Patients receiving cardiac rehabilitation can be vulnerable to falls, particularly if they have other comorbidities. The cardiac rehabilitation staff at Penn Medicine Chester County Hospital in West Chester, Pa., discussed the differing opinions about identification and assessment of patients who should be placed on a one-to-one status versus supervision only when needed. Our team, consisting of nurses, exercise physiologists and a respiratory therapist, realized we did not have a standardized process to evaluate the fall risk of our patients at the time of initial cardiac rehab evaluation.
One of our nurses volunteered to champion this project. After discussing next steps with the group, this nurse planned to research what methods and tools were being used for fall risk assessment in other cardiac rehabilitation programs. In addition, she would review the current process used for our inpatients for fall risk screening.
She began by performing a literature review, which did not uncover any data published on the topic of fall risk assessment in the cardiac rehabilitation environment. Her next steps were to bring back to the nurses examples of instruments currently in use for fall risk assessment, as well as a sample of the Timed Get Up and Go Test used on our inpatient admissions. After all options were reviewed, a collaborative decision was made by the nurses to use:
• The Timed Get Up and Go Test to be consistent with the hospital's fall prevention program. The test is a tool used to assess a patient's risk for falls (low to high).
• The Fall Risk Assessment Screen, which scores patients based on risk factors of recent falls, current medications, and psychological and cognitive status. Scoring reflects low, medium and high risk. Patients in the high-risk category require one-to-one supervision.
We now use both tools to more fully assess our patients' fall risk at initial evaluation. We can implement a re-evaluation if the patient exhibits a decline or improvement.
To be consistent with the hospital's color flag for falls, green stickers are used on our charts to alert the team to fall risk. In addition, fall risk, assistance needed and device needs are added to the patient's Individualized Treatment Plan.
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At a follow-up meeting of nurses, we decided to refine the process with the Fall Risk Assessment Screen tool, since cognitive evaluation is based on staff clinical expertise. Next step: Find a simple, valid tool for cognitive assessment of patients with more than mild cognitive impairment.
Additionally, we proposed making the Fall Risk Assessment Screening tools a permanent part of the patient chart by using a two-sided sheet to reflect both fall risk assessment scores.
We have also discussed repeating fall risk assessment when the patient completes a cardiac rehabilitation program. This would allow us to determine whether fall risk improved during participation in our program. This establishes an additional clinical outcome that is measureable and specific.
The Timed Get Up and Go Test has proved to be a valuable tool to evaluate a patient's fall risk in our department. This tool is a standardized, reliable method to maintain quality of care and ensure safe handling of each patient by every member of the team. By following these interventions, staff members are much more aware of fall risk and are proactive in identifying patients at risk.
Paula Levens is a cardiac rehabilitation direct care nurse at Penn Medicine Chester County Hospital in West Chester, Pa.