Preventing Falls in Hospitals - ahrq.gov

1 Preventing Falls in Hospitals A Toolkit for Improving Quality of Care The information in this toolkit is intended to assist service providers and Hospitals in developing Falls prevention protocols. This toolkit is intended as a reference and not as a substitute for professional judgment. The opinions expressed in this document are those of the authors and do not necessarily reflect the views of AHRQ. No statement in this toolkit should be construed as an official position of AHRQ or the Department of Health and Human Services. In addition, AHRQ or Department of Health and Human Services endorsement of any derivative product may not be stated or implied. Preventing Falls in Hospitals A Toolkit for Improving Quality of Care Prepared for: Agency for Healthcare Research and Quality 540 Gaither Road Rockville, MD 20850.

2 Prepared by: RAND Corporation Boston University School of Public Health ECRI Institute Contract No. HHSA290201000017I TO #1. AHRQ Publication No. 13-0015-EF. January 2013. Authors RAND Corporation David A. Ganz, , , VA Greater Los Angeles Healthcare System, University of California at Los Angeles, and RAND Corporation Christina Huang, , RAND Corporation Debra Saliba, , , VA Greater Los Angeles Healthcare System, UCLA/JH Borun Center for Gerontological Research, and RAND Corporation Victoria Shier, , RAND Corporation Boston University School of Public Health Dan Berlowitz, , , Bedford VA hospital and Boston University School of Public Health Carol VanDeusen Lukas, , VA Boston Healthcare System and Boston University School of Public Health ECRI Institute Kathryn Pelczarski, Karen Schoelles, , Linda C. Wallace, , Patricia Neumann, , This document is in the public domain and may be used and reprinted without special permission.

3 Citation of the source is appreciated. Suggested citation: Ganz DA, Huang C, Saliba D, et al. Preventing Falls in Hospitals : a toolkit for improving quality of care. (Prepared by RAND Corporation, Boston University School of Public Health, and ECRI. Institute under Contract No. HHSA290201000017I TO #1.) Rockville, MD: Agency for Healthcare Research and Quality; January 2013. AHRQ Publication No. 13-0015-EF. ii Contents Roadmap ..v ix Overview ..1. The Problem of Falls ..1. The Challenges of Fall Prevention ..1. Toolkit Designed for Multiple Audiences ..2. Implementation Guide Organized To Direct Hospitals Through the Change Process ..3. Sections of the Guide ..3. Adaptation of the Guide to Your Improvement as Puzzle Pieces ..4. Icons ..5. 1. Are you ready for this change? ..6. Do organizational members understand why change is needed?

4 6. Is there urgency to change?..8. Does senior administrative leadership support this program? ..9. Who will take ownership of this effort? ..11. What kinds of resources are needed? ..12. What if you are not ready for full-scale change? ..12. Checklist for assessing readiness for change ..13. 2. How will you manage change? ..14. How can you set up the Implementation Team for success? ..15. What needs to change and how do you need to redesign it? ..19. How should goals and plans for change be developed? ..25. Checklist for managing change ..26. 3. Which fall prevention practices do you want to use? ..27. Which fall prevention practices should you use? ..28. What are universal fall precautions and how should they be implemented? ..30. What is a standardized assessment of risk factors for Falls , and how should this assessment be conducted?

5 34. How should identified risk factors be used for fall prevention care planning? ..38. How should you assess and manage patients after a fall? ..46. How can your hospital incorporate these practices into a fall prevention program? ..49. What additional resources are available to identify best practices for fall prevention? ..51. Checklist for best practices ..51. 4. How do you implement the fall prevention program in your organization? ..52. What roles and responsibilities will staff have in Preventing Falls ? ..53. What fall prevention practices go beyond the unit?..59. How do you put the new practices into operation? ..60. Checklist for implementing best practices ..67. 5. How do you measure fall rates and fall prevention practices? ..68. How do you measure fall and fall-related injury rates? ..69. How do you measure fall prevention practices?

