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FY25 Proposed Licensed Falls Prevention

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Created on March 19, 2024

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FY25 VUHFalls Prevention

Demonstrate falls risk prevention strategies via interactive case study.

Know how and when to use resources available at VUH.

Discuss the Johns Hopkins Falls Risk Assessment Tool and how it is used at VUH.

Understand fall risk factors and why the prevention of falls is critical in the hospital setting

By the end of this activity, the learner will be able to:

Objectives

Risk Factors

Why patients fall and why it is important

THE WHY

700,000 to 1,000,000 patients fall in the hospital setting each year.

11,000 of those patients die as a direct result of the injury sustained from the fall.

The good news? Falls are largely preventable, and as a bedside staff member you can make a huge difference.

Among older adults, falls are the leading cause of injury deaths, unintentional injuries and hospital admissions for trauma
Falls are the leading cause of hospital-acquired injury nationwide

Why talk about falls prevention?

RISK FACTORS

Poor lighting, unlocked bed/chair, slippery floors, trip hazards (cords, equipment, changes in floor level), bare feet or footwear without a non-skid bottom, patient teathered to devices (SCDs, IV, monitor, etc.)

ENVIRONMENTAL

Age, cognitive function, medications, vision/hearing status, history of falls, use of mobility devices (like walkers, cane, wheelchair, etc.), first time ambulating since hospitalization or procedure, decreased awareness of risk

PATIENT SPECIFIC

Risk factors for patients falling with or without injury are placed into 2 categories:

What puts a patient at risk for falling?

Nursing Assessment

procedures and tools

After any fall event, with or without harm

With a change in the patient's level of care (with or without transfer)

FALLS ASSESSMENT

Within 8 hours of admission

When to complete a falls assessment.

If you are caring for a patient less than 18 years of age, confirm with your unit on the approved fall risk scale tool that should be used for that specific patient population (e.g., Graf Pif, etc.)

Click here for JHFRAT Tool Download

JHFRAT

At VUMC we use the JHFRAT on patients 18 years of age and older to assess fall risk. It is an evidence-based, nurse-driven tool that standardizes the assessment of fall risk and improves hospital and patient safety.

Johns Hopkins Fall Risk Assessment Tool (JHFRAT)

The fall risk calculation is based on: age, fall history, elimination (bowel and bladder) status, medications, patient care equipment, mobility, and cognition. 6-13 points= Moderate risk >13 points= High risk

If the patient is not a high fall risk, the RN completes the low fall risk assessment:1. Complete paralysis or completely immobile. If the patient meets the above condition, the assessment is complete. If not, the RN proceeds to the next step.

Using JHFRAT, the patient is automatically a high fall risk if:1. >1 fall in last 6 months 2. Fell this admission 3. High risk per policy (ex: seizure precautions) If the patient meets any of these conditions, the JHFRAT is complete and the patient is a high fall risk.

The JHFRAT is easy to complete because the RN is spared unnecessary charting. The RN is able to determine fall prevention interventions based on the risk level that the patient scores with this tool.

Fall Risk Score Calc

Low Fall Risk Assessment

High Fall Risk Assessment

Nurse Friendly

JHFRAT

ED

Peri-Op

Inpatient

Click on the area below that best describes where you are working to view the JHFRAT in eStar

JHFRAT in eStar

JHFRAT is found in your flowsheets under "Fall Risk Scale" If the patient meets automatic criteria for a high or low fall risk the nurse can stop screening and implement the appropriate fall prevention interventions based on risk score. If the patient does not meet criteria for an automatic high or low fall risk, complete the fall risk score calculation to determine the patient's fall risk.

JHFRAT Documentation in eStar - Inpatient

Complete the JHFRAT in ASAP, by using the following steps in the ED Narrator:
Step 1 - click "Safety Assessment" under "Assessment" on the right hand side of your screen
Step 2 - click the JHFRAT pop-up box to begin screening your patient
If the patient does not meet criteria for an automatic high or low fall risk, complete the fall risk score calculation to determine the patient's fall risk score and appropriate fall prevention interventions.

JHFRAT Documentation in eStar - ED

JHFRAT Documentation in eStar - Peri-Op

Complete the JHFRAT in Op-Time, by using the following steps:
Step 1 - click "Fall Risk" under "Screenings" on the left side of your screen
Step 2 - click "Show Row Info" on the top right of your screen
Step 3 - click JHFRAT to begin screening your patient
If the patient does not meet criteria for an automatic high or low fall risk, complete the fall risk score calculation to determine the patient's fall risk score and appropriate fall prevention interventions.

