Preventing Patient Falls: Starting Out on the Right Foot(s) - What Healthcare Facilities Should Know

Falls are an important patient safety and risk management issue. Doing this correctly can result in a loss of reimbursement from Medicare. CMS includes hospital-acquired conditions (HAC) in which hospitals will not receive a payment related to the adverse events for Medicare patients. One of these areas includes falls. In 2020, there is a 1% reduction in Medicare payments and will affect hospitals whose rate is in the top quartile.

Falls are the number one HAC. Patient death or serious injury associated with a fall is also one of the 29 National Quality Forum Never Events which some states have agreed not to bill for. Falls can result in the filing of a medical malpractice case. This seminar will discuss how to comply with the Joint Commission and the CMS hospital CoP standards on falls.

Every hospital should consider having a fall team to look at this important patient safety issue. Preventing falls among patients requires a multifaceted approach. This seminar will discuss recognition, evaluation, assessment, categories of risk, policies, and procedures, evidenced-based literature, toileting, medication alteration, hourly rounding, post-fall huddle, need to increase mobility, signage, no passing zone, safe room set up, patient education, incident reports and prevention of falls.

Preventing falls and fall-related injuries is an important issue for hospitals today. Fall prevention is a crucial topic for today’s aging population. Patient falls are the leading cause of injury-related deaths for patients over 65 years of age. The goal is to reduce the number of falls, the severity of falls, and increase mobility. All healthcare facilities must be up to date on the current evidence-based literature to reduce and prevent falls. This includes a toolkit on how to prevent falls by AHRQ and TJC 21 targeted solutions.

Falls are one of the most significant challenges for hospitals and other health care facilities. It will include information on medications that increase the fall rate and the pharmacist's role in the fall program. The program will cover a study on how the IT process helped a hospital reduce falls.

Attendance is a must for anyone serving on the falls team and anyone interested in preventing and reducing the number of falls in the hospital setting. All hospitals should have a falls team and fall team members should receive current and up-to-date information about falls.

• Recall that every hospital should have a falls program
• Describe that all staff should know how to define what constitutes a fall and how to measure the fall rate
• Explain that there are intrinsic and extrinsic causes of falls
• Recall that falls are one of the things CMS will not pay for on Medicare patients  if they occur during hospitalization and cause serious injury or death
• Discuss that toileting and hourly rounding can reduce falls in high-risk patients
• Discuss the issue of decreased mobility and how it can result in falls
• List evidenced-based fall assessment tools used in inpatient and outpatient settings

Introduction

• Why do You Need a Falls Program?
• Falls as a Joint Commission (TJC) Sentinel Event and revised definition
• Predicators for Risk for Falls
• Need to increase the mobility of patients
• TJC and CMS Standards
• TJC Speak Up on Falls and video
• TJC targeted solutions
• Falls road map
• CMS Adverse events and payment issue
• AHRQ Fall assessment toolkit and success stories
• Standard of Care, Lawsuits and Claims, Caselaw
• The extent of Problem
• Definitions of fall
• Risk Assessment Tools: Morse, Hendrich II,  STRATIFY, Johns Hopkins, Conley, Innes, Downton,  Schmid, Tinetti, Etc.
• Measurement of fall: Benchmarking, Comparison of falls
• Falls Research
• Dementia and fall assessments

Causes of Falls

• Intrinsic (age, history of falls, gait and balance deficit, weakness lower extremities, four or more prescriptions, decreased visual acuity, etc.)
• Extrinsic (distracting noises, use of restraints, toilets in the low position, bed in the high position, time of day—increased risk at shift change, highly polished floor, poorly designed bathrooms, etc.)

Falls assessments and Interventions

• 3 classifications of falls; accidental, unanticipated physiological falls, anticipated physiological falls
• Intervention/Prevention Strategies
• Risk Assessment
• Fall predictors
• Assessing Individual Risk Factors: Admission
• Change in Condition after a Fall
• Instruments to Conduct Risk Assessment
• Comprehensive Fall Prevention Program
• Environmental rounds
•  Responsibilities of staff
• Evaluating the Environment
• Bedrail Hazard
• How IT program reduced hospital falls by 50%
• Clinical Alarm System
• Staffing Levels
• Toileting
• Staff Education, Patient/Family

Education

• Medications and fall risk
• Restraint Issues
• Get up and go test procedure
• Post Fall Assessment
• FMEA/RCA
• Monitoring a Program’s Effectiveness
• New guidelines on falls

• Fall Team Members
• Nurses
• Quality Management Coordinator
• Joint Commission Coordinator
• Regulatory Affairs Director
• Patient Safety Officer
• Chief Nursing Officer
• Chief Medical Officer
• VP of Medical Staff
• Chief Operating Officer
• Pharmacist
• Risk Manager
• Hospital Legal Counsel
• Occupational or Physical Therapists
• Physicians
• VP of Medical Staff
• Nurse Managers
• Nursing Assistants
• Nurse Supervisor
• Nurse Educator
• Quality Director
• Patient Safety Officer
• Nurse Supervisors
• Joint Commission Coordinator
• Compliance Officer
• Legal Counsel
• Consumer Advocate
• Department Directors
• Department Falls Champion
• Falls Clinical Nurse Specialist
• Anyone involved in preventing patient falls