Fall Prevention

A vigorous and comprehensive fall prevention program at Cleveland Clinic Health System has resulted in an outperformance of national benchmarks and a 50% to 75% decrease in patient falls with significant harm over the past year alone.

The program owes much of its success to the nurses who co-chair the effort.

“Nurses co-chair the Cleveland Clinic Health System Multidisciplinary Patient Falls Committee, hospital-based multidisciplinary committees, and either co-chair or are active members of subteams pertaining to data management, transitions of care, screening and identification, education/communication, care environment and medication safety,” explained Kelly Hancock, DNP, MSN, RN, NE-BC, executive chief nursing officer at Cleveland Clinic Health Systems.

First the Specifics
Asked to pinpoint the specifics of the fall prevention program at Cleveland Clinic, Hancock said many steps impact the effort. They include:

  • a standardized fall prevention protocol
  • targeted toileting during hourly rounding
  • nurse and caregiver education on several topics, including scripting for toileting, specific roles in fall prevention, high-risk medications that are culprits for falls and dealing with impulsive patients
  • implementation of strategies to decrease the risk of patient falls
  • conduction of post-fall huddles
  • discussion of patients identified at high risk for falls embedded into the Professional Practice Model huddle process, allowing an opportunity to develop a plan for prevention
  • extensive use of visual communication, including high-risk patient signage to align with the event reporting system icon (portrayed as a yellow falling man, a communication tool intuitive to all caregivers and families), yellow non-slip socks, and a yellow wrist band
  • fall prevention rounds adopted by several units
  • emphasis on impactful hourly rounding
  • bed alarms, available on all inpatient beds, with criteria for use defined in a written fall prevention protocol
  • resource listing for fall prevention, including chair and personal alarms
  • fall banners in SBAR shift report across the entire inpatient stay; and
  • early mobility program, now being piloted in selected units.Communicating Responsibility

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“Though these are high-risk, challenging patient populations, including those with neurological deficits, overall we have consistently outperformed national benchmarks as required to be recognized as a Magnet organization for nursing excellence over the last two years,” Hancock pointed out. Falls with significant harm have decreased up to 75% over the past year due to signage change for high-risk patients and enterprise-wide falls prevention awareness communication initiatives that help identify specific responsibility in fall prevention.

“We have found it vital to engage the patient, family, and all caregivers in the fall prevention effort,” Hancock said. “Fall prevention information is incorporated into admission information for all patients and families, with a process for evaluating their understanding of that information. And do not forget the patient environment; it is of upmost importance to keep the bed at the lowest level, brakes on, the call light within reach, call lights and safety rails in bathrooms.”

“We have found that continued awareness is the key to fall prevention,” said Hancock.

Valerie Neff Newitt is a staff writer. Contact: vnewitt@advanceweb.com

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