fall prevention in behavioral health · fall prevention program ; recommendations. 30...

Fall Prevention in Behavioral Health

Caroline Stegeman, RN, BSN, MJ, ONC, CPHRM, CPSO

Director of Patient Safety

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Disclosure

HSLI, the LHA Trust Fund, nor the presenters have any conflicts of interest, commercial support, or sponsorship in the presentation of this educational program. No product endorsements are being made.

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Objectives

• Identify factors contributing to patient falls in Behavioral Health

• Identify fall risk assessment tools for Behavioral Health population

• Review key prevention strategies related to Behavioral health population

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Patient Falls

• Continue to be an issue in healthcare

• 30-40% of patient safety issues related to falls

• Goal: ─ Fall Free─ Decrease falls─ Decrease injuries

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Patient Fall-Definition

• Unplanned descent to the floor

• With or without injury

• Unplanned-falling, tripping, slipping, sitting, etc.

• Assisted & unassisted

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Major Areas of Focus

• Hospitals focus on ─ Prevention─ Reporting-drill down-data

• Locations─ Acute inpatient─ Med-surg─ ICU─ Telemetry

• Minimal focus on falls in BH

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General Fall Stats

• 2016 Predictions─ 2020 cost of falls 43.8 billion annually

• Studies─ 700,000-1 million falls per year─ 30-35 % sustain injuries─ 6.3 increase in LOS─ Cost of fall $14,056─ 1/3 falls preventable

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Behavioral Health Fall Stats

• Fall rates range ─ 4.5-25 falls per 1,000 pt. days

• Average patient age─ BH - 45 years of age─ Inpatient - 65 years of age

Contributing Factors to Patient Falls in Behavioral Health

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Contributing Factors in Behavioral Health

• Medications are #1─ Benzodiazepines─ Sedative/hypnotic drugs─ Antidepressants─ Antipsychotic─ Anticonvulsants

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Contributing Factors in Behavioral Health

• Medications may cause─ Orthostatic hypotension Underlying conditions Other medications

─ Inadequately monitored─ Most fail to conduct assessments

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Contributing Factors in Behavioral Health

• Activity─ More active & ambulatory

• Flooring

• Lighting

• Floor mats/carpeted areas

• Design of room/furniture set up

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Contributing Factors in Behavioral Health

• Clutter

• Improper footwear

• Loose or removed shoe laces

• Being left alone

• Rooms away from the nurses station

• Decreased visibility

• Inadequate staffing levels

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Contributing Factors in Behavioral Health

• Restrictions of ambulation devices─ Canes─ Walkers─ Crutches─ Hand rails─ Lifting devices

• Safety Hazard

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• Restrictions of safety devices─ Wired chair/bed alarms─ Side rails─ Call bell systems─ Safety Hazard

Contributing Factors in Behavioral Health

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Contributing Factors in Behavioral Health

• Communication─ Fail to communicate fall risk/history of

falls Shift to shift Caregiver to caregiver

─ Fall risk should be address during handoffs

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Contributing Factors in Behavioral Health

• Culture─ Staff may not see psychiatric patients as

medically ill─ Overlook need for assistance─ Medical conditions can be contributory

factors

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Contributing Factors in Behavioral Health

• Situational Factors─ Forced to be there─ Patient behavior─ Adherence to rules/recommendations─ Doing more than one task at a time

Fall Risk Assessment

Tools for Behavioral Health

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Fall Risk Assessment Tools

• Not always applicable to BH patients

• Low specificity for predicting falls-desensitize staff

• Medication regimen-high risk for falls

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Fall Risk Assessment Tools

Hendrich II Fall Risk Model

• Designed for acute care environments

• Assessment focus

• Recommendations for BH population

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Fall Risk Assessment Tools

Morse Fall Scale

• Intended for acute med-surg patients

• Assessment focus

• Recommendations for BH population

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Fall Risk Assessment Tools

Schmid Fall Risk Model

• Intended for general hospital patients

• Assessment focus

• Recommendations for BH population

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Fall Risk Assessment Tools

Saint Thomas Risk Assessment Tool for Falling Elderly Inpatients (STRATIFY)

• Intended for elderly inpatients

• Assessment focus

• Recommendations for BH population

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Fall Risk Assessment Tools

Edmonson Psychiatric Fall Risk Assessment Tool ( EPFRAT)

