risk patients are placed on 1:1 observation or on a safety watch, as appropriate, and patients and family members are educated on the importance of these measures to keep patients safe. All personnel who interact with ED patients, including nurses, clinical assistants, transporters, physicians, physician assistants, residents, and radiology technicians attended a one-hour-training session with ED educators to familiarize them with the new system, and the training is now incorporated into orientation for all new ED personnel. To foster compliance, staff receives monthly updates on their individual performance. Staff members that do not comply are reeducated about the importance of the program. An ED quality improvement coordinator evaluates fall data monthly to determine opportunities for improvement. The results of these assessments are reviewed at monthly staff meetings and posted on the staff quality improvement board.<br/><br/>Outcomes: The implementation of the program and education process itself has resulted in heightened staff awareness of fall prevention. Since the program's inception in February 2006 to evaluation of data in April 2007, ED falls have decreased from 1.3 falls per month to an average of 0.2 falls per month, for an overall decline of 85%. Of the falls that did occur, none have resulted in patient injury. Prior to the program's implementation, staff members unfamiliar with a patient were unable to know if the patient was at risk for a fall. Now, the bright orange signs at bedside alert everyone that the patient is a fall risk. Some staff nurses expressed skepticism about adapting an in-patient assessment for use in the emergency department, but were willing to comply once they realized it took only seconds to complete the assessment. To move closer to the goal of zero falls, a check box was added to the triage record, marked &quot;fall precautions&quot; to remind nurses to place patients on fall precautions. To date, nurses report satisfaction with the program and helping keep their patients safe by preventing falls. High-risk patients express feeling safer having a sitter assigned to them, and their family members feel reassured knowing a companion is available to sit with them after visiting hours.<br/><br/>Recommendations: Emergency departments that have not yet done so should assess the incidence of patient falls in their department and take measures to correct any problems. By implementing a few simple changes, emergency departments can significantly cut the risk of falls and unnecessary injuries to their patients. Indeed, creating a safe patient environment begins in triage, with early identification of at-risk patients and setting in place appropriate measures based on evidence based procedures that work.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:32:08Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:32:08Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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