Fall Prevention in Inpatient and Outpatient Units
Essential Hospitals Engagement Network
November 19, 2013
OUR NEW NAME
We’ve rebranded! The National Association of Public Hospitals and Health
Systems is now America’s Essential Hospitals.
Although we’ve changed our name, our mission is the same: to champion
hospitals and health systems that provide the highest quality of service to all
by achieving the best health outcomes for every patient, especially those in
greatest need. The new name underscores our members’ continuing public
commitment and the essential nature of our work to care for the most
vulnerable and provide vital community services, such as trauma care and
disaster response.
This is an exciting time for us and our members, as we lean forward into new
care models, opportunities and challenges of reform, and quality and safety
innovations that often take root in our member systems.
Our new website address:
www.EssentialHospitals.org
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CHAT FEATURE
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SPEAKER INFORMATION
Vickie Sears, RN, MS
Improvement Coach EHEN
Carol Boylan, MSS, LCSW
Director, Psychiatric Medical
Care Unit
Hahnemann University
Hospital
Philadelphia, Pennsylvania
Stefania Kaplanes, MSW
Injury Prevention Specialist
Alameda Health System
Highland Hospital
Oakland, California
John Young, RN, MBA
Improvement Coach EHEN
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AGENDA
• Falls work in EHEN and Partnership for Patients
• Feature falls prevention strategies in inpatient behavioral health
and ambulatory elder populations
• Q&A
• Wrap-up and announcements
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PARTNERSHIP FOR PATIENTS
Partnership
Patients (PfP)
• CMS-funded
• Reduce 9 hospital-acquired conditions by 40%
• Reduce readmissions by 20%
Hospital
Engagement
Networks
(HENs)
• 26 contracted organizations
• 3,700 U.S. hospitals
Essential
Engagement
Network
• 22 hospitals nationwide
• Only safety-net focused
• Special focus on health
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EHEN FALLS RESULTS (AS OF JUNE, 2013)
Measure
Baseline events
Performance
period events
% Change
Falls & Trauma
(UHC-Modified
CMS HAC)
11
6
-45.46%
Falls with Injury (JC
NSC-5)
19
18
-5.26%
All Falls (JC NSC-4)
155
154
-0.32%
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Risk Factors for Falls in
Psychiatric Inpatient Units
and
Tools to Prevent Falls
Carol Boylan, MSS, LCSW
Director of the Psychiatric Medical Care Unit
Hahnemann University Hospital
Broad & Vine Sts. MS 302
Philadelphia, PA 19102
tel: 215-762-4684
fax: 215-762-3104
pager: 215-762-7243 pin: 41693
carol.boylan@tenethealth.com
Hahnemann University Hospital
A 496-bed academic medical center in Philadelphia, Pa.
In 2009, Hahnemann earned Magnet® designation. The
Leapfrog Group awarded Hahnemann with an “A” Hospital
Safety Score in the spring of 2012 and 2013.
U.S. News & World Report ranked 5 medical specialties at
Hahnemann among the top 50 in the nation and 11 medical
specialties as high-performing in the Philadelphia metro
area.
Psychiatric Medical Care Unit
• In 1983 the Psychiatric Medical Care Unit (PMCU) opened a 20
bed acute locked unit to address the special needs of cooccurring psychiatric conditions and medically compromised
patients along with care to individuals with co-occurring drug
addictions.
• We specialized in adult patient programing that bridges
healthcare systems to address the holistic needs of the acute
mentally ill people in recovery
Reasons for Psychiatric
Medical Care Units
•
•
•
•
•
Multiple studies document a higher prevalence of chronic
illnesses such as diabetes, respiratory disease, hepatitis B
and C, and HIV.5
Depression increases risk of cardiovascular diseases and
diabetes.6
Schizophrenia may predispose persons to metabolic
syndrome, hypertension, and obesity.7
Fifty percent of patients affected by mental illness are
diagnosed with a known medical disorder.
Thirty-five percent of these patients have undiagnosed
medical conditions and one in five has a medical problem
that exacerbates their psychiatric condition(s).8
Risk factors for falls
• Although previous studies have aimed to identify risk factors
for falls, few have focused on falls in psychiatric hospitals
where many patients are taking psychotropic medications.
• Risk factors for falls frequently associated are sedative
medications, urinary urgency, history of falls, diagnoses,
mental status and ambulatory aid/gait.
