Fall Prevention Education: 5 Solutions for the Rehab Healthcare Practitioner

How are you measuring the effectiveness of your fall prevention program? If you’re simply using overall fall rate reduction, you might be surprised to learn that this is an error!

An overall fall rate is insufficient, too aggregated, and fails to examine program components such as structures and processes aligned to types of falls, whether they be accidental, anticipated physiological falls, or unanticipated physiological falls.

We Have a Duty to Use a High Reliability Fall Prevention Program

You must examine program components for effectiveness in these two areas:

• Program structures, such as clinical competencies, fall risk assessment tools, and care plan tools
• Program processes, such as actions after identifying fall risk identification, steps when implementing individualized care plan, procedure to conduct post fall huddles, methods to include interdisciplinary team members in care planning, and techniques for patient engagement

Unless you know the effectiveness of your structures and processes—which give you an indication of how dangerous your environment is—you are not a high-reliability organization.

The true measures of a successful fall prevention program are:

• Improved clinical competencies
• Individualized fall prevention plans of care
• Population-based fall prevention strategies
• Safer care environments
• Patient education programs

What Is a High Reliability Organization?

High reliability organizations are those that achieve a high degree of safety or reliability despite dangerous or hazardous conditions.¹

Some studies indicate that core processes in health care are defective 50 percent of the time and that patients only receive approximately 55 percent of the care that they should when entering the health care system.² High reliability organizations have a preoccupation with safe, reliable performance as the cornerstone for improving safety and this must be applied to fall prevention programs.³

We Have a Duty to Protect Patients from Preventable Falls

Rehabilitation practitioners and their interdisciplinary teams are responsible for leading, coordinating, and delegating specialty care that restores patients’ function and independence, minimizes complications of disability and chronic disease, and promotes confidence and social integration.

All healthcare providers have the duty to provide high quality care and to keep patients safe while they are in an inpatient setting, which includes increasing clinical competencies in assessment, fall risk identification, population-based fall prevention care, and individualized care planning processes. These competencies, when implemented, result in a reduction of fall risk, preventable falls, and falls that result in injury.

Many rehabilitation inpatients and residents continue to fall—sometimes more than once, and often resulting in injury. In fact, patients on inpatient rehabilitation units fall more often than patients in other kinds of units.^{4, 5} We have a duty to protect our patients from preventable falls, accidental falls, and anticipated physiological falls.

We Have a Duty to Implement Evidence-Based Care

While many factors contribute to these higher fall rates within inpatient rehabilitation, hospital, nursing, and rehab leaders are still slow to implement full-scale, evidence-based fall prevention programs that verify program adoption, implementation, and compliance on care plan effectiveness. Many current clinical practices are implemented based on policies and guidelines that focus on universal fall precautions and are not evidence-based, along with interventions that are not linked to specific fall risk factors.

The best practice approach to hospital-based fall prevention programs is based on four recommendations, which can be directly connected to preventing a particular type of fall:⁶

1. Create a safe environment, which reduces accidental falls
2. Identify modifiable risk factors, which reduces anticipated physiological fall risk factors
3. Treat modifiable risk factors, which reduces anticipated physiological falls
4. Should a fall occur, protect patients from fall-related injuries, such as concussion and hip fracture

Since the publication of these recommendations, few inpatient rehabilitation units have adopted a full-scale, evidence-based fall prevention program designed to predict the likelihood for anticipated physiological falls, reduce preventable falls, and sustain program integrity.

We Have a Duty to Act Now

While organizations may be slow to adopt evidence into practice, leadership within healthcare organizations needs evidence-based, peer-reviewed educational certification programs. These help expand, validate, and certify nursing and interdisciplinary staffs’ clinical knowledge and the skills needed for:

• Comprehensive fall and injury risk assessment
• Evaluation of risk associated with environmental interaction
• Individualized care planning
• Patient engagement
• Post-fall management

The MedBridge certificate program, “Fall & Injury Prevention: How to Manage, Engage, and Evaluate,” provides organizational leadership with the peer-reviewed courses needed to meet these needs through five solutions.

Solution 1

• Stop focusing on a fall risk score or level of fall risk, and start fall and injury risk assessment.
• Stop relying on universal fall precautions, and start population-based fall and injury prevention.
• Take the MedBridge course, “Fall and Injury Risk Assessment Is More Than a Score.”

All patients require a risk screen, which prompts an in-depth assessment upon admission. The complexity of fall risks requires comprehensive interdisciplinary assessment, care planning,⁷ and integration of interactive patient-to-practitioner communication technology. This in-depth assessment should trigger an interdisciplinary care team approach to seek the underlying cause of the identified risk factors that make an injurious fall more likely to happen.

Protecting these oldest adults, as well as those at greatest risk for serious injury due to falls in hospitals, has been a national priority since 2008, led by the Institute for Healthcare Improvement’s Transforming Care at the Bedside.⁸ The four vulnerable populations at greatest risk for loss of function or loss of life after experiencing a fall are classified as:

• A (age 85 and older)
• B (bone fracture risk and history)
• C (anti-coagulation/bleeding risk)
• S (post-surgical)

Some hospitals are already implementing A, B, C, S screening for injury risk but fail to implement the population-based interventions.

Solution 2

• Stop talking at your patients.
• Take the MedBridge course, “How Effective Is Your Patient Fall Prevention Education?”

Evidence confirms that patient outcomes improve when patients and caregivers are fully engaged as partners in their care.⁹ Interventions that tailor patient education and support to each patient’s level of activation and engagement as a partner in one’s fall prevention program build skill and confidence to prevent and manage falls. To effectively prevent and manage falls, a fall prevention program must build your patients’ skill and confidence.

Solution 3

• Stop unsafe toileting.
• Take the MedBridge course, “Reducing Fall Risks Associated with Toileting.”

Many hospital-based fall-prevention programs include toileting rounds, without evidence of effectiveness. The range of toileting-related falls in bathrooms was reported to be 38 percent to 47 percent.¹⁰ Many organizations are mandating programs in which no patient toilets alone or for a provider to stay within arms’ reach.

These programs have limited evidence of effectiveness, are not feasible with existing staffing, and violate patient autonomy and privacy. Importantly, alternatives for technology integration are needed to meet patient and nursing staff needs.

Solution 4

• Stop superficial patient rescue after a fall.
• Take the MedBridge course, “Post-Fall Management for Rehabilitation Nurses.” (Note: this course is also AOTA accredited.)

Many clinicians lack the knowledge and skills required to effectively conduct post-fall huddles and management to determine the root causes of falls and injury, implement strategies to mitigate and eliminate these root causes, and prevent repeat falls based on the same root causes.

This knowledge is critical to improving patient safety. Post-fall huddles and assessments must be conducted in all settings of care to determine the cause of the fall and intervene appropriately.^{11, 12, 13, 14}

Solution 5

• Stop aggregated fall rate analysis and universal fall approach to care.
• Take the MedBridge course, “Program Assessment, Evaluation, and Spread.”

Analysis of fall prevention programs requires more than examination of aggregated fall rates. Program evaluation should evaluate structures and processes that lead to improvement in outcomes. This session informs practitioners and teams about structures and processes attributable to fall and fall injury programs at the organization, unit and patient levels. With this level of program assessment, opportunities to enhance practice, clinical skills, and program infrastructure and capacity open up.

As a result, we are better positioned as clinical leaders to implement and spread interventions to improve patient and program outcomes