Pa Patient Saf Advis 2014 Jun;11(2):69-77.
Falls Reduction and Prevention Update: Pennsylvania Hospitals Increase Implementation of Best Practices
Healthcare Executive/Administrator; Other Licensed Professionals; Nurse; Pharmacist; Physician
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Authors
Michelle Feil, MSN, RN
Senior Patient Safety Analyst
Christina Hunt, MSN, MBA, HCM, RN
Senior Patient Safety Liaison
Pennsylvania Patient Safety Authority
Corresponding Author
Michelle Feil

Abstract

In 2012, the Pennsylvania Patient Safety Authority provided hospitals participating in the Pennsylvania Hospital Engagement Network Falls Reduction and Prevention Collaboration with two tools to evaluate their falls prevention programs: an annual self-assessment survey and a quarterly process measures audit. Hospitals that completed the survey in 2012 and 2013 reported an increase in full implementation for 16 of 17 categories of falls prevention best practices. Comparison of 2012 survey responses to audit results revealed a gap between levels of full implementation of best practices reported on the survey and compliance with falls prevention practices observed during the audit process. Analysis of 2013 data shows a decrease in this gap and improved compliance with falls prevention practices. Rates of falls with harm decreased for hospitals that completed the self-assessment survey in 2012 and 2013 in addition to all quarterly audits. Hospitals participating in the collaboration and utilizing these tools have been able to evaluate their current falls prevention programs, identify and implement evidence-based practices missing or in need of improvement, monitor staff compliance with falls prevention practices, and decrease rates of falls with harm.

Introduction*

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* The analyses upon which this publication is based were in part funded and performed under contract number HHSM-500-2012-00022C, entitled “Hospital Engagement Contractor for Partnership for Patients Initiative.”
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In December 2011, the Pennsylvania Patient Safety Authority partnered with the Hospital and Healthsystem Association of Pennsylvania to lead the Pennsylvania Hospital Engagement Network (PA-HEN) Falls Reduction and Prevention Collaboration. Beginning in January 2012, hospitals from across the commonwealth joined the collaboration and enrolled in the Pennsylvania Patient Safety Reporting System (PA-PSRS) Falls Reporting Program. A group of 80 hospitals participated through December 2013.

As part of the collaboration, the Authority developed two tools for the enrolled hospitals to use in evaluating their falls prevention programs: an annual self-assessment survey and a quarterly process measures audit. Analysis of results from the initial use of these tools in 2012, as well as hospital rates of falls with harm, was published in the December 2013 Pennsylvania Patient Safety Advisory article “Falls Prevention: Pennsylvania Hospitals Implementing Best Practices.”1 Highlighted findings include the following:

  • Thirty-five individual falls prevention practices and/or specific program elements were identified that correlated with lower rates of falls with harm.

  • Although the majority of hospitals reported full implementation for the majority of best practices in falls prevention, all hospitals reported practices that were missing or in need of improvement.

  • Medication review and sitters were identified as two categories of falls prevention practices that correlated with lower rates of falls with harm, but these practices were reported to have low levels of full implementation in most hospitals.

  • A “policy-practice gap” was identified (i.e., interventions prescribed by policy were not implemented in practice) when comparing best practices reported as having full implementation on the falls self-assessment survey with falls prevention practices observed during the audit process.

Hospitals participating in the collaboration that have continued to use these tools have been able to evaluate their current falls prevention programs and successfully identify and implement evidence-based practices missing or in need of improvement. They have also been able to monitor staff compliance with falls prevention practices and have seen increases in compliance, as well as reductions in rates of falls with harm.

Methods

Falls SAT Survey

The PA-HEN Falls Reduction and Prevention Collaboration Self-Assessment Tool (SAT) survey was adapted from an existing questionnaire2 and was designed to evaluate the current structure and content of hospital falls prevention programs compared with evidence-based best-practice guidelines. The SAT survey was intended to serve as a tool to assist hospitals in identifying best-practice elements that could be targeted for improvement in their current falls prevention programs. For each falls prevention practice listed in the SAT survey, respondents could report either full implementation, partial implementation, or no implementation. Hospitals participating in the collaboration were asked to complete the falls SAT survey in 2012 and again in 2013. The Authority analyzed and compared survey responses between the two years to identify changes in implementation level for falls prevention practices over the course of the collaboration. Only hospitals that completed the falls SAT survey for both time periods were included in the analysis.