6 77. Checklist for measuring iii 6. How do you sustain an effective fall prevention program? ..81. Who will be responsible for sustaining active fall prevention efforts on an ongoing basis? ..82. How will you continue to monitor fall rates and fall prevention care processes? ..82. What types of ongoing organizational support do you need to keep the new practices in place? ..83. How can you reinforce the desired results? ..84. Summary ..87. 7. Tools and Resources ..89. Appendix: Bibliography of Studies Implementing Fall Prevention Practices ..185. iv Roadmap Who Should Use The Section Action Steps Tool That Supports Action Tool Overview Enlist support of senior leaders Tool A, Introduction and Overview for Senior manager Stakeholders Section 1 Are you ready for this change? Assess the culture of safety in your Tool 1A, hospital Survey on Patient Safety Culture All interdisciplinary hospital team members Evaluate current organizational Tool 1B, Stakeholder Analysis Implementation Team attention to Falls leader Assess and develop leadership Tool 1C, Leadership Support Assessment Implementation Team support for the fall prevention leader program Tool 1D, Business Case Form Identify resources that are available Tool 1E, Resource Needs Assessment Implementation Team and resources that are needed leader Assess your progress on completing Tool 1F, Organizational Readiness Checklist Implementation Team readiness for change activities leader Section 2 How will you manage change?

7 Identify your Implementation Team Tool 2A, Interdisciplinary Team Implementation Team leader Assess the current status of fall Tool 2B, Quality Improvement Process Implementation Team prevention activities in your leader, individuals hospital Tool 2C, Current Process Analysis designated by the v Tool 2D, Assessing Current Fall Prevention Policies Implementation Team and Practices leader Determine staff knowledge about Tool 2E, Fall Knowledge Test Staff nurses and fall prevention nursing assistants Set goals for improvement based on Tool 2F, Action Plan Implementation Team outcomes and processes leader with quality improvement/safety/ris k manager Who should use the Section Action Steps Tool That Supports Action tool Assess your progress on completing Tool 2G, Managing Change Checklist Implementation Team the managing change activities leader Section 3 Which fall prevention practices do you want to use?

8 Identify how fall prevention care Tool 3A, Master Clinical Pathway for Inpatient Falls Quality processes connect to one another improvement/safety/ris k manager, staff nurses, nursing assistants Implement universal fall Tool 3B, Scheduled Rounding Protocol Unit manager, staff precautions nurses, nursing Tool 3C, Tool Covering Environmental Safety at the assistants, facility Bedside engineer, hospital employee who enters Tool 3D, Hazard Report Form patient rooms Tool 3E, Clinical Pathway for Safe Patient Handling vi Identify important risk factors for Tool 3F, Orthostatic Vital Sign Measurement Staff nurses, Falls in your patients pharmacist, nursing Tool 3G, STRATIFY Scale for Identifying Fall Risk assistants Factors Tool 3H, Morse Fall Scale for Identifying Fall Risk Factors Tool 3I, Medication Fall Risk Scale and Evaluation Tools Use identified fall risk factors to Tool 3J, Delirium Evaluation Bundle.

9 Digit Span, Educators, staff nurses, implement fall prevention care Short Portable Mental Status Questionnaire, and physicians, nurse planning Confusion Assessment Method practitioners, physician assistants, nursing Tool 3K, Algorithm for Mobilizing Patients assistants Tool 3L, Patient and Family Education Tool 3M, Sample Care Plan Assess and manage patients after a Tool 3N, Postfall Assessment, Clinical Review Staff nurses and fall physicians Tool 3O, Postfall Assessment for Root Cause Analysis Who should use the Section Action Steps Tool That Supports Action tool Assess your progress on completing Tool 3P, Best Practices Checklist Implementation Team the best practices activities Leader Section 4 How do you implement the fall prevention program in your organization? vii Assign staff roles and Tool 4A, Assigning Responsibilities for Using Best Implementation Team responsibilities for tasks identified Practices Leader, Unit manager in set of best practices Tool 4B, Staff Roles Assess current staff education Tool 4C, Assessing Staff Education and Training Implementation Team practices and facilitate integration Leader of new knowledge on fall prevention into existing or new practices Assess your progress on Tool 4D, Implementing Best Practices Checklist Implementation Team implementing best practices Leader activities Section 5 How do you measure fall rates and fall prevention practices?

10 Collect the right data to learn about Tool 5A, Information To Include in Incident Reports Quality Falls , fall-related injuries, and their improvement/risk causes manager, information systems staff Measure fall prevention practices Tool 5B, Assessing Fall Prevention Care Processes Unit manager and unit champions Assess your progress on measuring Tool 5C, Measuring Progress Checklist Implementation Team progress activities Leader Section 6 How do you sustain an effective fall prevention program? Identify factors need to sustain your Tool 6A, Sustainability Tool Implementation Team fall prevention efforts Leader viii Acknowledgments William Spector, , Senior Social Scientist at AHRQ, acted as project officer for this task order to develop a toolkit. Rhona Limcangco, , Health Analyst at AHRQ, provided additional support in carrying out the project.