A new tool, released today, could help your hospital address one of health care’s most pesky and persistent problems, all while saving money in the process.
The Joint Commission Center for Transforming Healthcare this morning debuted its newest instrument to help hospitals address a particular patient safety issue, following similar guides addressing hand hygiene, safe surgery and handoff communication. This time, the commission set its sights on falls, an issue that can spell 6.3 extra days in the hospital, on average, and excess costs of about $14,000.
Working with several hospitals over the past four years, the commission has devised a systematic approach to assessing whether a patient is at risk for falling, and then deploying 21 different solutions to try to address those falls based on the common risk factors in the organization. Using those tools, pilot hospitals have been able to reduce all falls by about 35 percent, and those resulting in injury by 62 percent.
By implementing this toolkit, the typical 200-bed hospital would experience about 70 fewer falls with injury annually, resulting in a savings of about $1 million.
"This is really exciting news," Mark Chassin, M.D., president and CEO of the Joint Commission, said during a conference call with reporters this morning. "Falls have persisted in health care and defied solutions for far too long. Patient falls can cause serious injuries and they can even be life threatening. We have to do a better job of protecting patients, and now we can."
Kaiser Permanente San Diego Medical Center, one of the original participating hospitals, strived to eliminate all falls during its own project, and looked to label each and every patient as a potential risk on arrival. Kaiser was able to achieve that goal and completely change its culture using the toolkit, said Leah Apatan, R.N., nurse manager of a surgical and oncology unit at the hospital and clinical lead for its falls project.
During the project, Kaiser analyzed all variables that might result in falls, from bed placement to mobility issues and medication. Engaging with patients and their families on falls was an "eye opening" part of that assessment process, Apatan said. They found that often pride was a factor resulting in falls, giving the example of a big burly man who needed help going to the bathroom, but was too stubborn to ask for assistance. "It can be an emotional issue. For some, it feels like they’ve lost their independence." About 86 percent of Kaiser’s falls resulted from patients getting up without assistance, often two to three hours after meals. Solutions they ended up implementing included bed alarms, nonskid footwear and further education of patients.
While the solutions used will differ from hospital to hospital, Apatan noted that any successful falls prevention program should include a few key elements, namely, measurement, staff engagement, consistent messaging, focused operational and cultural changes, and patient communication. She said it’s also critical to include all employees in the process, and not just a select few.
"We had all hands and eyes on deck, from environmental services to physicians, nutrition to lab and physical therapy. Anyone in that room was responsible for ensuring that the patient did not walk alone," she said.
Erin DuPree, M.D., chief medical officer and vice president of the Center for Transforming Healthcare — with whom I spoke for a June story I wrote on falls — said that also includes hospital executives, who must make patient safety and fall prevention an organizational priority. "It is not a nursing problem. It requires the attention of leadership from the very top."