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New Tool to Prevent Patient Falls Could Help Hospitals Save $1M in Costs

Joint Commission offers step-by-step process to measure fall and fall-with-injury rates

The Joint Commission Center for Transforming Healthcare has released its targeted solutions tool (TST) for preventing hospital inpatient falls and falls with injury. The Preventing Falls TST is an online resource that provides a step-by-step process to assist hospitals in measuring fall and fall-with-injury rates and in identifying and measuring barriers to fall prevention.

Using the TST, a typical 200-bed hospital could potentially reduce the number of patients injured in falls from 117 to 45 and could avoid approximately $1 million in costs annually through fall prevention efforts, according to the Joint Commission.

“Hundreds of thousands of patients fall in hospitals every year, and many of these falls result in moderate to severe injuries that can prolong hospital stays and require the patient to undergo additional treatment. These outcomes for patients are unacceptable,” said Erin DuPree, MD, FACOG, vice president and chief medical officer of the Joint Commission. “We are encouraging hospitals to use the TST to improve patient safety and to reduce patient falls.”

The Joint Commission addressed the issue of patient falls because it is a persistent issue in health care and because falls have been identified by the Centers for Medicare & Medicaid Services (CMS) as an event that is preventable and should never occur. The CMS has also identified “falls and trauma” on its list of hospital-acquired conditions for which reimbursement may be affected, specifically for falls that result in fractures, dislocations, and intracranial injuries. Serious injuries, on average, add 6.3 days to a patient’s hospital stay and cost approximately $14,000.

The TST was developed with the initial assistance of seven collaborating hospitals. Following the original participating group, five additional health care organizations participated in a pilot study to test the fall-prevention methodology. These organizations validated the project’s contributing factors, measurement tool, and solutions for improving their fall and fall-with-injury rates.

Working with the Joint Commission, the original participating hospitals were able to reduce the rate of falls by 35% and the rate of falls with injury by 62%. Their efforts included creating awareness among staff, empowering patients to take an active role in their own safety, using a validated fall risk-assessment tool, engaging patients and their families in the fall safety program, hourly rounding with scheduled restroom use for patients, and engaging all hospital staff and patients to ensure that no patient walks without assistance. These examples are some of the 21 targeted solutions developed to address factors that contribute to why patients fall.

Kaiser Permanente San Diego Medical Center, one of the original participating hospitals, strived to eliminate all falls during its own project, and looked to label every patient as a potential risk on arrival. Kaiser was able to achieve that goal and completely change its culture using the toolkit, Leah Apatan, RN, clinical lead for the hospital’s falls project, told Hospitals & Health Networks Daily.

During the project, Kaiser analyzed all variables that might result in falls, from bed placement to mobility issues and medications. Engaging with patients and their families on falls was an “eye opening” part of that assessment process, Apatan said. They found that often pride was a factor resulting in falls, giving the example of a big burly man who needed help going to the bathroom but was too stubborn to ask for assistance. “It can be an emotional issue. For some, it feels like they’ve lost their independence,” Apatan said.

About 86% of Kaiser’s falls resulted from patients getting up without assistance, often 2 to 3 hours after meals. The hospital implemented several solutions, including bed alarms, nonskid footwear, and further education of patients.

While the solutions used will differ from hospital to hospital, Apatan noted that any successful falls-prevention program should include the following key elements: measurement, staff engagement, consistent messaging, focused operational and cultural changes, and patient communication. She said it’s also critical to include all employees in the process, and not just a select few.

Sources: JCCTH; August 12, 2015; and H&HN Daily; August 12, 2015.

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