Falling is a part of life - when we learn to walk, play sports, or sometimes we trip over our own feet. However, when hospitalized patients experience a fall, the consequences can be devastating, causing the Joint Commission to identify reducing the risk of patient harm resulting from falls as a National Patient Safety Goal.
At Jordan Hospital in Plymouth, MA, a specialized unit has been designed and implemented specifically to identify those most at risk and also strategies to minimize the risk of falls.
|SAFETY NET: Nurses on the Fall Prevention Unit at Jordan Hospital, Plymouth, MA, include (from left) Sara Parks, RN, Michelle Sluhocki, CNA, Melissa Killham, BSN, RN, Ellen Elwood, RN, and Luciana Jacobs, CNA. photo courtesy Kimberley S. Jordan-Horte
In the Beginning
Jordan's Professional Nurse Practice Council was researching different models of care and they discovered the Nurses Improving Care for Healthsystem Elders (NICHE) program [www.nicheprogram.org], explains Kristine Morse, BSN, RN, nurse director of the hospital's Critical Care Center. At the time, Morse was also the nurse director of 3 East B, a med/surg unit with a focus on orthopedics which was later designated as the pilot unit.
In February 2008, Morse and two staff nurses attended the annual NICHE Leadership Conference in Philadelphia. They brought back an idea posed at the conference - dedicating a specific unit for the care of patients at high risk of falling. Leaders at Jordan Hospital agreed, seeing the benefits that could be achieved.
The staff members who were selected to work on the unit received specialized training that included identification of appropriate patients, as well as specific interventions designed to address patient needs and behaviors.
The eight-bed Fall Prevention Unit opened in spring 2008 and has been very successful as evidenced by a lower number of falls compared to the general population. Also, the strategies that are used on the Fall Prevention Unit can also be applied throughout the rest of the hospital.
When a patient is admitted to Jordan hospital, they are evaluated using the Schmid Fall Risk Assessment Tool which measures every patient's risk of falling and examines physiological, pharmacological, mobility issues, etc. Every morning, Melissa Killham, BSN, RN, nurse director of the Fall Prevention Unit and 3 East B, reviews these assessments and identifies appropriate candidates for the unit.
During daily bed rounds, patients on other units are also recommended for transfer to the Fall Prevention Unit. Evaluation of patients can also be requested by the staff nurses who are assigned to them. The goal is to always keep the unit full, and this is not a challenge because the need is so great.
"It is difficult when the number of appropriate patients is greater than the number of available beds," Killham says. "This is why it is crucial education is hospitalwide, in order to reduce the risk of falls for all Jordan Hospital patients."
Patients admitted to the Fall Prevention Unit must have a Schmid score of greater than 3; the patient cannot be deemed suicidal; and they must meet at least one of the following criteria:
- at risk to themselves or to others;
- confused and attempting to get up without assistance;
- repeated interruptions of medical treatment for at least 4 hours;
- sundowning (state of agitation late in the day); and
- in need of physical restraints.
Patients may not be on a chemical restraint. Patients with telemetry orders must have the following diagnoses: syncope, chronic atrial fibrillation, and minor electrolyte imbalances.