• Reducing the risk of patient harm from falls is one of the
stated goals of the Joint Commission on Accreditation of
Healthcare Organizations.
• Falls prevention protocol activated at Hahnemann and a
Shared Governance Committee reviews cases weekly for
areas to improve and new techniques to roll out.
Risk Factors on Psychiatric Units
• People admitted to inpatient psychiatric care are at a higher
risk for falls due to the nature of care which promotes
mobility, independence with self-care activities, community
style dining and interaction of patients in a group setting.
• Psychopharmacology also impacts the risk for falls due to the
sedating side effect of certain medications such as Ativan and
Clonazepam.
• Co-occurring medical and psychiatric disorders such as
management of heart disease and diabetes with depression
may impact the person’s awareness of their environment.
• People with co-occurring substance and mental health
illnesses have an increased risk for falls due to withdraw
symptoms.
• Impulsivity and active psychosis may also increase risk for falls
due to increase in behavioral actions.
Preventing falls
• Upon admission patients are screened for falls by using the
Morse Fall Scale risk screen. Nurses complete risk
assessments during each 12 hour shift and document any
changes. Information is shared at change of shift reports.
• Patients at risk are educated on fall prevention, given clothes
that prevent tripping and fall socks to prevent slipping.
• Daily interdisciplinary treatment meetings occur twice a day
to review at risk patients. Review of medications, behaviors,
symptoms, mental status, sleep, nutrition and ambulation are
discussed to continuation of safety plan.
Preventing falls…
• Treatment plans are developed for patients at risk for falls and
consideration is given to medication use, dosages and
management of behaviors.
• Uses of traditional bed alarms are considered only as a last
resort due to the increase risk of use to harm self or others.
• 1-1 unit companion use is recommended to help reeducate
the patient and support the patient with their psychiatric
treatment.
What has been the best intervention?
• Safety Huddles
• Review of high risk patients multiple times during the day and
night gives the treatment team the opportunity to be
proactive rather than reactive.
• Staff sharing observations and changes in patient behaviors
allow for treatment interventions to be quickly altered to
meet the patient’s needs.
2012 PMCU Fall Rates
7 Falls
No injuries
THE
FALL PREVENTION
CENTER
HIGHLAND HOSPITAL
Stefania Kaplanes, MSW
Injury Prevention Specialist
Trauma Services
Alameda Health System: Highland Hospital
Oakland, CA
skaplanes@alamedahealthsystem.org
Projected Senior Population Growth 2005 – 2030
RAND Roybal Center for Health Policy Simulation
INCIDENCE
 30%
of community-dwelling
people over the age of 65 fall
each year
 Increases to ~50% for those
80 years and older
 Half are repeat fallers
 If
you’ve fallen once….
FALLS CAUSE MORBIDITY AND MORTALITY
 2.2%
of injurious falls death
 Cost of fall-related injuries for 65+
 $20.2 billion in 1994 -> 32.4
billion by 2020 (in 1994 dollars)
 Injuries
are common:
 40% of falls result in minor
injuries
 10% result in major injuries
Fracture, soft tissue injury, TBI
THE LAUNCH
FALL PREVENTION CENTER (FPC)
• Initial Discussions and
Research
– Senior Injury Prevention
Program (SIPP) &
Community Partners
– Trauma Director
– Trauma Team Residents
– ED Physicians
– Out-Patient Clinics
– Out-Patient Physical Therapy
FALL PREVENTION
CONTINUITY OF CARE
 The
Issues:
 Early
identification
of those at risk
 Who’s responsible
SOLUTIONS
THE FALL PREVENTION CENTER
Emergency
Department
Staff
Out-Patient
Clinic Staff
Discharge
Planners
FALL PREVENTION
CONTINUITY OF CARE
 The
 How
Issues:
are those at
risk identified
 What is done
with those at risk
 Time lapse in
setting follow-up
appointments
REFERRAL GUIDELINES
*Abnormal get Up and Go (>13.5 sec)
*60 years old or older (no age turned away)
*Previous Fall/s
*Balance or Gait Problems
*Dizziness
*Vision Problems
*Polypharmacy or High Risk Medications
Psychotropic:
Neuroleptic/Antidepressant
Benzodiazepine, Sedative, or Hypnotic
*History of Stroke or Parkinson’s
*Recent Acute Illness or Injury
*Recent Weight Loss
*Fear of Falling
THE FALL PREVENTION CENTER
 What
happens next
 Referral
made to the FPC
 Reminder call
made to patient
Importance
reinforced
 Reminded to
bring all
medications
 Herbs,
Vitamins,
OTCs

