Addressing Falls in the Ambulatory Setting: Excitement Reaching High Temperature!!!!

Purpose:
Falls continue to be a major health problem. The primary focus of falls has been in the inpatient arena, with little concentration on reduction strategies for patients in ambulatory areas. The goal was to create the safest environment for patients and families, as possible.

Significance:
Falls can cause injury as well as incur cost for the patient and/or the institution. Falls lead to patient and family embarassment and dissatisfaction. There is little research-based evidence regarding effective strategies to reduce falls in ambulatory settings.

Strategy and Implementation:
A multidiscipliinary falls commmittee was created, starting with members of the hospital Falls Advisory Board and adding others from ambulatory areas. Multiple reduction strategies were implemented including additional seating in hallways coming from the garage, 'wheelchair corrals' with wheelchairs readily available, and changes to appointment letters to instruct on patient drop off and wheelchair availability. Computer changes allowed identification of patients at risk for falls, thus communicating to all areas that patient was at risk for falling. Yellow falling star stickers were placed on paperwork of any patient identified at risk to communicate this to the next caregiver. Staff were identified as fall champions and were educated via a workshop and online videotaped vignettes. Almost 100 champions were educated and over 500 additional staff have been trained by the falls champions. Additional strategies will be shared.

Evaluation:
During the first 4 months, a 33% reduction in falls and a 25% reduction in falls with injury was seen in all ambulatory areas. The first 3 pilot areas experienced greater than a 50% reduction in the previous year fall rate. Additional data will be shared that has been used in making improvement.

Implications for Practice:
Certainly, creating a safe environment is of the utmost importance. Anything that can be done to communicate falls risk and heighten awareness on the part of ALL staff in all areas is critical.