Emerging Trends in Preventing Falls: "Code Fall"

Purpose:
Falls and falls related injury is the leading cause of morbidity and mortality among the elderly and cost hospitals in excess of $ 2.4 billion per year. Among the nursing quality indicators, the rate of falls can be most positively impacted and improved through nurse led strategies.

Significance:
On our 33 bed elder care medical unit, the falls rate in 2004 and 2005 average 60 falls per year. In 2006 we reached an all time high of 78 falls, despite implementing falls prevention strategies.

Strategy and Implementation:
In accordance with the Joint Commission's national patient safety goals, we evaluated the effectiveness of our falls prevention program and identified the opportunities for improvement. A paradigm shift for staff to perceive and react to fall occurrence as an emergency equivalent to code blue, called "code fall" increased awareness and changed our culture and staff's attitude toward falls. Code fall is a qualitative investigation that occurs immediately after the fall occurrence. The patient care team immediately convenes to identify factors that may have contributed to the fall such as clinical condition, medication, toileting needs, dementia, and delerium etc. Patients who have a fall occurence are eligible for video monitoring, which is a system that continuously observes patients at risk for fall occurence. The patient and family are educated and consent is obtained. This modality serves an alert to patients with mild dementia and needs verbal cues to wait for assistance.

Evaluation:
Since the implementation of "code fall" and video-monitoring we have seen a reduction in the rate of falls and falls related injuries. In 2007 and 2008 our unit fall rate averaged 44, and to date the fall rate is 12.

Implications for Practice:
The video system can also be purchased and utilized in high risk populations such as geriatric patient care areas. Code fall has spread to all adult inpatient units and video-monitoring has been expanded to 5 patient care units. Code Fall could easily be implemented immediately in any hospital.