1. S ERIOUS SAFETY EVENT

2. C ASE STUDY

4. W AITING ROOM PATIENT ACCOUNT Per patient witness in waiting room: 4.3.13 Man stood at counter. 3 ft from counter, stiff legged, fell forward catching chin on counter. Head hit water cooler and turned man so he hit back of head. Fell like a tree stiff armed, stiff legged. Seemed to be knocked out before he fell. As he fell, hit arm of woman standing at water cooler and she was stiff legged, looking in purse for card, fell backward and hit right posterior head on chair arm. Patient stated that it was a weird scene where both patients were stiff legged and fell in slow motion.

5. I MMEDIATE ACTIONS TAKE Call for help Slowly allow patient to fall to ground with assistance. Do not move patient to another location or a chair Apply pressure to wound for 5 minutes or until bleeding subsides. Do not remove bandage Talk to patient, stay calm and orient them

6. F ALL P REVENTION Assess for orthostatic hypotension Take blood pressure laying/sitting. Decrease of systolic pressure of 20mm Hg or more, decrease of diastolic pressure of 10mm Hg or more Increase in heart rate of 20bpm or more If patient has change in pressure, do not move the patient, stay with them and observe for syncope. Once patient has recovered for greater than 15 minutes, ambulate patient around hallway prior to discharge. Assess for history or syncope

7. A CUTE SYNCOPE / FAINTING TREATMENT Slowly allow patient to fall to ground as described previously Elevate legs greater than heart Ammonia inhalant 12 inches from the nostril arcing No food or beverages until patient is alert and oriented, not nauseated

8. A CUTE LACERATION TREATMENT Apply immediate pressure to wound for a minimum of 5 minutes Compress bandage to wound ASAP

9. MFP P ROTOCOL P OST INJECTION OR PHLEBOTOMY 1. Wait 15 minutes post injection/phlebotomy 2. Recheck blood pressure prior to discharge 3. Ambulate in hall prior to check out

10. R EFERENCES CCHMC policy Trihealth policy www.cdc.gov “syncope, also called fainting, has been reported after vaccination and serious injuries have occurred. ACIP currently recommends that “vaccine providers should strongly consider observing patients for 15 minutes after they are vaccinated. If syncope develops, patients should be observed until the symptoms resolve.”