Gov. Inslee has declared September 22 Falls Prevention Awareness Day, which is an opportunity to engage your organization in efforts to reduce falls that result in injuries. This is a relevant issue for Washington State, as 13 percent of residents are older than 65, and falls are the leading cause of nonfatal injuries and hospital admissions among these adults. In addition, the rate of death from falls among older adults has increased 25 percent in the last 18 years.
Several factors contribute to falls, such as variation in assessment tools to identify fall risk factors, ineffective communication and handoffs, inadequately individualizing a patient’s plan of care, and physical environment.
Reducing injuries related to falls is complex. Key elements for a sustainable fall prevention program include:
- Organizational leadership support;
- An interdisciplinary and diverse team that meets routinely and systematically to analyze fall data and identify trends and opportunities for continuous improvement;
- A standard comprehensive fall risk assessment tool, communication plan and educational training for all staff;
- Patient and family engagement; and
- A standard post-fall process.
Conduct a post-fall huddle as soon as possible with the clinical team and the patient and their family. The huddle is a discussion with the care team to learn what happened, what interventions were in place and what modifications will be made to prevent the patient from having a recurrent fall.
Patient falls with serious injuries are listed as one of the top 10 sentinel events (any unanticipated events in a health care setting resulting in death or serious physical or psychological injury, unrelated to a patient’s illness) reported to the Joint Commission Sentinel Event Database. Last fall, the Joint Commission released Sentinel Event #55, which emphasized preventing falls with injuries in the health care setting.
For more information on evidence-based fall-reduction strategies, tools and support, contact WSHA Patient Safety Director of Quality and Performance Improvement Tina Seery. (Tina Seery)