May 1, 2009

New safety measures target patient falls

After months of research and collaborative input from national fall experts and nurses systemwide, the Donald D. Wolff Jr. Center for Quality Improvement and Innovation at UPMC has launched a new safety initiative to prevent patient falls. Even people who have never fallen before are at risk for falls when they are hospitalized. They are in unfamiliar surroundings and may not have confidence in their footing; if they’ve had surgery, the after-effects of anesthesia may affect their balance; or the medications they are taking may make them unsteady.

“Patient safety is of paramount importance to UPMC,” says Tami Minnier, UPMC’s chief quality officer. “Serious injuries can result from falls, and we want to make sure that all of our hospitals implement a well-thought-out plan to prevent patients from falling.”

The systemwide initiative ensures that universal precautions are taken for all patients. Precautions include:

• Orienting the patient and family to the call light.
• Verifying that all the lighting is working.
• Placing the patient’s personal items within easy reach.
• Ensuring that patient beds are in the low position with locks on the side rails.
• Keeping pathways clear and free of spills. 
• Equipping patients get nonslip footwear.
• Instructing patients and families about fall safety.
• If the patient uses a walker or cane, keeping it close at hand.
• Identifying for the patient and family a “safe exit” side of the bed.

The “safe exit” is the side of the bed on which the patient can most safely get out. This should be the patient’s strong side. If one side of the patient’s body is weaker for any reason — for instance, when a limb on that side has had surgery — the safe exit is the other side. Otherwise, the safest exit is generally nearest the bathroom. The “safe exit” side should be kept free of guest chairs, waste baskets, and tray tables — but if the patient has an IV pole, it belongs on the safe exit side, because it has to go with the patient when he or she leaves bed.

Additional precautions are taken for patients identified to have higher risks for falls.

Level 1 precautions

When a patient is admitted to a unit, the nurse assesses whether these universal precautions are adequate for this individual or whether additional measures are advisable. If the nurse decides that Level 1 precautions are called for, the patient would get the universal precautions and in addition:

• The patient and staff are informed about the patient’s risk for harm.
• A yellow arm band is placed on the patient to remind staff to be extra careful.
• Staff make rounds regularly to meet the patient’s needs for pain relief, change of position, bathroom needs, and to be sure that the call bell, personal items, and bedside table are all in their proper place.

The nurse also considers whether the patient should have a bed alarm, chair alarm, elevated toilet seat, bedside commode, physical or occupational therapy, or a consult with a pharmacist about his or her medicines.

Level 2 precautions

If the nurse decides the patient needs a still higher level of precautions, then all of the universal and Level 1 precautions go into effect and, in addition, the patient gets a bed alarm and a chair alarm. The nurse also considers whether the patient should have a low-bed suite, a room location near the unit station, a perimeter mattress cover, a hip protector, a helmet, or a sitter.

Each time there is a shift change, each patient is reassessed and the level of precautions may be adjusted accordingly. Patients are also reassessed if they are transferred to a different unit or have a change of status, such as after surgery.

Return to list of stories in this issue