• Intended for psychiatric inpatient population

• Assessment focus

• Recommendations for BH population

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Fall Risk Assessment Tools

Wilson Sims Fall Risk Assessment Tool

• Intended for psychiatric inpatient population

• Assessment focus

• Recommendations for BH population

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Fall Risk Assessment Tools

Proprietary or Homegrown

• Not tested for validity and reliability

• May place too many patients at risk

• Cause fall prevention program to lose significance

Comparison of Fall Risk Assessment Tools

Rank Risk Assessment Tool

PopulationDesigned For

Recommendation for BH

1 Wilson Sims Tool BH Inpatients Comprehensive BH fall assessment includes nurses clinical judgment

2 Edmonson Psychiatric Tool

BH Inpatients Comprehensive BH fall assessment; does not include place for nurses’ clinical judgment

3 Hendrich II Model Acute Care Leaves out variables for BH population; better than using homegrown tool

4 Schmid Model General Hospital Not indicated for BH use, factors measured are fair indicators in BH population

5 Morse Scale Med-Surg Reliable for general hospital areas; not for BH population

6 Saint Thomas Tool Elderly inpatients

Meds are not part of assessment; major factor for BH population

Behavior Health Fall Prevention

Program Recommendations

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Multidisciplinary Fall Prevention Team

• Specifically for BH• Include everyone at the table• Review fall data• Monitor attendance• Encourage an active voice• Meet frequently and prn• Audit compliance with all fall-prevention

strategies

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Fall Risk Assessment

• Effective tool for BH population• Standardized process• Admission• Daily• Change in status• After a fall• Med changes

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Fall Risk Prevention Interventions

• At minimum document after each assessment

• Document in detail─ Interventions implemented based on

risk assessment─ Continuation of interventions in place

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Communication

• Fall risk assessment, history, injury─ Handoff communication-standard item

on handoff tool─ Multidisciplinary case

conference/Treatment team─ Psychiatrists need to be aware

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Medication Safety

• Every change in medication─ Assess fall risk

• Meds known to cause orthostatic hypotension-─ Monitor orthostatic signs daily─ Conduct correctly

• Meds having extrapyramidal side effect─ Examine patients daily

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Education

• Staff─ Educate on fall program and

processes

• Patients/Family─ Educate on specific risk factors

─ Fall prevention interventions in place for the patient

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Fall Prevention Recommendations

• Physical rehabilitation services─ Initiate early─ Assess─ Evaluate─ Manage─ Gait/mobility issues

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Environmental Risk Assessment

• Conduct a comprehensive risk assessment─ Entire unit-inside and outside─ Sharp edges─ Sources of trauma─ Slip/trip hazards─ Safety concerns─ Fluid stations

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Environmental Risks

• Consider use of motion-sensitive lighting to assist with night time bathroom trips

• Keep beds low to floor

• Fall mats

• Ensure floor is free of clutter─ Linen─ Personal items

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Rounding

• Q 15 min checks

• Conduct ─ Fall prevention checks─ Environmental assessments─ Check floors for slip/trip hazards Water Personal items

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Rounding

• ICARE rounding tool– Introduce– Check for comfort– Ask/assess 4 P’s Pain, Position, Potty, Periphery

─ Reassure/reorient─ Environmental rounding tool

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Rounding

• Take steps to minimize bathroom trips at night─ Bedtime potty rounds─ Limit fluid intake after supper─ Monitor meds cause an increase Thirst Dry mouth

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Proper Attire

• Assess patients to ensure proper attire ─ Pant leg length is above the ankle─ Footwear is appropriate─ Provide non-slip footwear

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Staffing

• Ensure adequate staffing ratios─ Based on acuity of patients─ Based on the layout of facility─ Based on the needs of patients

• Pulled Staff-need to be oriented

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Unanticipated Falls

• If a fall occurs─ Post fall huddle─ Implement intervention to prevent

another fall ─ Assess medications─ Move patient closer to nurses station

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Hot Take Away Tips

• Identify factors contributing to patient falls in Behavioral Health

• Identify & implement appropriate fall risk assessment tools for Behavioral Health population

• Implement key prevention strategies to reduce falls in Behavioral health population

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Contact Information

Caroline Stegeman, RN, BSN, MJ, ONC, CPHRM, CPSODirector of Patient Safety

225-247-8014carolinestegeman@lhatrustfunds.com

Stacie Jenkins, RN, MSN, CPSOVP of Patient Safety & Risk

225.368.3823staciejenkins@lhatrustfunds.com

Allison Rachal, RN-BC, CPSOSr. Patient Safety Consultant

318-227-7207allisonrachal@lhatrustfunds.com

LHA Trust Funds Websitehttps://lhatrustfunds.com