Presented by: Angela Greetham, Bay of Plenty DHB
at OHSIG 2014, Thursday 11/9/14, Limelight Room 1, 11.15am
Video URLs:
HQSC on fall prevention: www.youtube.com/watch?v=NdO7JCXJBO4
In the presentation, a summary of initiatives to be taken by hospitals in different areas for patient safety have been described for the knowledge, practices and implementation of patient safety initiative by hospital managers/Administrators.
Patient safety and Risk Management in hospitalsAvanti Kulkarni
The presentation is about ensuring the safety of patients by installing controls, preventive techniques and assuring optimal quality of care in the hospital setting.
Das: Physical Health in the In-Patient Mental Health Settinghenkpar
Wonca Working Party on Mental Health
World mental Health Day
presentation Dr Mrigendra Das (UK)
Physical Health in the In-Patient Mental Health Setting
Presented by: Angela Greetham, Bay of Plenty DHB
at OHSIG 2014, Thursday 11/9/14, Limelight Room 1, 11.15am
Video URLs:
HQSC on fall prevention: www.youtube.com/watch?v=NdO7JCXJBO4
In the presentation, a summary of initiatives to be taken by hospitals in different areas for patient safety have been described for the knowledge, practices and implementation of patient safety initiative by hospital managers/Administrators.
Patient safety and Risk Management in hospitalsAvanti Kulkarni
The presentation is about ensuring the safety of patients by installing controls, preventive techniques and assuring optimal quality of care in the hospital setting.
Das: Physical Health in the In-Patient Mental Health Settinghenkpar
Wonca Working Party on Mental Health
World mental Health Day
presentation Dr Mrigendra Das (UK)
Physical Health in the In-Patient Mental Health Setting
Fall-related injuries can be some of the most common, disabling, and expensive health conditions encountered by adults, especially older adults. According to researcher Janice Morse, approximately 14% of all falls in hospitals are accidental, another 8% are unanticipated and 78% are anticipated falls. Guideline to prevent falls in the hospital has helped to bring down the numbers and improve patient safety.
Fall-related injuries can be some of the most common, disabling, and expensive health conditions encountered by adults, especially older adults. According to researcher Janice Morse, approximately 14% of all falls in hospitals are accidental, another 8% are unanticipated and 78% are anticipated falls. Guideline to prevent falls in the hospital has helped to bring down the numbers and improve patient safety.
Simple and Safe Approaches Towards Patient SafetyEhi Iden
A conference presentation on simple approaches and steps in achieving and managing patient safety in health. It talks about team approach, mutual support, just system, leadership commitment, complications of blame game and case study of the popular Kimberly Hiatt story.
Fall preventionApplying the evidence By Kathleen Fowier, MS.docxnealwaters20034
Fall prevention:
Applying the evidence By Kathleen Fowier, MSN, RN, CMSRN Quality Improvement Manager
UPMC St. Margaret, Pittsburgh, Pennsylvania
As told to Janet Boivin, BSN, RN
S u c c e s s f u l fall pre
vention program s use m u lti
m odal interventions, such as detailed
fall risk assessments, fre q u e n t m o n ito rin g by
staff, and a p p ro p ria te use o f equipm en t. Healthcare
facilities typically im p le m e n t best practices in b un
dles, m aking it often d iffic u lt to determ ine which in
terventions are the m ost effective.
UPMC St. M argaret Hospital in Pittsburgh, Penn
sylvania jo in e d the Pennsylvania Hospital Engage
m ent N etw ork (PA HEN) in A pril 2012 to reduce
falls w ith injury. This set us on a path th a t resulted
in a 75% reduction in falls w ith serious injuries.
(See graph.) Here is how we accom plished this
reduction.
Analysis: Role of data and best practices
A fte r jo in in g PA HEN, we fo rm e d a m ultidisciplinary
team tasked w ith review ing and investigating all fall
events, extracting and analyzing data, and evaluat
ing best practices im p le m e n te d as a result o f root
cause analysis.
Case study
This case study illustrates our fall team in action
An 80-year-old fem ale p a tie n t w ith im paired cognitive
function and m u ltip le risk factors— including an
unsteady gait, im paired vision, and m u ltiple
m edications— was assessed as a high fall risk when
a d m itte d to our facility.
