Nursing EVIDENCED-BASED PRACTICE ASSIGNMENT REGISTERED NURSING STUDENT

Notable interventions/procedures for fall prevention:

1. Assessment

a. All patients are assessed for fall risk using the Johns Hopkins Fall Risk Assessment tool on admission

b. Reassessments required every shift, upon transfer, on change in patient condition, and post-fall.

2. Interventions

a. See Appendix A for complete list

b. Use of Fall ID bands

c. High fall risk signs posted outside the room (white/yellow for high fall risk, red for patients who fell during their admission)

d. Bed alarms

i. Centrella smart beds: Our newer beds featuring lights allows at-a-glance checking if side rails are up, bed alarms on, and if bed is in lowest position. Note green light for active (in-use), yellow for inactive.

e. Hourly rounding: Shared responsibility between PCT and RN; frequently address pain, toileting, positioning, etc. during hourly rounds to reduce risk for falls. Reaching for out-of-reach items and needing to the toilet are common pre-fall activities.

f. Chair alarms (Posey chair alarm)

i. For use for fall-risk patients who are OOB to chair

ii. Connects to our call bell system, producing a loud alert and sending high-priority alarms to nursing stations while flashing the call light outside the patient room when triggered

g. Use of roll belt (not considered a restraint) and/or lap belts (when OOB to chair)

h. Patient spotters/sitters: a PCT or staff member tasked with staying with patient at all times to ensure patient safety

i. Incident reports and post-fall evaluations for quality improvement

3. Unit-specific fall initiatives (10CD)

a. Case review during staff meetings: RNs present their fall incident during staff meetings to raise awareness of commonly occurring issues leading to falls, and what processes/workflow can be improved on the unit

b. Early Mobility Initiative

i. LPNs and/or PCTs focus on mobilizing all abled patients with the idea of reducing fall rates by preventing functional decline during their stay at the hospital

c. Mobility board: located on patient's white board, communicates mobility function of patients (i.e. 2-person assist vs 1-person assist, bedpan vs OOB to toilet/commode, etc.). Informs any staff member responding to a patient's call how patient toilets, walks, and identifies any mobility issues and restrictions.