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Falls with injuries are down considerably at Cambridge Health Alliance (CHA).
That's due, in part, to all eyes being on the feet, according to Mary Samost, MSN, RN. And if there is a pair of red socks afoot, the patient wearing them can count on more than the usual TLC treatment by the team of health professionals serving Cambridge, Somerville and Boston's Metro North communities in Massachusetts. 
The "Red Socks" program is part of the award-winning health system's overall campaign to curb falls, Samost said.
A nurse for 20 years, Samost has been director for nursing quality improvement at CHA for the past 3.
The program has proven to be a fun way of shifting focus on a serious problem - one that must now be reported to the Massachusetts Department of Public Health under serious reportable events.
In Massachusetts, falls were the No. 1 most serious reported event in 2008. Statewide, there were 224 incidents, which accounted for 66 percent of all reportable events.
Assessing Risk
At CHA, "The red socks are for the high-risk patients," Samost said. "Until they are assessed, we assume every patient is high-risk. Every day we assess the patient using two tools."
After approval by a patient advisory panel, the pilot program started in October 2008 on the med/surg unit in CHA's Whidden Hospital in Everett, MA.
Today, Samost said, "We are using it everywhere on all in-patient units."
The universal standard of care continues to apply to all other patients.
Of the 198 patients hospitalized on one day in September, 51 were deemed high-risk - donning red socks, along with a lime green wristband that creates an easy-to-spot ensemble.
"It's catchy," Samost said of the "Red Socks" moniker. "We are in [Boston] Red Sox [baseball] country. Any gimmick that gets patients, families and staff energized is a good thing."
Human Factor
Falls are an unfortunate reality, Samost said, and CHA's commitment to the year-old program is scoring successes.
Since the program's opener, the hospital has had 14 falls with injuries ranging from minor to serious, a decrease from 25 the previous year. Among them was a man in his 80s who, when he stood to try and clean a small spill from his urinal, lost his balance and fell to the floor. He suffered a hip fracture.
"He was embarrassed, and he didn't want the nurse to get in trouble," Samost said, noting his nurse had been in to see him 20 minutes prior.
Samost described the patient, who was wearing both his socks and bracelet, as independent. Despite every element of the program being followed, he still got hurt. It's what Samost called "the human factor," and something that can rarely, if ever, be predicted.
"Something like that could easily happen again, and that is what's so frustrating to the team. They all do the very best they can," she said. "But accidents do happen."
At CHA, she said, "You now walk down any hallway in the nursing units and you can see who is at-risk. And if you see those little red socks getting out of bed by themselves, you run to help the patient."
Additionally, the hospital has taken steps to eliminate potential issues like keeping the hallways clutter-free and using nightlights in patient rooms, Samost said. "A lot of the problems are environmental," she said.
Environmental issues also apply once the at-risk patient is sent home. Patients and their families are encouraged to look around the house. Removing a scatter rug can prevent problems.
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