The nursing staff im plem ented a bed alarm to alert
them when the p a tie n t was g e ttin g up w ith o u t using
the call light. They also m oved her closer to the nurse's
station and used purposeful rounding to anticipate and
attend to her needs. The average response tim e fo r
alerts w ith this p a tie n t was a rapid 10 seconds. D espite
these steps, the patient's bed alarm sounded several
tim es to alert staff, who fou n d her standing beside
the bed.
The nurses reached o u t to the fall team fo r support.
The team reviewed th e bed-alarm
settings (three sensitivity settings— low,
m edium , and high) and sim ulated alarm
tim e studies w ith the nursing staff. Their
efforts revealed m isperceptions in
em ployee understanding o f bed-alarm
settings. For example, the staff th o u g h t
the bed alarm w ould alert them th a t the
p a tie n t was o ff the p e rim e te r o f the
mattress no m atter what the sensitivity
setting.
The fall team used sim ulated bed-alarm
scenarios to educate the staff and help
to change practice. The nursing staff
learned it's not enough to sim ply engage
the alarm; the alarm also needs to be at the
a p p ropriate setting. The staff began using more
sensitive settings fo r patients w ith im pulsive behaviors.
We learned an im p o rta n t lesson: How well em ployees
understand facility equipm ent, its variations, and how
to use it are im p o rta n t considerations when analyzing
p a tie .
Fall preventionApplying the evidence By Kathleen Fowier, MS.docxmglenn3
Fall prevention:
Applying the evidence By Kathleen Fowier, MSN, RN, CMSRN Quality Improvement Manager
UPMC St. Margaret, Pittsburgh, Pennsylvania
As told to Janet Boivin, BSN, RN
S u c c e s s f u l fall pre
vention program s use m u lti
m odal interventions, such as detailed
fall risk assessments, fre q u e n t m o n ito rin g by
staff, and a p p ro p ria te use o f equipm en t. Healthcare
facilities typically im p le m e n t best practices in b un
dles, m aking it often d iffic u lt to determ ine which in
terventions are the m ost effective.
UPMC St. M argaret Hospital in Pittsburgh, Penn
sylvania jo in e d the Pennsylvania Hospital Engage
m ent N etw ork (PA HEN) in A pril 2012 to reduce
falls w ith injury. This set us on a path th a t resulted
in a 75% reduction in falls w ith serious injuries.
(See graph.) Here is how we accom plished this
reduction.
Analysis: Role of data and best practices
A fte r jo in in g PA HEN, we fo rm e d a m ultidisciplinary
team tasked w ith review ing and investigating all fall
events, extracting and analyzing data, and evaluat
ing best practices im p le m e n te d as a result o f root
cause analysis.
Case study
This case study illustrates our fall team in action
An 80-year-old fem ale p a tie n t w ith im paired cognitive
function and m u ltip le risk factors— including an
unsteady gait, im paired vision, and m u ltiple
m edications— was assessed as a high fall risk when
a d m itte d to our facility.
The nursing staff im plem ented a bed alarm to alert
them when the p a tie n t was g e ttin g up w ith o u t using
the call light. They also m oved her closer to the nurse's
station and used purposeful rounding to anticipate and
attend to her needs. The average response tim e fo r
alerts w ith this p a tie n t was a rapid 10 seconds. D espite
these steps, the patient's bed alarm sounded several
tim es to alert staff, who fou n d her standing beside
the bed.
The nurses reached o u t to the fall team fo r support.
The team reviewed th e bed-alarm
settings (three sensitivity settings— low,
m edium , and high) and sim ulated alarm
tim e studies w ith the nursing staff. Their
efforts revealed m isperceptions in
em ployee understanding o f bed-alarm
settings. For example, the staff th o u g h t
the bed alarm w ould alert them th a t the
p a tie n t was o ff the p e rim e te r o f the
mattress no m atter what the sensitivity
setting.
The fall team used sim ulated bed-alarm
scenarios to educate the staff and help
to change practice. The nursing staff
learned it's not enough to sim ply engage
the alarm; the alarm also needs to be at the
a p p ropriate setting. The staff began using more
sensitive settings fo r patients w ith im pulsive behaviors.