Falls Prevention Process Measures Audit Tool

The Falls Prevention Process Measures Audit Tool is a point prevalence data collection tool used to assess compliance with falls prevention practices most commonly included as part of hospital falls prevention programs. Hospitals were asked to complete quarterly audits on the unit or units where they were piloting small tests of change as part of collaboration. This point prevalence audit consisted of documentation review (e.g., “Was a fall prevention plan documented?”) and observation of patients and the environment (e.g., “Does the patient have risk identifiers?”). The Authority analyzed the results of audits conducted for the quarter beginning July 1, 2013, and ending September 30, 2013, to identify overall compliance with falls prevention practices. A secondary analysis of audit results was completed to evaluate compliance with specific practices in hospitals reporting full implementation of these practices on the falls SAT survey.

Falls-with-Harm Rates

Rates of falls with harm per 1,000 patient-days were calculated for January through June 2012 and for January through June 2013 using falls with harm as reported through PA-PSRS (i.e., any fall reported as a Serious Event, as defined by Pennsylvania reporting requirements) and total facility patient-days as reported to the Pennsylvania Health Care Cost Containment Council (PHC4).3 At the time of the initial analysis in 2012, the period of January through June was selected for two reasons: (1) this was the time period for which the most complete data was available from PHC4, and (2) this time period immediately preceded completion of the falls SAT survey, therefore controlling for the influence survey completion may have had on rates. The second time period of January through June 2013 was selected for these same reasons, as well as to allow for comparison between two similar time periods.

Results

Falls SAT Survey—Overall

Of the 80 hospitals that completed the falls SAT in 2012, 74 completed the falls SAT in 2013. Most hospitals reported full implementation for the majority of falls prevention best practices both years. As a group, these 74 hospitals reported 68.2% of all practices with full implementation in 2012, ranging from 20.5% to 92.7% for individual hospitals. In 2013, the percentage of practices reported with full implementation increased to 78.2% for the group, ranging from 52.3% to 98.6% for individual hospitals. Figure 1 shows the percentage of full implementation reported by these 74 hospitals for each category of falls prevention practices by year.

Figure 1. Reported Percentage of Falls Prevention Best Practices with Full Implementation by Category for Hospital Engagement Network Facilities Completing the Falls Self-Assessment Survey Tool in 2012 and 2013 (N = 74)
 

Falls SAT Survey—High Levels of Full Implementation

Event reporting, postfall assessment, and fall alarms were the top three categories of falls prevention best practices reported with full implementation in 2012 and 2013.

Event reporting. Hospitals reported an average of 85.7% of practices in the category of event reporting as fully implemented in 2012, increasing to 91.8% in 2013. Because most practices were reported as fully implemented in 2012, there was not much change reported in 2013, with a few exceptions. The largest increase was seen in the number of hospitals requiring staff to establish a new intervention plan to prevent repeat falls as part of a standardized patient safety event report (45 hospitals in 2012, 60 in 2013).

More hospitals also reported full implementation for each of the following best practices in 2013:

  • Communicating clear and consistent guidelines for completing patient safety event reports and follow-up or investigation forms for patients who have fallen as part of mandatory in-service educational programs (46 hospitals in 2012, 60 in 2013)

  • Utilizing a follow-up or investigation form, separate from the patient safety event report form, for patients who have fallen (48 hospitals in 2012, 60 in 2013)

  • Requiring staff to include a description of any equipment in use at the time of the fall in patient safety event reports (65 hospitals in 2012, 73 in 2013)

Postfall assessment. Hospitals reported an average of 80.2% of best practices in the category of postfall assessment as fully implemented in 2012, increasing to 88.7% in 2013. The two practices with the largest increase in the number of hospitals reporting full implementation were (1) postfall event interventions are reviewed and, if necessary, revised and documented in the individual’s chart (49 hospitals in 2012, 64 in 2013) and (2) following a fall, the patient is reassessed for falls risk and assessment findings are communicated to staff who interact with the patient (58 hospitals in 2012, 68 in 2013).

