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Reducing the Risk of Patient Falls 

One patient fall is one too many for UPMC. But how do you find the best way to prevent falls and reduce the seriousness of injuries when falls do occur?
 
To locate the best protective equipment, UPMC nurses go right to the source. They meet with the manufacturers and suppliers of safety equipment to ensure that it meets UPMC standards for quality. A systemwide Falls Committee worked with manufacturers so that hospital floor pads, which can prevent serious injuries if a patient falls, have beveled edges. The committee rejected other types of floor pads with straight edges because patients could trip over them.
 
UPMC recognizes that any protective equipment we ask a patient to wear should be aesthetically pleasing. To address this patient satisfaction issue, UPMC again worked with the manufacturers of safety equipment to provide tasteful and safe options in protective headwear and other items.
 
To eliminate the potential for falls, UPMC has developed new strategies that can identify those patients who may be susceptible for falling while in our care.
 
At the time of admission and each day during their stay, patients are assessed for their risk of falling. And, depending on the score the patient receives on this assessment, appropriate fall protection measures can be put into place. Basic precautions such as providing nonslip footwear work well for patients at low risk for falling. However, for those assessed at moderate and high risk, UPMC uses protective equipment such as floor pads and lower beds and other precautionary measures to keep its patients safe.
The assessment tool in place was developed with significant input from physicians, nurses, and other clinicians from throughout the health system. By drawing this expertise from across our service area, patients and their families can be assured that best practices for fall prevention are in place in all UPMC hospitals and facilities.
 
Each section of this assessment tool has a list of criteria. A numerical score is assigned to each criterion. The scores are weighted to give higher numbers to those criteria with the greater likelihood of contributing to a fall. Each line must be filled in with a number or a zero to ensure that all criteria were assessed.
 
In the mobility section, for example, nurses are asked to assess and assign scores to four criteria. A patient who needs an assistive device (cane, walker, prosthesis, etc.) to ambulate receives a score of 2. An unsteady gait due to joint problems, pain, dizziness, or balance compromise will result in a 4.
 
Some assessment tools simply ask whether or not the patient is receiving multiple medications. UPMC’s new assessment tool is more detailed. It requires nurses to document whether the patient is taking medications that belong to six specific drug classes:
  • antihistamines
  • cathartics or diuretics
  • anti-hypertensives
  • narcotics
  • benzodiazepines/sedatives/hypnotics
  • hypoglycemics
The nurse writes a 2 if the patient is receiving a medication in the appropriate drug class.
 
UPMC’s assessment tool also recognizes that many falls occur while the patient is trying to reach the bathroom. To address this concern, the elimination section lists three criteria — nocturia, incontinence, and patient urgency or frequency to visit the bathroom. A score of 2 is noted for each criterion that the patient may meet.
 
When the assessment tool has been completed, the nurse totals the scores from all six sections. This final number determines the patient’s level of risk for falling:
 
​Patient Score ​Risk Level
​0 - 9 ​no risk or low risk
​10 - 14 ​moderate risk
​15+ ​high risk
  

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