We learned an im p o rta n t lesson: How well em ployees
understand facility equipm ent, its variations, and how
to use it are im p o rta n t considerations when analyzing
p a tie .
Nursing Practice Field Experience Essay
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Capstone Project Change Proposal Presentation for Faculty Review a.docxbartholomeocoombs
Capstone Project Change Proposal Presentation for Faculty Review and Feedback
Assessment Description
Create a 10-15 slide Power Point presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated. Submit the presentation in the digital classroom for feedback from the instructor.
PICOT Question (See other file uploaded)
Interventions
Falling incidences can cause several complications, including health care costs, severe health issues, immobility, etc. With the severity of this issue, appropriate interventions should take place. In this context, proper monitoring is one of the significant interventions to prevent this incidence (Huang et al., 2020). Hence, incorporating educated and efficient technicians while providing patient care can be an essential step. Yet, due to decreased mobility or functionality, older people often require help in doing basic activities, in this aspect, providing help to the patients while changing to hospital-approved gowns (Liu-Ambrose et al., 2019). In addition, one significant and effective intervention is providing quick education to the patient regarding fall prevention strategies (Radecki, Reynolds & Kara, 2018). Another critical aspect is providing a safe environment for clinical care. Outpatient clinics should improve their workflow and environmental condition, such as removing hazardous materials, and keeping the floor clean and dry, so that the clinic can provide a safe area for older patients. These interventions can help prevent falls (Guirguis-Blake et al., 2018).
Benchmark - Capstone Change Project Objectives
1. Prevent elderly falls in an outpatient radiology clinic.
Rationale: Falls occur as age advances due to individual risk factors or environmental factors. For example, gait or balance deficits, chronic conditions, medications, and footwear the patient is wearing. Assisting these patient populations can prevent falls in the department.
2. Educate patients and people in the community on how to prevent falls.
Rationale: Educate patients regarding physical changes and chronic health conditions that cause or probability of falls.
3. Provide a safe environment for clinical care in the outpatient clinical setting.
Rationale: Design the clinical area accessible to patients in wheelchairs, with assistive devices, and with mobility deficits. Have handrails on walls and hallways for support, clean, non-skid floors, and lighted pathways in hallways, rooms, and bathrooms.
4. A patient care technician (PCT) is available in the outpatient clinical area for patients.
Rationale: Having a PCT in the clinical area, especially around the dressing rooms, would benefit the patients needing help when changing to hospital-approved gowns and monitoring patients for risk.
Malignant Mixed Mullerian Tumor – Case Reports and Review ArticleApollo Hospitals
Malignant mixed mullerian tumors are very rare genital tumors. They are biphasic neoplasms composed of an admixture of malignant epithelial and mesenchymal elements. In descending order of frequency they originate in the uterus, ovaries, fallopian tubes, cervix and vagina. Also they arise denovo from peritoneum. They are highly aggressive and tend to occur in postmenopausal low parity women. Because of rarity, there is as such no treatment guidelines available. Multimodality treatment in the form of radical surgery followed by adjuvant chemotherapy or radiotherapy or combined chemoradiation gives a better prognosis & outcome. Two case reports of such tumors, one from ovary and other from penitoneum are presented along with the review of literature.
Intra-Fetal Laser Ablation of Umbilical Vessels in Acardiac Twin with Success...Apollo Hospitals
To interrupt blood supply to the acardiac twin in a case of TRAP sequence of monochorionic diamniotic multiple pregnancy to allow for continuation of the normal twin.
Breast Cancer in Young Women and its Impact on Reproductive FunctionApollo Hospitals
Breast cancer is the most common cancer in women in developed countries. Chemotherapy for breast cancer is likely to negatively impact on reproductive function. We review current treatment; effects on reproductive function; breastfeeding and management of menopausal symptoms following breast cancer.
Turner syndrome (gonadal dysgenesis) is one of the most common chromosomal abnormalities occuring 1 in 2500 to 1 in 3000 live-born girls. It is an important cause of short stature in girls and primary amenorrhea in young women that is usually caused by loss of part or all of an X chromosome. This review briefly summarises the current knowledge about the syndrome and the management strategies.