Fall alarms. The category of fall alarms consists of three best practices. Hospitals reported an average of 79.3% of these practices as fully implemented in 2012, increasing to 86.5% in 2013. The number of hospitals reporting full implementation for each practice increased as follows:

  • Holding staff accountable for a timely response to fall alarms (48 hospitals in 2012, 56 in 2013)

  • Adequately training staff to use fall alarms, such as bed-exit alarms, including inspection and maintenance of the systems
    (57 hospitals in 2012, 64 in 2013)

  • Using other falls prevention interventions in conjunction with fall alarms (71 hospitals in 2012, 72 in 2013)

Falls SAT Survey—Low Levels of Full Implementation

Of the falls prevention best-practice categories, medication review remained the category with the lowest percentage of full implementation, followed by sitters, with less than 50% full implementation in each category reported both years.

Medication review. Despite being reported with the lowest level of full implementation both years, some hospitals reported progress in implementing falls prevention best practices in the category of medication review. More hospitals reported including pharmacists on their falls prevention team in 2013 (n = 59) than in 2012 (n = 46), and the average percentage of medication review best practices reported as fully implemented increased from 21.6% in 2012 to 34.2% in 2013.

The following medication review best practices had the largest increases in the number of hospitals reporting full implementation:

  • Instituting periodic review of formulary medications by the pharmacy and therapeutics committee to identify those that increase falls risk and make recommendations about those medications (10 hospitals in 2012, 31 in 2013)

  • Providing nurses access to a list of medications that increase an individual’s risk of falling that is used when assessing patients for falls risks (28 hospitals in 2012, 43 in 2013)

  • Having pharmacy recommend alternative medications to reduce the patient’s risk of falling if the prescribed medications increase the risk of falling (8 hospitals in 2012, 17 in 2013)

Sitters. The only category of falls prevention best practices that decreased in terms of full implementation was sitters. As a group, hospitals reported an average of 44.6% of sitter best practices as fully implemented in 2012, decreasing to 41.3% in 2013 (see Figure 1). The number of hospitals reporting full implementation of sitter programs increased from 37 to 38 between 2012 and 2013, but only 30 of those hospitals reported full implementation in both years. The other eight hospitals reporting full implementation in 2013 reported having either no sitter program (n = 5) or only a partially implemented sitter program (n = 3) in 2012. Also, of those hospitals that reported having sitter programs, fewer hospitals reported full implementation for the following best practices in sitter program design in 2013 compared with 2012:

  • Having a pool of sitters (32 hospitals in 2012, 30 in 2013)

  • Defining criteria for sitter qualifications (34 hospitals in 2012, 30 in 2013)

  • Conducting a training program for sitters (32 hospitals in 2012, 29 in 2013)

  • Creating a job description with expectations for sitter behavior and responsibilities (37 hospitals in 2012, 31 in 2013)

  • Establishing a process for requesting and discontinuing sitters (33 hospitals in 2012, 28 in 2013)

Falls SAT Survey—Largest Increases in Full Implementation

Overall, of 1,745 individual practices reported to have no implementation in 2012, hospitals reported moving 767 (44.0%) to full implementation in 2013. In addition, of 1,450 practices reported to have partial implementation in 2012, hospitals reported moving 921 (63.5%) to full implementation in 2013. Of 7,621 practices reported with full implementation in 2012, 6,944 (91.1%) were reported to remain at full implementation in 2013. Figure 2 shows the absolute change in the average percentage of practices reported with full implementation between 2012 and 2013 by category (i.e., the percentage of practices reported with full implementation in 2013 minus the percentage reported with full implementation in 2012). The greatest increases were reported in the categories of assistive devices, patient and family education, and policies and protocols. Increases were reported in 16 of 17 categories, with sitters identified as the only category in which the percentage of best practices with full implementation decreased.

Figure 2. Absolute Change in Percentage of Falls Prevention Best Practices with Full Implementation by Category for Hospital Engagement Network Facilities Completing the Falls Self-Assessment Survey Tool in 2012 and 2013 (N = 74)

 

Assistive devices. The greatest increase in the number of hospitals reporting full implementation for falls prevention best practices was seen in the category of assistive devices. The following practices had the largest increases:

  • Having the falls team and/or physical therapy evaluate types of devices and aids (e.g., canes, walkers, wheelchairs, grab bars) used by the facility to prevent falls (48 hospitals in 2012, 61 in 2013)

  • Providing training to staff on their use and maintenance (40 hospitals in 2012, 53 in 2013)

  • Ensuring the weight-bearing capacities of these devices and aids are known to staff (25 hospitals in 2012, 41 in 2013)

  • Having physical therapy evaluate patients identified as being at risk to fall and recommend appropriate assistive devices (41 hospitals in 2012, 52 in 2013)

