The Travel Nurse’s Role in Fall Prevention
Learn techniques to prevent patient falls in every assignment facility
By Debra Wood, RN, contributor
Every year, tens of thousands of patient falls occur in health care facilities, and approximately 11,000 patients who fall will die from their injuries, according to The Joint Commission Center for Transforming Healthcare.
“Falling is a huge problem,” said Eileen Costantinou, MSN, RN, BC, practice specialist and senior coordinator at Barnes-Jewish Hospital in St. Louis and the chair of the hospital’s team on The Joint Commission center’s Preventing Falls with Injury project. “It is life-changing, and any support person deals with the whole process—not only going through surgery and being in a nursing home, but the eventual death.”
Costantinou cautioned nurses that falls are prone for litigation, especially when injuries are involved. The Centers for Medicare and Medicaid Services (CMS) considers a fall a preventable event, so lawyers and the public think they should not happen. While travel nurses are usually covered by professional liability insurance, a nurse should know the limitations of their agency’s policy, and be aware of the personal consequences if a fall should happen.
“The events are devastating to nurses,” Costantinou said. “They feel a sense of guilt.”
The Joint Commission’s four-year project aimed to change those statistics and outcomes--and succeeded, with participating pilot hospitals reducing rate of patient falls by 35 percent and their fall with injury rates by 62 percent.
“A lot has been done in this arena, but we are still seeing patient falls,” said Klaus Nether, director of solutions development at the Center for Transforming Healthcare.
The center has now released a targeted solutions toolkit to guide other organizations in their quest to reduce patient falls. While the kit includes a business case for reducing falls--each fall with injury costs a facility about $14,056 and 6.3 additional days as an inpatient--it also includes advice for nurses at the bedside.
The fall prevention project
Seven health care organizations assisted in the project, identifying the top 10 contributing factors to a patient fall.
“It’s not a one-size-fits-all model,” Nether said. “What is key is the approach, what your specific contributing factors are.” That may vary among units.
The top contributing factor, an inconsistent or incomplete communication about the patient’s risk of falls between caregivers, was reported by all participating organizations. Six reported toileting, medications that increased the risk, and the patient not knowing or choosing not to use the call light. These were followed by not educating the patient/family or inconsistent education about fall prevention and his or her risk; the risk assessment tool not being a valid predictor of the risk; inconsistent ratings on the assessment tool by different caregivers; and a falls culture. Travel nurses should be aware of and prepared to address these fall risks.
The Joint Commission came up with targeted solutions to each contributing factor. Some are directed at administration, such as implementing the use of a patient agreement form to use the call light or implementing a validated assessment tool that includes a cognitive component and is standard among departments.
However, travel nurses, without an order, can implement other Joint Commission recommendations. For instance, a nurse can:
- Get the patient up to the toilet on a regular basis
- Check on assigned patients hourly and offer to take them to the bathroom
- Include fall-risk concerns in shift report
- Educate patients about medication side effects and the associated increased fall risk
- Show patients how to use and remind them when to use the call light
- Engage patients and families in the fall safety program from time of admission
- Target education to the patient’s individual fall risks
- Indicate fall risk on the white board or with an arm band, so other staff know
Fall prevention starts from the minute every person arrives and is a complex problem requiring a multitude of interventions. Nurses can keep the bed low, raise upper side rails, give the patient nonskid footwear and orient the person to the environment, Costantiou said. Then the nurse can complete a fall risk screening. Those at moderate or high risk need more interventions, tailored to each particular patient’s risk factors and addressing the underlying causes.
Such interventions may include providing diversional activities, using a gait belt or engaging the family in helping figure out solutions. Nurses can ask family members about previous falls and what has worked in the past.
Nurses can reach out to physical therapy staff, or ask the physician for a consult to assess balance and obtain recommendations for transferring and getting the person up, Costantinou suggested.
“Documentation of what they have done to prevent the fall is critical,” Costantinou said. “Each intervention has a certain purpose. It’s a multiple of things you have to do.”
Download this infographic for more details on fall prevention.
Courtesy The Joint Commission Center for Transforming Healthcare