Every day, clinicians at UCHealth Memorial Hospital gather to talk about a most important subject to them — keeping patients safe.
That conversation often leads to a discussion about preventing patients from falling while in the hospital. As health care facilities across the nation care for people who are living longer than ever with a myriad of complex illnesses, the need for strong fall prevention programs has never been greater.
Falls are the leading cause of fatal and non-fatal injuries in the elderly, and the number of people coming to hospital emergency rooms for fall-related injuries is also on the uptick.
Keeping people safe once they’re in the hospital is a considerable challenge. Between 700,000 and 1 million people in the United States fall in a hospital each year. Falls can cause serious injuries – fractures, lacerations or internal bleeding.
To call attention to this issue, the National Council on Aging has designated Sept. 22 – the first day of fall – as Falls Prevention Awareness Day and encouraged health care workers in hospitals, nursing homes and other facilities to raise awareness of the issue.
“Our goal is to get people back home and back to their normal life, and if they fall in the hospital, chances are, it will delay them from getting back home,’’ said Leighann Jock, a clinical nurse specialist in the ICU at Memorial Hospital Central.
Every patient who comes to Memorial is assessed for their risk of falling. If a patient has fallen at home, he or she is considered an automatic fall risk. Those who have confusion, dementia or an unsteady gait are also considered at risk for falling – a population that includes patients who have had a stroke, a total knee or hip replacement or a traumatic brain injury.
At Memorial Hospital, a patient who is at risk of falling wears a yellow hospital gown, yellow armband and yellow, non-skid socks. Their hospital bed and the chair in their room is fitted with an alarm that sounds when they attempt to leave the bed without assistance. Signs outside the door and in the patient rooms that say “High Fall Risk’’ are posted to remind care takers that these patients may be unsteady on their feet.
“We stay within arm’s length of these patients when they are up, regardless of where they are,’’ Jock said. “We stay with them in the bathroom. We’re often fond of saying, ‘Safety before modesty.’ ’’
Not every patient who comes to the hospital, however, is immediately agreeable to being placed on these precautions, said Cheryl Melnyk, manager of acute care rehabilitation at Memorial.
“Sometimes, we’ll have people who come in for an elective knee surgery, and they were totally fine before they came in, and they’ll say, ‘Now you’re telling me that I can’t get up?’’’ Melnyk said.
Most of the people who fall at Memorial do so when they are trying to get out of bed to go to the bathroom, said Shalou Herrera-Puno, a registered nurse and quality clinical specialist who analyzes how people fall in the hospital.
“When we talk to them, they say they didn’t want to bother us, but we assure them that we want to be called. We tell them, ‘Please bother us. It’s very important to us and to you that you do not fall. We are here to help,’’’ Herrera-Puno said.
As a physical therapist, Melnyk impresses upon patients how a fall can cause injury and delay returning home.
“’We want to get you home safely and if you fall, you may not be able to go home or you may have to go somewhere else before you go home,’’’ she tells her patients. “’Our goal is to get you home as soon as possible.’ That’s what everyone wants.’’
Patients are assessed every 12 hours at a minimum for potential fall risk.
“Just because you are a high fall risk today, tomorrow you may not be a high fall risk. So, as your condition improves or meds are changed, we continually reassess that. We try to get patients off the fall risk precautions as soon as we can so they can be more independent,’’ Jock said.
Sometimes, patients who do not understand why they are considered a fall risk receive a visit from members of a Fall Resources Team, or Chief Medical Officer Dr. Jose Melendez or Chief Nursing Officer Kay Miller. The team members explain the importance of fall prevention.
“We talk to patients about the multi-disciplinary team that is working on their behalf. You have pharmacists who are looking at your medications and nurses making sure you are safe,’’ said Darrell Lee, a nurse studying to be a clinical nurse specialist. “Part of the nurses’ job is to consider the environment of care – to make sure the room is clear of clutter and any potential hazard.’’
The recent remodel of patient rooms at Memorial Hospital Central to single occupancy has benefited patient safety. The more spacious rooms make it easier for nurses and physical therapists to maneuver and assist patients.
When someone falls in the hospital, there’s an immediate review. Clinical staff, house supervisors, managers and the patient (if alert) examine why the fall occurred and consider whether any other steps could have been taken to prevent the fall.
Memorial Hospital also offers a program – Stepping ON – to teach people fall-prevention skills. Stepping ON is a free, seven-week program offered through HealthLink that helps people maintain independence and gives them confidence to do daily activities.
“It’s an evidence-based fall prevention program,’’ said Lori Morgan, injury prevention specialist at Memorial Hospital. “It’s for people who either have fallen or are afraid of falling.’’
During the class, which meets for two hours a week for seven weeks, physical therapists teach strength and balance exercises. There’s a vision expert who comes to talk about changes in your vision and how vision plays a role in balance.
Public safety representatives from the Colorado Springs Fire Department talk about fire safety, and a Memorial pharmacist talks to Stepping ON students about medications and how they may or may not contribute to the risk of falling.
Home safety – keeping the environment free of clutter – and having proper lighting and level flooring reduces the risk of falling.
“I’ve seen improvements in people who come to the program. They do standardized tests to measure balance, and I’ve seen true improvements from the start of the program to the end,’’ Melnyk said.
With Fall Prevention Awareness Day around the corner, it’s a reminder for everyone – whether they’re in the hospital or not – to consider their risk for falling.
For more information about the Stepping ON program, please call HealthLink at 719-444-CARE.