Due to pregnancy thyroid economy is affected with changes in iodine metabolism, TBG and development of maternal goiter. The incidence of hypothyroidism in pregnancy is quite common with autoimmune hypothyroidism being the most important cause. Overt as well as subclinical hypothyroidism has a varied impact on maternal and neonatal outcome. After multiple studies also, routine screening in pregnancy for hypothyroidism can still not be recommended. Management mainly comprises of dosage adjustments as soon as pregnancy is diagnosed based on results of thyroid function tests. The aim should be to keep FT4 at the upper end of normal range.
Growth Hormone Deficiency (GHD) can persist from childhood or be newly acquired. Confirmation through stimulation testing is usually required unless there is a proven genetic/structural lesion persistent from childhood. Growth harmone (GH) therapy offers benefits in body composition, exercise capacity, skeletal integrity, and quality of life measures and is most likely to benefit those patients who have more severe GHD. The risks of GH treatment are low. GH dosing regimens should be individualized. The final decision to treat adults with GHD requires thoughtful clinical judgment with a careful evaluation of the benefits and risks specific to the individual.
Advances in the management of thalassemia have led to marked improvements in the life span and quality of life of children and young adults. This poses new challenges for the treating physicians. There is now increasing recognition that thalassemics have impaired bone health which is multifactorial in etiology. This paper aims to highlight the factors that predispose these patients to osteoporosis and suggests measures to minimise the impact on bone health.
Laparoscopic Excision of Foregut Duplication Cyst of StomachApollo Hospitals
Retroperitoneal gastric duplication cysts lined by ciliated columnar epithelium are extremely rare lesions and its presentation during adulthood is a diagnostic challenge for treating clinicians. This entity often resembles cystic pancreatic neoplasm, retroperitoneal cystic lesions and sometimes as an adrenal cystic neoplasm. Correct diagnosis on the basis of radiological investigation is difficult and histopathologic analysis. We report a case of gastric duplication cyst in a 16year old girl that mimicked as a retroperitoneal /pancreatic /adrenal cystic lesion and was successfully managed by laparoscopy.
Occupational Blood Borne Infections: Prevention is Better than CureApollo Hospitals
Viral infections like HIV, hepatitis Band C virus pose a big risk to the contacts of individuals with high risk behaviour as well as to the attending health care workers. Blood, semen, vaginal and other potentially infectious materials can transmit the infection to the susceptible contacts. Universal precautions should be strictly implemented during clinical examination, laboratory work and surgical procedures to prevent transmission to the health care providers. Health care workers should receive vaccination for hepatitis B infection. An inadvertent exposure should be managed with proper first aid and infectivity of the source and severity of exposure should be assessed. Severity of exposure is based on the nature and area of exposed surface, mode of injury and volume of infective material. Post-exposure prophylaxis (PEP) should be started as soon as possible after a proper counseling about the effectiveness of post-exposure prophylaxis, side effects and risk of carrying the infection to his familial contacts and its prevention.
Evaluation of Red Cell Hemolysis in Packed Red Cells During Processing and St...Apollo Hospitals
Storage of red cells causes a progressive increase in hemolysis. Inspite of the use of additive solutions for storage and filters for leucoreduction some amount of hemolysis is still inevitable. The extent of hemolysis however should not exceed the permissible threshold for hemolysis even on the 42nd day of storage.
Efficacy and safety of dexamethasone cyclophosphamide pulse therapy in the tr...Apollo Hospitals
Various drugs used to treat pemphigus can cause remission, but none can provide permanent remission as relapses are common. With the introduction of DCP in pemphigus in 1984, patients started being in prolonged/permanent remission. This study was done to compare the efficacy of DCP to oral corticosteroids and cyclophosphamide in combination.
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)Apollo Hospitals
Severe skin adverse drug reactions can result in death. Toxic epidermal necrolysis (TEN) has the highest mortality (30–35%); Stevens-Johnson syndrome and transitional forms correspond to the same syndrome, but with less extensive skin detachment and a lower mortality (5–15%). Hypersensitivity syndrome, sometimes called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), has a mortality rate evaluated at about 10%. It is characterised by fever, rash and internal organ involvement. Prompt diagnosis is vital, along with identification and early withdrawal of suspect medicines and avoidance of re-exposure to the responsible agent is essential. Cross-reactivity to structurally-related syndrome caused by Carbamazepine medicines is common, thus first-degree relatives may be predisposed to developing this syndrome. We report a case of DRESS secondary to use of Carbamazepine.