  • Providing face-to-face training in their use to patients and families (44 hospitals in 2012, 52 in 2013)

Patient and family education. The next greatest increase in the number of hospitals reporting full implementation of falls prevention best practices was seen in the category of patient and family education. Increases were reported in staff providing all patients and their family members direct education regarding the causes of falls and the interventions used to prevent falls (36 hospitals in 2012, 55 in 2013) and in documentation of education (41 hospitals in 2012, 54 in 2013). Increases were also reported for nurses educating patients specifically about the following:

  • Intrinsic risk factors for falling (43 hospitals in 2012, 62 in 2013)
  • How to walk and transfer in and out of bed safely (45 hospitals in 2012, 63 in 2013)
  • How to use assistive devices (44 hospitals in 2012, 57 in 2013)
  • What to do if he or she falls (30 hospitals in 2012, 52 in 2013)

Policies and protocols. The category of falls prevention practices with the third greatest increase in the number of hospitals reporting full implementation was policies and protocols. The practice in this category that increased the most in terms of full implementation was including the composition, responsibilities, and goals of the falls team in the hospital’s falls prevention policy (17 hospitals in 2012, 38 in 2013). Large increases in the number of hospitals reporting full implementation were also reported for the following practices:

  • Establishing a frequency and process for conducting environmental rounds (29 hospitals in 2012, 46 in 2013)

  • Outlining requirements to collect and review data on patient falls, including unit type, time of day, staffing ratios, interventions in place, equipment in use, toileting patterns, and medication (32 hospitals in 2012, 48 in 2013)

  • Developing a process for revising assessment and intervention strategies based on data (31 hospitals in 2012, 47 in 2013)

  • Defining the appropriate responses to falls, including protocols for postfall investigation (49 hospitals in 2012, 63 in 2013)

  • Planning for initial and ongoing falls prevention education for staff (29 hospitals in 2012, 43 in 2013)

Falls Prevention Process Measures Audit Tool

Sixty-four hospitals submitted point prevalence audits between July 1 and September 30, 2013. A total of 1,758 patients were audited, of which 1,748 (99.4%) had completed falls risk assessments and 1,222 (69.5%) were identified as being at risk to fall. Of the patients identified as being at risk to fall, most had documentation of a falls prevention plan (92.3%), a call bell within reach (89.6%), nonskid socks or slippers (79.0%), documentation of patient and family education (77.7%), and two siderails in the up position (76.8%). Falls risk identifiers, specialty equipment, and alarms were found to have lower levels of implementation. Table 1 details the percentage of patients at risk to fall who were found to have each falls prevention practice in place.

Table 1. Hospital Engagement Network Facilities' Compliance with Falls Prevention
Practices* in Patients Identified as Being at Risk to Fall (N = 1,222) ​
Falls Prevention PracticeFalls Risk Patients (%)
Falls Prevention Plan Documented
    92.3
Call Bell Within Reach
    89.6
Patients have Appropriate Footwear: Nonskid Socks or Slippers
    79.0
Patient and Family Education Documented
    77.7
Special Equipment is in Use: Two Siderails Up
    76.8
Patients have Risk Identifiers: Wristband
    65.5
Hourly Rounds Documented
    64.3
Patients have Risk Identifiers: Sign Outside Room
    46.9
Alarms are in Use: Bed Alarm
    39.3
Patients have Risk Identifiers: Colored Socks
    36.7
Special Equipment is in Use: Low Bed
    32.3
Patient have Risk Identifiers: Sign Inside Room
    26.2
Patients have Risk Identifiers: Other
    12.9
Alarms are in Use: Chair Alarm
    10.7
Patients have Appropriate Footwear: Rubber-Soled Shoes
    7.1
Special Equipment is in Use: Floor Mat
    4.7
Patients have Risk Identifiers: Colored Blanket
    3.8
Sitter is in Place
    3.1
Special Equipment is in Use: Other
    2.5
Alarms are in Use: Other
    1.7
Special Equipment is in Use: Hip Protectors
    0.7
Patients have Appropriate Footwear: Other
    0.1
* Assessed through use of the Falls Prevention Process Measures Audit Tool, July through September 2013

 

In hospitals that completed the 2013 falls SAT, 56 were identified that completed point prevalence audits between July 1 and September 30, 2013. As in 2012, comparison of falls SAT survey responses with audit results revealed a gap between levels of full implementation of best practices reported on the falls SAT survey and compliance with falls prevention practices observed during the audit process. However, in comparing results from 2012 with 2013, an increase in compliance was observed. The category of falls risk indicators has been used to illustrate this gap and the improvement (see Figure 3). For example, in 2012, in hospitals that reported full implementation for posting of signs communicating falls risk outside patient rooms, only 52.7% of patients identified at risk to fall were found to have the signs in place during audits. This percentage increased to 75.4% in 2013.

