Fall Reduction : Sustaining the Gain

Purpose:
Decribe the use of video monitor system, Code Fall huddle data collection tool, HELP- Hospitalized Elder Life Program and RN assessment to reduce inpatient falls on an ACE-Acute Care Elder Unit. Discuss the role of the team and the combination of fall prevention strategies that yield sustainability.

Significance:
3-20% of inpatients fall on average one time during thier hospitalization.50% of people over the age of 80 fall once in the community.It is a challenge to prevent falls in this population, especially during an acute admission. However,the focus from CMS and ACO will increase fall prevention focus.

Strategy and Implementation:
9 video cameras were installed to provide 24 hour monitoring of patients meeting criteria. Among this criteria is age over 70, history of fall, dementia and/or delirium. High risk fall patients are observed by staff who rotate every 2 hrs and immediately respond to any movement that may result in a fall. The nursing staff of our ACE unit are trained in assessing cognitive status using the MMSE or Sweet 16. Patients are constantly assessed and may be moved to a video room at any time during thier stay based on condition. One of our nurses is the chair of the Falls Reduction Resource Team. She analyzes data from each fall using the code fall huddle,which provides real time information and input from staff at the time of the fall. A report is generated showing key factor that may have contributed to the fall. This is communicated to staff to gain greater awareness and knowledge regarding why patients are falling. The HELP program works with our team and sees patients at risk of delirium.

Evaluation:
The fall rate on the ACE unit has decreased by 50% 2007-2009. We had a 30% decrease in 2010. The staff report each fall via event reports and code fall huddle data collection tools. These reports are reviewed by nurse manager, PI team, Risk management and Falls Reduction Resource team.

Implications for Practice:
Code Fall huddle can be implemented on any unit. It is vital to learn why patients are falling and this is the first step to reducing falls. Video monitoring system costs $5-20K but cost effective compared to falls with injury. HELP has low initial start up costs and only requires 1.5 FTE's.