THE FALL PREVENTION CENTER

AT THE FPC
Medication Review by:
 Clinical Pharmacist
 Screenings by:
 Physical Therapy
 Occupational Therapy
 Fall Prevention Education by:
 EMS Educator & Patients*
 Geriatrician Consult

as needed
It’s a family affair!
MATERIALS
FALL PREVENTION CENTER

For Staff



Data
Fall Risk Pocket Cards
for MDs
For Patients











Follow-up Letter
Medication Mgmt Form
Fitness Checklist
Fall Prevention Manual
Local Resource
Information
Dynaband
Pedometer
Cook Book
Pill Box
Local Walking Groups
Home Safety Resources
HIGHLAND’S DIVERSE WORLD
American Sign
Language (by
appointment)
Amharic
Arabic
Bosnian
Burmese
Cantonese
Cambodian
Croatian
Dari
Farsi
Hindi
Korean
Karen
Laotian
Mandarin
Mien
Nepali
Pashtu
Punjabi
Russian
Serbian
Spanish
Thai
Tigrigna
Urdu
Vietnamese
MRS. B & LAS TRES HERMANAS
Mrs. B
88yoF; resides alone
Brought all meds
Pharmacists asked which
ones she takes at night?
“Well dear….the ones on my
dresser by my bed”
Las Tres Hermanas
98yoF
95yoF
89yoF
Sisters living independently with each
other. THANKS FPC!

Out-patient Physical Therapy
 Special
block set aside for quick apt
Clinics
 Primary Care MD
for Follow-Up

 With
notes from
FPC staff

Community
Programs
 Physical
Activity
 Home Modification
 Social
THE FALL PREVENTION CENTER

Is a Work In Progress and will
hopefully in the future include:
 Podiatry
 Vision
 Visit Fall-Risk In-Patients at
bedside before discharge
 Research and Include
additional Resources
 Inform/Educate All Staff re:
resources
 Wii Fit and Balance
 Tai Chi
 Annual FPAW
 Neuro Psych Consults
THE RESULTS………

100% of our FPC participants have not returned
to Highland Hospital Trauma Center due to a
fall.
FALL PREVENTION CENTER MISSION
The Fall Prevention Center’s
mission is to identify older adults
who are at risk for a fall and
provide them with assessments,
screenings, education, resources,
and interventions that will
decrease their fall risk and
thereby reduce the number of
preventable falls suffered by older
adults in Alameda County.
GOALS
THE FALL PREVENTION CENTER

To help ensure that continuity of care for
older adults at risk for a fall is provided by:




Early Identification
Quick Appointment at the FPC
Needed Interventions Received in a
Timely Manner
Follow up by their primary care physician
RECOGNITION

Alameda County Board of
Supervisor’s Commendation (2010)

United States Congressional
Recognition (2010)
THANKS EHEN FOR
ALLOWING ME TO SHARE
ALAMEDA HEALTH SYSTEM:
HIGHLAND HOSPITAL
FALL PREVENTION CENTER!
Q&A
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THANK YOU FOR ATTENDING!
• Patient and Family Engagement Webinar – December 3 @ 2pm
ET
The Patient Advisor’s Voice in Patient and Family Engagement
Speakers:
• Sharon Cross, LISW, Patient/Family Experience Advisor Program
Manager, OSU Wexner Medical Center Patient Experience
Department
• Cortney Forward, Patient Family Experience Advisor, The Ohio
State University Wexner Medical Center
• Evaluation: When you close out of WebEx following the webinar a
blue evaluation will open in your browser. We greatly appreciate
your feedback!
• Essential Hospitals Engagement Network website:
http://tc.nphhi.org/Collaborate
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