Figure 3. Compliance with Use of Falls Risk Indicators in Hospitals Reporting Full Implementation on the Falls Self-Assessment Tool Survey, July through September 2012 and July through September 2013



Falls-with-Harm Rates

Complete data to calculate rates of falls with harm was available for January through June 2012 and for January through June 2013 for 68 of the 74 hospitals that responded to the falls SAT survey in 2012 and 2013. Of the 68 hospitals that completed both falls SAT surveys, 41 hospitals completed all quarterly point prevalence audits from September 2012 through September 2013. Table 2 shows the difference in rates of falls with harm during these two time periods for hospitals completing all quarterly audits compared with those that did not. Rates were lower and decreased for hospitals that completed all quarterly point prevalence audits, while hospitals missing audits had a higher rate that increased between the two time periods.

Table 2. Change in Rates of Falls with Harm in Hospitals Completing the Falls Self-Assessment Tool Survey, January through June 2012 and January through June 2013 ​ ​ ​
2012: Falls with Harm
per 1,000 Patient Days
2013: Falls with Harm
per 1,000 Patient Days
% Change
Hospitals Missing Quarterly Audits (n = 27)0.1560.221+41.7
Hospitals Completing All Quarterly Audits (n = 41)0.1250.119
    -4.8

 

Discussion

A major focus of the PA-HEN Falls Reduction and Prevention Collaboration has been to ensure that hospitals are implementing evidence-based practices in falls prevention. Education provided to hospitals in the collaboration has included a review of what is currently established as best practice based on individual, high-quality research studies and systematic reviews, as well as evidence-based falls prevention guidelines.4-12 The falls SAT survey was provided as a tool for hospitals to complete an annual review of their falls prevention programs, assessing for congruence with these evidence-based best practices. Hospitals were also provided with an audit tool to be completed quarterly, assessing for compliance with use of falls prevention practices for patients identified at risk to fall.

Analysis of falls SAT survey responses, audit results, and rates of falls with harm has allowed the Authority to identify the following: (1) an increase in full implementation for 16 of 17 categories of falls prevention best practices, (2) categories of falls prevention best practices in which hospitals have reported the largest increases in full implementation, (3) a decreased gap between levels of full implementation of best practices reported on the survey and compliance with falls prevention practices observed during the audit process, and (4) a lower rate of falls with harm in hospitals completing the annual falls SAT and quarterly audits.

Increased Implementation of Falls Prevention Best Practices

Overall, hospitals reported a 10% increase in the percentage of best practices reported with full implementation—from 68.2% in 2012 to 78.2% in 2013. Variability in the average percentage of practices reported with full implementation also narrowed from a range of 20.5% to 92.7% in 2012 to 52.3% to 98.6% in 2013, meaning there were fewer hospitals at the lower end of full implementation in 2013 (i.e., while some hospitals reported as few as 20.5% of all practices with full implementation in 2012, no hospital reported less than 52.3% of all practices with full implementation in 2013).

Hospitals were advised to create action plans targeted to best practices identified through completion of the falls SAT survey as missing or in need of improvement. It is therefore feasible that each hospital could have been targeting multiple and different falls prevention program elements for improvement over the course of the collaboration. Comparison of falls SAT survey responses from 2012 with 2013 suggests that this is true. As a group, these hospitals have reported making the most progress in moving best practices in the categories f assistive devices, patient and family education, and policies and protocols to full implementation.

Falls Prevention Best Practices with Low Levels of Full Implementation

Medication review and sitters continue to be the two categories of best practices in falls prevention reported with the lowest levels of full implementation. Because both categories of best practices were found to correlate with lower rates of falls with harm, and because low levels of implementation for these practices were reported on the 2012 falls SAT survey, hospitals participating in the collaboration were encoraged to carefully evaluate the need to implement these practices in their institutions.1

While some collaboration members were able to add pharmacists to their teams and move medication review best practices to full implementation in 2013, this continues to be an area where hospitals struggle. Likewise, even though the number of hospitals reporting full implementation of sitter programs increased by one between 2012 and 2013, six hospitals eliminated their sitter programs in that time, and the number of hospitals with sitter programs remains low. Of the hospitals with sitter programs, the number reporting full implementation of best practices in sitter program design decreased. (Additional information on the use of patient sitters to prevent falls is available on the Authority’s website.)

