Smart Caregiver Corporation shares news & events in several publications. Many are listed below and are available for download.
Fall prevention safety bundle: Collaboration leads to fewer falls
July 2017 Vol. 12 No. 7
Author: Marty Pond, MS, RN-BC–Gerontology as told to Janet Boivin, BSN, RN
At St. Joseph’s Hospital and Health Center in Syracuse, NY, we’re committed to providing a safe, comfortable, caring environment for our patients. We believe all patients deserve to be cared for in the most humane way possible to preserve their dignity and individual rights. This means ensuring our patients’ physical safety, including preventing injuries from falls, during a hospital stay.
Central to our fall prevention program is the hospital’s patient safety care bundle. We found that bundling (standardizing) fall prevention practices prevents more falls than nonbundling or variable approaches. We also learned that involving all unit and house-wide staff in this approach inspires greater buy-in and participation and fosters best practices.
Our bundling journey
St. Joseph’s didn’t always use bundling to prevent falls. Our journey began in 2010 when I was asked to lead a task force to review and revise the hospital’s fall prevention program. After reviewing many articles in the nursing literature, our task force decided to take different concepts that proved effective and combine them into the bundled approach.
All clinical and nonclinical staff were taught how to use the new bundle. Rapid-cycle piloting in select care areas was implemented. Following a process and outcome review and revision of the bundling approach, full implementation followed throughout our facilities. St. Joseph’s bundled approach to fall prevention includes safety huddles, hourly rounding, use of the Morse scale, individual care plans, and post-fall debriefings.
Safety huddle: To consistently identify patient safety needs for all shifts, each unit has a safety component as part of its shift-change huddle. The safety huddle must be documented on a form designed by the unit.
Hourly rounding: Nurses round on patients hourly. The RN uses a consistent, caring conversation, which starts with an introduction, such as, “Mrs. Jones, I’m Marty, your nurse, and I’m here to check on you.” Unless necessary, sleeping patients aren’t awakened. Rounds are documented in the electronic documentation system. The RN admitting new patients explains that hourly rounding is done to anticipate their needs and ensure their safety.
Morse scale: The Morse fall scale assessment tool, which is individualized for each patient, assesses for the following measures:
• history of falls
• secondary diagnosis
• ambulatory aid
• I.V.s/normal saline lock
• mental status.
According to St. Joseph’s fall prevention protocol, the Morse scale is used upon admission of every inpatient 14 and older, once during every day shift, when a patient’s level of care changes, upon transfer, and after a fall.
Individualized care interventions: The following interventions are implemented based on individual patient needs:
• Falls that take place while the patient is hospitalized are documented on the plan of care under the Morse scale section. When physical therapy or medication review is requested, it’s documented in the plan of care under the safety and activity section and communicated during handoff.
• Nurses have the option to ask for a gerontology review, which includes consultation with an expert gerontology RN and a pharmacist, and a physical therapy screen.
• Door signs or door magnets alerting staff to the patient’s risk of falls must be used when the patient’s Morse scale score is ≥ 85 (considered high risk), when staff believe the patient is at risk of falling despite a lower fall assessment score, and when patients have an epidural infusion until they’re able to ambulate independently.
• Bed exit and chair alarms* must be used for patients who overestimate or forget their limitations and for those with an impaired gait transfer (as documented in the Morse assessment). Patients with bed exit alarms also must have a chair alarm when out of bed. Any patient with a bed exit alarm, chair alarm, or door magnet is not to be left alone on the commode or in the bathroom.
Post-fall defusing: Immediately after a fall, we hold a debriefing with the staff involved with the patient’s care. At the debriefing, similar to the huddle concept, we review and discuss the event to help formulate a collaborative approach for immediate care, treatment, and review and prevention of potential future falls.
Since our implementation of the bundled approach to fall prevention, we have seen a decrease in the number of falls and a reduction in the severity of injury when falls do occur. (See Reduction in falls.) Perhaps most important, though, is that an all-staff approach to quality care inspires greater buy-in and participation, which fosters best-practice outcomes.
A man in his late 80s was admitted to the medical-surgical unit after several falls at home, including one that resulted in a hip fracture. He had a urinary tract infection (UTI) and was confused and sleep deprived. His family reported that he’d fallen many times at home. Our challenge was to keep him safe while treating his UTI and giving him the rest he needed to get well.
The patient’s admitting nurse evaluated him with a Morse scale of more than 85, so a magnet indicating this designation was placed on his door and every shift was notified of his fall risk every day. In addition to the door magnet, our interventions included a bed alarm when the patient was in bed, a chair alarm, hip protectors to add extra protection if he fell, and floor mats* on each side of the bed.
As a result of our interventions, the patient got much-needed rest, his UTI resolved, his cognition improved, and he was able to return home. We gave the hip protectors to the family for use at home.