Fall Prevention

Methods and tools

PURPOSEFUL ROUNDING

Set up a schedule and alternate every hour to complete purposeful rounding
Remember the "5 Ps": Pain, Positioning, Pump (IV), Potty, and Proximity
Approximately 50% of falls occur due to toileting related activities
Never leave a high fall risk patient alone on the toilet
Always do an environmental safety scan and ask the patient if they need anything else before you leave

Licensed andnon-licensed staff should partner to complete hourly, purposeful rounding.

Pain

Ask and address any pain needs

Positioning

Educate and assist patient on changing positions/ambulating

Pump (IV)

Ensure the pumps are working appropriately, plugged in, and not alarming

Proximity

Personal belongings and call light are within reach of the patient

Potty

Encourage/assist with toileting related activities such as assisting patient to the restroom, washing hands, etc.

Pearls of the 5 Ps of Purposeful Rounding

PREVENT FALLS

Bed in low position with wheels locked and placing personal items, phone, and call light within reach.
Ensure adequate lighting, unobstructed pathways, clutter free area, and ensuring appropriate side rails are up.
Also remember to partner with your patient and remind them:

Always use the call light
Do not get out of bed or chair without a staff member and explain the "why"
Keep the door to your room open so we can see if you need help

Prevent falls through standard environmental safety.

Bed & Chair Alarms

High Fall Risk Signs

Yellow Fall Risk Arm Band

Yellow Non-Skid Socks

The high fall risk bundle consists of yellow items and a high fall risk signs to provide visual cues that serve as reminders for the patient and staff. Bed and chair alarms are auditory reminders/alerts that should be used based on patient's condition and assessed need.

Falls Bundle

Zero the bed scale prior to admitting a new patient or placing the patient in the bed.

The bed alarm will sound when it detects changes in the patient's weight, so it is vital to have an accurate patient weight.

Once the patient is in the bed, set the bed alarm to the alarm "Zone" that meets the patient's needs.

Click on each picture to learn more about the sensitivity of each "Zone"

Reminders for Setting a Bed Alarm

The chair pad should be placed in the middle of the chair held in place by a tucked in sheet, then covered with an absorbent pad.

Chair pads are single patient use
Parasol Chair Alarm Monitor is reusable

When a patient sits down on the chair pad, listen for a confirmation beep. If no beep, check connections and confirm position of pad under patient

Staff can choose between a standard alarm tone or personalize a voice recording

Reminders for Setting the Chair Alarm

SAFE PATIENT HANDLING

It is essential that our patients are moving to the height of their ability. The impact of immobility on patients can include increased delirium, decreased muscle mass, and places patients at a greater fall risk.

VUH provides equipment to help prevent you and the patient from getting injured while encouraging/assisting with patient mobility.

Protect yourself while protecting your patients.

Equipment at VUH

Gait BeltGait belts can lead to decreased assisted falls with injury as they provide a place to grip onto the patient and assist with lowering them to the floor.

Side RailsIf used to help remind patients of fall precautions and not used as a restraint, they are a useful tool

Maxi Move Also called a Hoyer or Total Lift, the Maxi-Move provides maximum assistance in moving patients

SaraAlso known as the sit to stand, the Sara does just that, and prevents staff from having to lift the patient to a standing position

StedyStedy provides a simple way to encourage patients to participate in the transfer and activates existing mobility

Virtual Sitters (vSitter)

vSitter is a remote visual monitor that uses a camera and 2-way audio to observe and communicate with patients
Partners in patient safety initiatives
Communicate regularly throughout the shift and at handoff with primary RN
Inclusion critera: falls despite interventions, medical hold, altered mental status, interfering with medical care/devices
Exclusion criteria: suicidal ideation, suicide precautions, non-redirectable, Vsitter has to use STAT alarm >3 times in 30 minutes

Case Study

simulated practice

You have just received report on a 72 year old, Spanish-speaking patient.
The patient arrived in the ED after tripping and hitting their head on the ground.
The CT in the Emergency Department showed a small subdural hemorrhage.
You go to the room the patient is going to be admitted in and have some concerns.
Click to the next slide to view the room and identify fall risks present.

Case Study

Hint: Your cursor will change to a hand when you find something wrong!