Difficult Laparoscopic Cholecystectomy-When and Where is the Need to Convert?Apollo Hospitals
Laparoscopic cholecystectomy has now become the treatment of choice for the gall bladder stone. With increasing experience, surgeon has started to take more difficult cases which were considered relative contra indications for laparoscopic removal of gall bladder few years back.
We conducted this study at our hospital and included all laparoscopic cholecystectomy done from May'08 to January'10. Total time taken in surgery, conversion rate and complication rate were analysed. Factors making laparoscopic cholecystectomy difficult were also analysed. We defined difficult laparoscopic cholecystectomy when we found -dense fibrotic adhesions in and around Callot's triangle, gangrenous gall bladder, empyma, large stone impacted at gall bladder neck, contracted gall bladder, Mirrizi's syndrome, h/o biliary pancreatitis, CBD stones, acute cholecystitis of <72 hrs duration.
Out of 206 cases done during above period, 56 cases were considered difficult. Only two cases were converted to open.
With growing experience and technical advancement surgery can be completed in most of the difficult cases. This is important because recently it is shown in literature that laparoscopic cholecystectomy is associated with less morbidity than open method irrespective of duration of the surgery.
Deep vein thrombosis prophylaxis in a tertiary care center: An observational ...Apollo Hospitals
Deep vein thrombosis (DVT) is a major health problem with substantial mortality and morbidity in medically ill patients. Prevention of DVT by risk factor stratification and subsequent antithrombotic prophylaxis in moderate- to severe-risk category patients is the most rational means of reducing morbidity and mortality.
The spread of dengue and dengue haemorrhagic fever is increasing, atypical manifestations are also on the rise, although they may be under reported because of lack of awareness. We report two such cases of dengue hemorrhagic fever with hepatitis, intraocular hemorrhage, ARDS and myocarditis.
A 71-year-old male presented in ENT department with dysphagia for last three weeks, more to solids than liquids. He had a hard bony bulge in the posterior pharyngeal wall on palpation and hence was referred for an Orthopaedic opinion. Lateral radiograph of the cervical spine revealed diffuse ossification of the anterior longitudinal ligament. This ossification was extending almost half the width of the cervical body from its anterior body at C1 and C2 vertebra level.
Pediatric Liver Transplant (LT) is now an established procedure for End Stage Liver Disease (ESLD) with biliary atresia being the commonest indication. Intensive pre-transplant evaluation, nutritional buildup and immunization are the fundamental pre-requisites of a successful LT. With improvement in surgical micro-anastomotic techniques and superior immunosuppressive regimens the success rate of pediatric LT is in excess of 90%. Most of the transplants in our country however are Living related, due to which a fairly large number of children expire awaiting a donor liver. There should be a concerted effort to evolve the cadaveric donation program, so that majority of the children are benefitted.
2. Quality in Health
Prevention of patient falls e A case study
Gaurav Loria a,b,
*, Ankita Bhargava c
a
Coordinator Quality, Apollo Group, Jubilee Hills, Hyderabad, India
b
National Head Quality, Jubilee Hills, Hyderabad, India
c
Executive Quality, Apollo Hospitals, Hyderabad, India
a r t i c l e i n f o
Article history:
Received 23 January 2013
Accepted 18 February 2013
Available online 28 February 2013
Keywords
Patient safety
Precautions
Morse fall risk scale
Root cause analysis
a b s t r a c t
Fall-related injuries can be some of the most common, disabling, and expensive health
conditions encountered by adults, especially older adults. According to researcher Janice
Morse, approximately 14% of all falls in hospitals are accidental, another 8% are unantic-
ipated and 78% are anticipated falls. Guideline to prevent falls in the hospital has helped to
bring down the numbers and improve patient safety.
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Patient falls: introduction
Patient falls have been identified by the Joint Commission as
one of the top five sentinel events for home care organizations
in its December 2003 sentinel event report.1
According to the
researcher Janice Morse, approximately 14% of all falls in
hospitals are accidental, another 8% are unanticipated and
78% are anticipated falls.2
Fall-related injuries can be some of the most common,
disabling, and expensive health conditions encountered by
adults, especially older adults.
