Reducing patient falls in the home care setting by:

Reducing patient falls in the home care setting by:
I was most interested in the Home Care specific 2016 National Patient Safety Goals. After a quick search I found that there were only 5 goals identified for Home Care. The goal that most interested me was to prevent patients from falling (NPSG.09.02.01). In a nut shell, the aim of this goal is for Home Care agencies to identify which patients are most likely to fall, and then to take action to prevent falls for those patients. The way in which Home Care agencies should identify at risk patients is largely unregulated, however, there are suggestions such as identifying medications that can contribute to falls.

The article I found was from a hospital home health journal. The article noted that Home Care Surveyors “look for a comprehensive, well-planned program to assess each patient’s risk of falling, identify steps to reduce the risk, and ongoing evaluation of the patient’s risk.” (Hospital Home Health) The article goes on to note that not all Home Care agencies meet this standard, because they fail to include all patients, only those that are at increased risk for falls. The successful Home Care agencies that perform a muti-factorial fall risk assessment at the Start of Care and then reassess as the patient’s condition changes are noted to have better patient outcomes at reducing falls. Once a fall risk is identified, an intervention is implemented, this could range from a Physical Therapy consult and subsequent treatment, or education related to maneuvering their environment with adaptive equipment such as walkers, canes or wheelchairs. Medication reconciliation from the post-acute care setting is a crucial component to any falls reduction program. Nurses will identify any medication that is high-risk, or likely to impair the patient’s ability to ambulate and will provide through education to the patients and/or care givers about how to properly take the medication and how to monitor and report side effects. Even with the best fall programs in place, there are patients who will experience a fall at home. One RN noted, “We can’t control environmental factors, such as width or doors of the number of stairs a patient has in the home, but we can offer as many suggestions as possible to improve the patient’s safety” (Hospital Home Health).

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I came into the Home Care industry as an RN Case Manager in 2008. Although this 2016 goal has been brushed up with some tweaks, the standard was essentially the same in 2008. During my training, I was introduced to how I should perform a multifactorial assessment of the patient’s environment, functional mobility, cognitive status, medications, age, current health status and adaptive equipment (or lack thereof) to assess if the patient required a Physical Therapy assessment for falls prevention. I would also perform a home safety check and provide education to the patient and family about any risk factors identified that could contribute to a fall. Safety education was performed at every home care visit, as it was a standard of care of all patient’s. The assessments I did in the home made a difference to the outcomes of the patient, through Performance Improvement audits it was proved that Nurses that routinely assessed for fall needs and implemented appropriate interventions had better patient outcomes, including a decreased number of falls per patient.

For many, falls mean re-hospitalization. (2010). Hospital Home Health, Retrieved from http://search.proquest.com/docview/758897082?accountid=34574
Post 2
Universal Protocol Time Out by:
Kayla Fields posted Oct 25, 2016 10:08 AM

One of The Joint Commission’s National Patient Safety Goals is Ambulatory Care Surgery and preventing mistakes during the surgical process. There are two main things that can be done to ensure this goal is obtained. This includes performing a Universal Protocol Time Out and marking the correct site and side (National Patient Safety Goals, 2016).

In the article “The Inside of a Time Out,” Dr. Feldman describes a time out as an

active communication among all members of the surgical/procedure team, consistently initiated by a designated member of the team, conducted in a ‘fail-safe’ mode,’ so that the planned procedure is not started if a member of the team has concerns. It consists of confirmation of the correct patient, correct side and site, agreement on the procedure to be performed, correct patient position, and availability of needed equipment/supplies/implants (Feldman, 2008, para 5 and 6).

Prior to any procedure being started, a timeout is a standard that should be performed for each and every case. Performing a timeout is meant to force the staff to stop what they are doing to ensure that the right procedure is performed on the right patient and is an “opportune time for the entire team to confirm that important and preventive steps have been taken” (Feldman, 2008, para 6). It is imperative that all members are documented as being involved and agreeing to the procedure to prevent backlash if a problem occurs, and would be in best practice if they all documented their agreement personally. Unfortunately, this is not usually the case due to most care team members being sterile or scrubbed in. Therefore, one member of the team must be designated to correctly document the time out and all other information regarding the case. Best practice also includes using each institution’s deemed documentation or checklist during a timeout and examining barriers that could prevent some team members from speaking up if they are concerned or disagree with information provided (Feldman, 2008). Also, marking the site in the pre-op area with an appropriate marker will act as a way for providers to ensure that they are operating correctly. This step also includes the patient to guarantee the right side and site.

The Labor and Delivery Unit that I work on requires a timeout to be completed during each stage of the surgical process in compliance with Joint Commission standards. A timeout is performed by the pre-op nurse where they ask the patient to state their name, date of birth, allergies and what they are having done. The nurse then confirms this information by double-checking the patient identifier wrist band. Then, upon entering the operating room, the circulating nurse will perform a second timeout prior to the administration of anesthesia. If the patient is being put to sleep, the time out would include the anesthesia and the procedure so that the patient can be included in the time out to prevent any errors. If the patient is not put to sleep, like for a caesarian section, another time out is performed with all staff and the patient prior to the incision being made. This time out includes any other procedures, such as a tubal ligation. In a standard case, three time outs are usually performed. Because there is no laterality for any of the procedures performed in Labor and Delivery, that is not included in our Universal Protocol. The only time that a time out is not completed on a patient is during an emergency. This is due to time sensitive interventions to ensure the health and safety of both the mother and the baby, and because the patient is often not able to make an informed decision under extreme duress. Due to this process, there have never been any documented mistakes concerning wrong patient, procedure or site in the six years that I have worked there.