For both of these categories of falls prevention practices, cost may be the barrier to full implementation.13,14 In fact, cost can serve as a barrier to implementation for any number of falls prevention practices. The Authority has developed a falls-with-harm calculator that may help hospitals make the business case for investing in practices that a falls prevention team seeks to implement. By tracking reductions in the rates of falls with harm that occur as a result of implementing new falls prevention practices, cost savings can be estimated that could justify the expense.

Policy-Practice Gap

As in 2012, comparison of responses to the 2013 falls SAT survey with the results of audits conducted on inpatient units at hospitals participating in the PA-HEN falls collaboration revealed a gap between levels of full implementation of best practices reported on the survey and compliance with falls prevention practices observed during the audit process. This gap has narrowed, but compliance with implementation of the specific falls prevention practices audited has failed to reach 100%, suggesting falls prevention practices are not being implemented reliably in patients identified as being at risk to fall. Of special note, this gap may be expected depending on the patient population and the hospital’s fall prevention protocol (for example, spinal cord injury patients may score as being at risk to fall in a hospital that reported full implementation of nonskid socks or shoes with rubber soles; however, for this select patient population, this footwear would not be indicated).

Ongoing audits and engagement of staff in the audit process is suggested. This provides an opportunity for the falls prevention team to implement missing falls prevention practices and provide “just-in-time training”15 to staff while in the process of conducting audits, rather than waiting for future meetings to discuss the results of the audits. Education surrounding hospital falls prevention policies and protocols can be reinforced, and solutions can be designed for barriers identified when compliance is low.

Falls-with-Harm Rates

In comparing hospitals participating in the PA-HEN falls collaboration that did and did not perform quarterly point prevalence audits, rates of falls with harm were lower initially and decreased for hospitals that completed all audits. Rates of falls with harm were higher initially and increased for hospitals that did not complete all audits. While cause and effect cannot be confirmed, this suggests that hospitals that are engaged in an ongoing audit process may achieve greater reductions in rates of falls with harm.

Limitations

The initial falls SAT survey was administered at hospitals in July and August 2012, whereas the data used to calculate falls-with-harm rates was collected for the period of January through June 2012. It is therefore possible that hospitals implemented falls prevention measures in July and August and indicated full implementation on the falls SAT survey even though the practices were not in place when the falls with harm were occurring.

Information on the implementation level for best practices in falls prevention was gathered from self-reporting hospitals completing the falls SAT survey. Designation of implementation level (i.e., full implementation, partial implementation, or no implementation) is subjective to the respondent.

Compliance with implementation of best practices in falls prevention practices was not able to be calculated for all hospitals participating in the PA-HEN falls collaboration. Of the hospitals that completed the falls SAT survey in 2012 and 2013, only 63 submitted audit data for July through September 2012 and only 56 submitted audit data for July through September 2013. It is possible that compliance with falls prevention practices may have been higher or lower across the 80 participating hospitals. In addition, while performance of all quarterly point prevalence audits of falls prevention practices appears to correlate with lower rates of falls with harm, cause and effect cannot be inferred.

Data used in calculating falls-with-harm rates is dependent on accuracy and consistency in reporting falls and identifying injury level through PA-PSRS. Hospitals included in this analysis have agreed to consensus definitions for falls and falls with harm as a condition for participation in the PA-HEN falls collaboration; therefore, this limitation should have been minimized. The consensus definitions were introduced in March 2012, which may have affected reporting in the baseline period. This data is also dependent on accurate and complete reporting of total facility patient-days to PHC4.

Conclusion

Hospitals participating in the PA-HEN Falls Reduction and Prevention Collaboration have been able to evaluate their current falls prevention programs and successfully identify and implement evidence-based best practices missing or in need of improvement using the Hospital Engagement Network Falls Reduction and Prevention Collaboration SAT survey. Hospitals completing the falls SAT survey and monitoring staff compliance with falls prevention practices through quarterly use of the Falls Prevention Process Measures Audit Tool have seen increases in compliance and have achieved reductions in rates of falls with harm.