Marty Pond, MS, RN-BC–Gerontology is the NICHE Coordinator and Falls Chairperson, St. Joseph’s Hospital and Health Center, Syracuse, New York
Published July 2017 – American Nurse Today
Preventing Patient Falls – A Systemic Approach from the Joint Commission Center for Transforming Healthcare Project
This report describes the types of risks that lead to patient falls and falls with injury, the root causes for those risks, and the solutions designed to reduce them. Also included are examples and lessons learned from five of the participating and pilot health care organizations. The case study section highlights individual hospital and system experiences preventing falls with injury.
Five of the participating organizations submitted data throughout the project timeline. In aggregate, these organizations demonstrated a 62 percent reduction in the falls with injury rate and a 35 percent reduction in the falls rate. Five other hospitals have tested the original work with similar results.
Fall Alarms were utilized throughout as an integral component of these Fall Management Programs.
Health Research & Educational Trust. (2016, October). Preventing patient falls: A systematic approach from the Joint Commission Center for Transforming Healthcare project. Chicago, IL: Health Research & Educational Trust. Accessed at www.hpoe.org
Read the Article: http://www.hpoe.org/Reports-HPOE/2016/preventing-patient-falls.pdf
Tips for Helping Your Aging Parents (without losing your mind) – Paperback
Author: Kira Reginato – Gerontologist & Elder Care Consultant
Published: April 15, 2016
As an experienced elder care consultant, Kira has helped countless families and individuals navigate the pitfalls and challenges of caring for seniors without feeling overwhelmed or under-prepared. This book is a guide to caring for your aging parents and offers handy checklists, product suggestions and easy-to-follow advice. In the section on “SOLUTIONS TO REDUCE FALL AND ACCIDENT RISK,” Kira highlights the use of Smart Caregiver’s easy-to-use Cordless Fall Monitors to ensure adequate supervision for at-risk individuals in their own homes. You can find additional elder care resources, including podcasts, on Kira’s website at CallKira.com and her book can be purchased through Amazon. See links below:
Visit Kira’s Website: Call Kira About Aging!
Get Your Copy on Amazon
CDC MMWR – Falls and Fall Injuries Among Adults Aged ≥ 65 Years
Weekly / September 23, 2016 / 65(37); 993–998
Gwen Bergen, PhD; Mark R. Stevens, MA, MSPH; Elizabeth R. Burns, MPH[SUMMARY] Falls are the leading cause of fatal and nonfatal injuries among persons aged ≥65 years (older adults). In 2014, 28.7% of older adults reported falling at least once in the preceding 12 months, resulting in an estimated 29.0 million falls. Of those who fell, 37.5% reported at least one fall that required medical treatment or restricted their activity for at least 1 day, resulting in an estimated 7.0 million fall injuries. Although falls are common, approximately half of older adults who fall do not discuss it with their health care provider. However, older adult falls are largely preventable. Health care providers can play an important role in fall prevention by 1) screening older adults for fall risk, 2) reviewing and managing medications linked to falls, and 3) recommending vitamin D where appropriate for improved bone, muscle, and nerve health
Read the Article: http://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm
CDC Podcast – Taking Steps to Prevent Falls
MMWR: A Minute of Health with the CDC, 9.22.2016
More than one in four adults U.S. adults over 65 fell at least once in the preceding year. This podcast discusses the importance of preventing falls among older Americans.
Listen Here: http://www2c.cdc.gov/podcasts/player.asp?f=8643609
Monitoring and PERS in Retail Produce Profits
Tap into this lucrative market by Shawn Langwell
Competitive bidding, Medicare cutbacks, slow reimbursement rates and diminishing profitability are a few of the concerns that HME/DME retailers have been faced with during the past 12 to 18-plus months due to the Medicare competitive bidding process.
The DMEPOS Competitive Bidding Program was mandated by Congress through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Many HME/DME retailers were scrambling to win Round 2 of this process which started in July 2013. Some were fortunate enough to win a bid in the competitive bidding process. Read more…
– Publisher: HomeCare – Spring 2014
New technology provides better anti-wandering solutions for caregivers by Shawn Langwell
One of the most challenging, life-threatening issues related to the care of a person with cognitive loss is the occurrence of wandering, wherein an individual strays into unsafe territories and may be harmed. The most dangerous form of wandering is elopement, which occurs when a confused person leaves an area and does not return. The risk of wandering is a growing concern of families, long-term care facilities, regulators and insurers.
No one wants to face the emotional challenge of caring for someone who may not recognize us or their surroundings, yet—according to the Alzheimer’s Association—6 in 10 people with dementia will wander. Read more…
– Publisher: HomeCare – Winter 2013
- Affordable Anti-Wandering Monitors – Nursing Homes, January 2004
- Fall Prevention in LTC facilities – Provider, December 2003 & Nursing Homes, August 2003
- Pull String vs. Pressure Pad Patient Monitors – Provider, October 2003
- Always-On System Reduces Risk – Assisted Living, June 2003
- Anti-Wandering Solution – Contemporary Long Term, July 2003 & Provider, April 2003
- At-Risk-For-Fall Patient Monitoring – Nursing Homes, May 2003
- Alert on Alarm Modifications – Advance for Post Acute Care, February 2003