The number of persons above the age of 60 years is fast
growing, especially in India. India as the second most popu-
lous country in the world has 76.6 million people at or over the
age of 60, constituting above 7.7% of total population. The
problems faced by this segment of the population are
numerous owing to the social and cultural changes that are
taking place within the Indian society.3
Every year thousands of cases of patient falls are reported
which majorly comprise of the elderly.
Main reasons for falls:
Lack of staff communication, orientation and training
No proper patient’s assessment
Physical environment
Care planning
Organization culture
Vulnerable patients are mainly those who are more
susceptible to a fall when admitted in a hospital like
patients above 65 years old (geriatrics), children less than
16 years of age (pediatrics), patients who are physically/
mentally challenged or patients who cannot perform acts of
daily living.
For effective management of such patients, five balancing
steps are required. These are:
* Corresponding author. Coordinator Quality, Apollo Group, Jubilee Hills, Hyderabad, India.
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/apme
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 1 7 5 e1 8 0
0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2013.02.006
3. 1. Determine the vulnerability of the patient and identify them
2. Patient First program or a special program to be
implemented
3. Frequent assessments and reassessments
4. Specific therapy
5. Supportive care
Team composition: Quality Systems and Nursing in
charges.
2. Objectives of study
To study the trend of patient falls in the hospital
To trace the causes of falls
To make necessary interventions to reduce the fall rate
To improve patient safety by introducing practices to pre-
vent falls
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 1 7 5 e1 8 0176
4. 3. The process flow/guideline for fall
prevention
Fall and fall-related injury outcome measures
4. Assessment parameters
1. Number of patient falls per month
2. Patient fall rate
3. Percentage of patients who were classified under ‘low risk’
but had a fall
Key tasks: Modified Morse fall Risk Assessment was
made a part of the admission record. A separate sheet was
also designed and circulated in all Outpatient and Day
Care Areas to ensure the assessments of the patients.
Training of the nursing team was done by the Quality
Team.
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 1 7 5 e1 8 0 177
5. Interventions annexure4
Interventions High Moderate Low
Patient
education
- Orient patient to surroundings and hospital routines
- Orient patient about the call bells and make sure patient
is able to use it
- Instruct patient to call for help before getting out of bed.
- Instruct the patient and family about the significance of
fall prevention program
- Teach patient to use grab bars
- Discuss toileting needs of the patient and implement
bowel and bladder program if necessary
- Instruct the patient on side effects of drugs
- Orient patient to surroundings and hospital routines
- Orient patient about the call bells and make sure patient
is able to use it
- Instruct patient to call for help before getting out of bed
- Instruct the patient and family about the significance of
fall prevention program
- Teach patient to use grab bars
- Orient patient to surroundings and hospital routines
- Orient patient about the call bells and make sure patient
is able to use it
Nursing Place Patient First Card bed side
Side Rails Always Up
Lock all moveable
Equipment before transferring
Provide adequate lighting
Place Bed Pan/urinal within easy reach
Position the bed at low level with brakes locked/position
the foot stool in place
Communication Board Placement
Place assist devices within reach
Develop a schedule for turning and positioning
Increase frequency of patient rounds
Instruct housekeeping supervisor to keep pathway clear
from obstacles and keep toilet floor dry
Consider obtaining doctors order for physiotherapy
consult
Place Patient First Card bed side
Lock all moveable equipment before transferring
Provide adequate lighting
Place Bed Pan/urinal within easy reach
Position the bed at low level with brakes locked/position
the foot stool in place
Place Patient First Card bed side
Side Rails Always UP
Lock all moveable equipment before transferring
Provide adequate lighting
Documentation Vital signs recording as per orders
Assess patient’s condition in his ability to do acts of daily
living (ADL)
Physical restraints ordered
Physical therapy as ordered
Document the falls in incident report form and inform
Medical Head
Vital signs recording as per orders
Assess patient’s condition in his ability to do acts of daily
living (ADL)
Physical restraints ordered
Physical therapy as ordered
Document the falls in incident report form and inform
Medical Head
Vital signs recording as per orders
Assess patient’s condition in his ability to do acts of daily
living (ADL)
Physical restraints ordered
Physical therapy as ordered
Document the falls in incident report form and inform
Medical Head
Medication Minimize the use of medications that alter mental status.