Use of a self-assessment tool, such as the falls SAT survey, is suggested to identify gaps between current hospital programs and evidence-based guidelines. Conducting audits of falls prevention practices being implemented at the bedside using a tool such as the Falls Prevention Process Measures Audit Tool is also suggested to monitor for compliance with hospital falls prevention policies and protocols. Hospitals are encouraged to focus continued attention on best practices missing or in need of improvement, as identified through use of a self-assessment tool, as well as practices with which staff are found to be noncompliant during audits. Hospitals may choose to focus particular attention on best practices found to correlate with lower rates of falls with harm but reported to have low levels of implementation for hospitals participating in the PA-HEN Falls Reduction and Prevention Collaboration, namely practices in the categories of medication review and sitters.

Acknowledgments

Denise M. Barger, BA, CPHRM, CPHQ, CPPS, HEM, patient safety liaison, Delaware Valley-South, and Richard M. Kundravi, BS, patient safety liaison, Northwest Region, contributed to the design and administration of the falls SAT survey and the Falls Prevention Process Measures Audit Tool as members of the PA-HEN Falls Reduction and Prevention Collaboration project leadership team.

Notes

  1. Feil M. Falls prevention: Pennsylvania hospitals implementing best practices. Pa Patient Saf Advis [online] 2013 Dec [cited 2014 Feb 20]. http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2013/Dec;10(4)/Pages/117.aspx 
  2. ECRI Institute. Falls [self-assessment questionnaire]. Healthc Risk Control 2012 May;1:Self-assessment questionnaires 1.
  3. Pennsylvania Health Care Cost Containment Council (PHC4) [website]. [cited 2013 Aug 5]. Harrisburg (PA): PHC4. http://www.phc4.org
  4. Institute for Clinical Systems Improvement. Health care protocol: prevention of falls (acute care) [online]. 2012 Apr [cited 2012 May 15]. https://www.icsi.org/_asset/dcn15z/Falls.pdf
  5. Registered Nurses’ Association of Ontario. Prevention of falls and fall injuries in the older adult [online]. 2011 [cited 2012 May 15]. http://rnao.ca/sites/rnao-ca/files/Prevention_of_Falls_and_Fall_Injuries_in_the_Older_Adult.pdf
  6. Patient Safety First. The ‘how-to guide’ for reducing harm from falls [online]. 2009 Sep [cited 2012 May 15]. http://www.patientsafetyfirst.nhs.uk/ashx/Asset.ashx?path=/Intervention-support/FALLSHow-to%20Guide%20v4.pdf
  7. Gray-Micelli D, Quigley PA. Fall prevention: assessment, diagnoses, and intervention strategies. In: Boltz M, Capezuti E, Fulmer T, eds. Evidence-based geriatric nursing protocols for best practice. 3rd ed. New York: Springer Publishing Company; 2012:268-97. Also available at http://www.guideline.gov/content.aspx?id=43933
  8. Boushon B, Nielsen G, Quigley P, et al. Transforming care at the bedside how-to guide: reducing patient injuries from falls [online]. 2012 [cited 2013 May 8]. http://www.ihi.org/knowledge/Pages/Tools/TCABHowToGuideReducingPatientInjuriesfromFalls.aspx
  9. Health Care Association of New Jersey. Fall management guideline [online]. 2012 [cited 2013 May 8]. http://www.hcanj.org/files/2013/09/hcanjbp_fallmgmt13_050113_2.pdf
  10. National Center for Patient Safety. Falls toolkit [online]. 2004 Jul [cited 2013 May 8]. http://www.patientsafety.va.gov/professionals/onthejob/falls.asp
  11. National Institute for Clinical Excellence. Clinical practice guideline for the assessment and prevention of falls in older people [online]. 2004 Nov [cited 2013 May 8]. http://www.nice.org.uk/nicemedia/pdf/CG021fullguideline.pdf
  12. Agency for Healthcare Research and Quality. Preventing falls in hospitals: a toolkit for improving quality of care [online]. 2013 Jan [cited 2013 May 8]. http://www.ahrq.gov/research/ltc/fallpxtoolkit/index.html
  13. Harding AD. Observation assistants: sitter effectiveness and industry measures. Nurs Econ 2010 Sep-Oct;28(5):330-6.
  14. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003 Dec 8-22;163(22):2716-24.
  15. Babylon 10 dictionary. Just-in-time training [online]. [cited 2014 Mar 12]. http://dictionary.babylon.com/just-in-time_training
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