Evaluating Fall Prevention in Emergency Department Patients

Aim: : The purpose of this project was to evaluate fall prevention strategies in the emergency department by evaluating if the correct tools were in place to assist staff in decreasing anticipated physiological falls and make the essential tools available to staff.

Framework:: LEAN strategies were used throughout this project.

Setting:: This hospital system is public, not-for-profit located in rural North Carolina serving seven counties. The main hospital, where this project was conducted, has 350 beds with 40 ED beds and operates as a referral hospital. The ED sees a mix-population of adults and pediatrics.

Stakeholder Team:: The stakeholders were the Direct of Nursing Excellence who aided in running reports and obtaining resources for quality metrics, ED Directors approved purchasing of equipment and ensured project was supported with hospital administration. Other stakeholders were Epic Analysts who were essential in updating the documentation for the ED specific assessment tool, ED Supply Tech ensured supplies for staff and patients were maintained, and infrastructure services assisted with relocation of phones in ED patient rooms.

Methods: : A 3-question survey was sent to all ED staff to gather information on fall prevention and barriers. This information was used to determine if they had supplies needed to assist in fall prevention and whether there were barriers to implementing fall prevention strategies. With this information, a safety drawer with fall prevention supplies was implemented in all patient rooms, patient phones were relocated for ease of access, and ceiling tiles with “Call Don’t Fall” reminders were placed over patient beds. In addition, an evaluation of documentation was completed after a review of evidence and ENA practice guidelines were reviewed. This led to a change in documentation (in process) to appropriately identify ED patients who were high risk versus all patients being high risks (current practice).

Outcomes:: The initial survey revealed gaps to fall prevention practices, however, after changes were implemented, the staff report fall prevention tools are now easier to access and showed an increase in their likeliness to implement. Although data showed an increase in falls, it was found that long-boarders during this time frame were directly related to this increase. In addition, high turnover for all staff, not just nursing, may have negatively impacted this project. Ongoing projects are completing the transition of phone relocation in patient rooms, completing the work with Epic to implement the ED specific documentation tool versus the tool currently in place, and using this documentation to implement fall bundles for patient according to level of risk.

Implications:: Ensuring patient safety is essential, however, what inpatient units implement is not always appropriate for the ED. Using ED specific tools and strategies, including ED specific documentation for fall risk patients, is necessary to identify risks and prevent falls in the ED, as well as improve staff compliance with implementing safety measures.