The Patient Safety First campaign (UK) has recently put out a “How to” Guide for Reducing Harm from Falls. Some of the recommendations are ones you are probably already doing: involving leadership, setting up a multidisciplinary falls team, setting aims, measuring baselines and developing outcome measurements. They reinforce tying your falls initiatives to other initiatives such as your delirium prevention and management projects. They stress that the real goal is to prevent injuries from falls, not just preventing falls, and stress the importance of balancing the fall prevention program against the need to foster patient independence, aid in rehabilitation, and preserve privacy, dignity and personal choice.
In their “do’s and don’ts” section they caution against expecting an immediate and dramatic improvement. They note that even the best falls management programs produce improvements on the order of only 18% and it may take many months or even years to reach significant outcome improvements. They also caution against external benchmarking since fall rates and injury rates are heavily dependent upon characteristics of the patient population at each hospital. And as we’ve mentioned before, they caution against using fall risk assessment tools that just “score” patients because such may miss patients who still fall and may make you focus too much attention on patients who will not fall. In fact, they provide a tool to assess the effectiveness of your fall risk assessment tool. Instead, the focus needs to be on identifying and mitigating individual risk factors in the individual patient. They provide a nice example of an individually targeted falls are plan.
They appropriately place a premium on the evaluation of the patient after a fall, stressing identification of factors that may have led to that fall. In fact, they suggest that one of your measurements be the % of falls receiving a complete post-fall evaluation.
And the best part of the “How to” Guide is probably the “useful links” section at the end, plus a good bibliography.
Patient Safety First (UK). The “How To Guide” For Reducing Harm From Falls.