1. Patient Engagement: A Critical Component of Fall Prevention
Amy Roberson, MS, APRN, AGCNS-BC, CMSRN

2. Objective
Describe at least one strategy used to engage patients in fall prevention

3. Background Units were seeking to decrease falls
Unit 1: 14 Bed, Cardiovascular Surgery/Transplant/Mechanical Cardiac Device Support (Progressive Care)
Falls attributed to side effects of medications
Unit 2: 44 Bed, General Medical, Hospice (General Care)
Falls attributed to toileting and ambulating without assistance

4. Background Literature Innovative strategies
700,000-1,000,000 people fall in the hospital each year (AHRQ, 2018)
Most patients report not feeling at risk for falling during their hospitalization (Sonnad et al., 2014; Twibell et al., 2015)
Variable predictive value of fall risk assessment tools (Park, 2018)
Innovative strategies
Robert Wood Johnson University Hospital (RWJUH) Fall Safety Agreement
Falls with serious injury decreased with use of the agreement (Zavotsky et al., 2014)
Pilot in Mayo Clinic, Arizona
Implemented falls agreement similar to RWJUH
Falls decreased

5. Background Standard Patient Engagement Strategies
Prevent Falls While You Are Here education pamphlet
Patient Safety Video
General patient engagement strategies are the same for all patients

6. We wondered…
Can use of a fall prevention agreement tool enhance patient engagement in fall prevention and decrease falls?

7. Phase I: Developing Engaging Tools
Unit 1:
CV Surgery/Transplant (Progressive Care)
“Falls Safety Agreement”
Unit 2:
General Medical/ Hospice
(General Care)
“Fall Prevention Agreement”
Origination
Conceptually similar to the RWJUH Falls Safety Agreement and Mayo Clinic, Arizona’s Falls Agreement
Utilized concepts from Mayo Clinic, Arizona’s Falls Agreement and RWJUH Falls Safety Agreement
Incorporated principles of adult-learning theory, fostering interactive patient participation
Considered health literacy
Key Components
Highlighted the patient’s medication(s) affecting fall risk (prevent syncope)
Check boxes to indicate patient-specific risk factors, patient’s role in fall prevention, and the health care team’s role in fall prevention
Layout
Multiple page booklet including risks for falling, tips for reducing falls, and the signed agreement
Two-sided document

8. Implementation Implemented with all patients on admission
Includes patients with cognitive deficits
Posted visibly in the room
Ongoing discussion of the agreement during bedside shift handoffs

9. Results of Phase I

10. Results of Phase I
Increased ability to verbalize patient specific risk factors
Demonstrates patient understanding and engagement

11. Results of Phase I – Nurse Perception
How effective are current tools for educating your patients about their risk for falls?
How do current fall risk tools impact workflow?

12. Phase I: Feedback Surveyed nurses and patients regarding the tools
Important factors: Concise, easy for patients to understand, ability to personalize
Pictures were helpful
Word “agreement” seemed too binding
Patients:
Important factors: Concise, easy to read
Open to the tool being posted in the room
Open to signing the tool

13. Phase II: Combining Forces, Expanding
Revised the tools based on patient and staff feedback
Merged into one tool
“Fall Prevention Plan”
Sought to determine if the tool was generalizable in additional populations
Expanded pilot to include a 3rd unit
28 Bed, Neurosurgical - Spine and Brain (General Care)

14. Phase II: Fall Prevention Plan
(front)
(back)

15. Results After Phase 2

16. Results After Phase II: Percent of Falls That are Unassisted by Staff
Unassisted falls decreased
Patients are engaged and committed to partnering in fall prevention

17. Results After Phase 2 – Nurse Perception
How effective are current tools for educating your patients about their risk for falls?
How do current fall risk tools impact workflow?

18. Strategies Utilized to Promote Change
Unit-based fall champions
Involvement of all roles (RN, PCA, HUC)
Multidisciplinary education
Engaging introductory movie
Sample nursing scripts to use with patients
Role play video
FAQs
Celebrate success!

19. Keeping the Momentum Fall Champions
Real-time feedback given by peers and leadership
Competition between units
Frequent communication

20. Next Steps
Additional modifications to the tool
Research study

21. Conclusion
Literature highlights that patients do not perceive fall risk
Individualized Fall Prevention Plans
Fostered patient engagement and partnership in fall prevention
Decreased falls among diverse populations
Perceived as effective and efficient by nursing
Engaging patients is a critical component of fall prevention

22. Acknowledgments References Christy Chua Patel, MS, APRN, CNS
Lisa Douglas, MS, APRN, CNS
Chelsey Graning, MS, APRN, AGCNS-BC
Crystal Ryan, MS, APRN, CNS
Donna Miller, MD
References
Park, S. (2018). Tools for assessing fall risk in the elderly: A systematic review and meta-analysis. Aging Clinical and Experimental Research, 30(1). doi: /s Preventing Falls in Hospitals. Content last reviewed July Agency for Healthcare Research and Quality, Rockville, MD. Sonnad, S., Mascioli, S., Cunningham, J., & Goldsack, J. (2014). Do patients accurately perceive their fall risk? Nursing. doi: /01.NURSE f7 Twibell, R., Siela, D., Sproat, T., & Coers, G. (2015). Perceptions related to falls and fall prevention among hospitalized adults. American Journal of Critical Care, 24 (5). Zavotsky, K., Hussey, J., Easter, K., & Incalcaterra, E. (2014). Fall safety agreement: A new twist on education in the hospitalized older adult. Clinical Nurse Specialist. doi: /NUR