Use alternatives to sleeping medications
Dispense diuretics before afternoon/evening
Treat pain
Screen and treat for hypoxia
Assess the clinical status of delirious patients to rule out
reversible etiologies
Promote mobility and fitness
Minimize the use of medications that alter mental status.
Use alternatives to sleeping medications
Dispense diuretics before afternoon/evening
Minimize the use of medications that alter mental status.
Use alternatives to sleeping medications
Dispense diuretics before afternoon/evening
Reassessments Every hour Frequent Every day
apollomedicine10(2013)175e180178
6. 5. The falls project
The project was implemented as a pilot for a week wherein
few departments were covered. The success in the pilot
project helped us to implement the same initiative all across
the hospital.
Data collection: The patient fall-related incidents
were reported to the Quality Team by Incident Forms.
These forms were the source of information of the falls
which were further analyzed through Root Cause Analysis
(RCA).
Sustainability initiatives: The completion of the form was
also checked through the Wake Up Call Rounds and reported
to the Nursing Heads. Continuous surveys and surprise checks
for documentation compliance and equipment safety were
carried out to ensure safety.
Patient and Family Education (PFE) was an integral part of
the whole process. Handbooks were introduced which helped
in explaining the patients and attendants better.
Improvement: Before taking up the project, our patient
falls were about 7 in the first six months (JaneJun 2011).
With vigorous training of the staff the incidents reporting
also improved and the number of falls reported was high
in the next six months (JulyeDec 2011). The following
six months (JaneJun 2012) the numbers came down dras-
tically which was a result of PFE and vigorous staff
training.
Findings/Results:
Findings JanuaryeJune 2011 JulyeDecember 2011 JanuaryeJune 2012
Number of falls 7 14 4
Reasons Patient fell in bathroom
(no assistance)
Patient ambulating to bathroom
Patient fell from bed
Patient’s physiological condition
Broken chair
Patient fell in bathroom (wet floor)
Patient fell in the bathroom
(no assistance)
Patient slipped in the room
Patient’s physiological condition
Patient’s physiological
condition
Patient fell from the bed
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 1 7 5 e1 8 0 179
7. The number of patient falls per 1000 discharges were found
to be well within the benchmarked limits.
It was also found that of all the patients who had a fall
21% were already categorized by the nursing staff as one
vulnerable to fall while 42% at a moderate risk and 37% at a
low risk.
The major reasons for fall were also analyzed after
completing a detailed review of every fall. The major reasons
ranged from patient’s fall from the bed to his physiological
condition to a fall in the bathroom at night.
It was also observed that maximum patient falls happened
at night (between 1 am and 4 am) when patients try to go
unassisted to the toilet without informing anyone (even the
attendant).
6. Conclusion
The implementation of the guideline has brought some
important outcomes.
The number of falls have been varying from 0 falls to 5 falls
per month. The staff has been trained on prevention and
management of falls. The Patient and Family Education has
been stressed upon with the bilingual patient education
booklets and flip charts.
Patient falls have happened due to various reasons of which
patientfallsinthebathroomandphysiologicalconditionofthe
patient have been the major causes. These have been taken
seriously and brought to the notice of the patient caregivers.
Adequate assessment of the fall risk has been stressed upon
to reduce the risk and training is being given to ensure fall
prevention.
To reduce such patient falls, patients as well as attendants
are being educated using flip charts.
We have also conducted training programs and competency
assessments for the entire staff of the hospital.
Conflicts of interest
All authors have none to declare.
r e f e r e n c e s
1. Reducing the Risk on Falls in Your Health Care Organization.
Joint Commission Resources http://www.patientsafety.gov/
SafetyTopics/fallstoolkit/index.html.
2. Preventing Patient Falls e Establishing a Fall Intervention
Program (2nd ed.) Janice M. Morse.
3. Falls in older people. National/regional review India. Dr. B.
Krishnaswamy, Professor and Head; Dr. Gnanasambandam
Usha, Assistant Professor, Department of Geriatric Medicine,
Madras Medical College and Government General Hospital,
Chennai City, Tamil Nadu State, India.
4. http://www.downstate.edu/patientsafety/falls.html.
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