Reducing the risk of patient harm resulting from slips and falls is among the National Patient Safety Goals required for accreditation by The Joint Commission. Many factors may contribute to an individual patient’s risk of falling, including age, medication, illness or physical ailment.
The environment of care also plays a key role in fall reduction. In addition to the usual precautions like handrails and strategic lighting, there are other measures facilities can take to address patient falls, including careful floor maintenance and the use of monitors that alert caregivers when patients get out of bed.
Floor safety
Tim Cole, director of environmental initiatives and product development for Forbo Flooring Systems (www.forbo.com), Hazleton, Pa., and a committee member for the American Society for Testing and Materials (ASTM), West Conshohocken, Pa., notes there is currently no established standard test method for measuring the slip resistance of a particular flooring surface that is in use. He says proper maintenance is one of the best things facilities can do to improve floor safety. Dirty or highly waxed floors can be hazardous; green cleaning techniques that employ few chemicals create safer walking surfaces in addition to protecting the environment, Cole says. He also strongly recommends hospitals implement a system of walk-off mats at each entrance to trap dirt and other contaminants and prevent moisture from rain or snow from creating a dangerous situation on a hard-surface floor.
The Safe Floor Program by Cintas Corp. (www.cintas.com), Cincinnati, takes a multipronged approach to the prevention of slips and falls. The program involves a comprehensive mat system; tools for safe and effective cleaning, such as microfiber mops and an automated chemical dilution system; and periodic deep cleaning.
Rich Bing, marketing manager, facilities services, Cintas, is qualified as a Certified Walkway Auditor by the National Floor Safety Institute (NFSI), Southlake, Texas. He says the Safe Floor Program is being extended to include floor auditing to help identify and alleviate risk zones in a facility. With auditing, “we can create documentation that shows the hospital has taken every step possible, or every reasonable step, to make a safe environment,” says John Savage, senior marketing manager for health care, Cintas.
Nu-Safe Floor Solutions Inc. (www.nu-safe.com), Walton, Ky., offers a 30-day Walkway Safety Program. In this program, analysts use the BOT-3000 device by Regan Scientific Instruments (http://reganscientific.com), Southlake, Texas, to determine the coefficient of friction (COF) of wet and dry flooring in several areas of a facility. COF is a measure of slip resistance; the higher the COF, the less likely the surface will contribute to a slip or fall accident.
Two Nu-Safe products are designed to remedy high-risk areas. The company’s Friction product raises a floor’s COF without dulling its finish, while MainTain removes calcium ions from the surface of hard tile, in essence creating a tread pattern, says Luke Sestito, director of health care surfaces, Nu-Safe. Both Friction and MainTain have been certified by the NFSI and are included in the Department of Agriculture’s catalog of BioPreferred products (www.biopreferred.gov).
Staff education and patient awareness are additional components of Nu-Safe’s approach to fall prevention. Warning signs that are changed out on a regular basis, so they continue to capture attention, can help reduce falls by a significant amount, Sestito says.
InterfaceFLOR Inc. (www.interfaceflooring.com), with U.S. offices in LaGrange, Ga., reports that the dense fiber surface of its modular carpet products has a higher COF than hard surface flooring, particularly when wet. Gail Nash, vice president of health care, InterfaceFLOR, says the products’ patented thermoplastic vinyl fiberglass-reinforced backing provides additional stability and support for heavy, rolling traffic. Carpeting also reduces glare, which can be a factor in falls. And studies have shown carpet can reduce the impact of a fall, Nash adds.
Patient monitoring
The Bed-Check monitoring system (www.bedcheck.com) by Stanley Healthcare Solutions, a division of Stanley Security Solutions Inc., Indianapolis, uses pressure-sensitive mats to alert caregivers to patient movement. Bed-Check control units feature a number of programmable settings, including 10 alarm tones, seven volumes, three delay settings and separate day and night modes. The units are portable, compatible with nurse call systems and can be used with both beds and chairs.
The Model Vr control unit can record and provide data on a patient’s last 24 alarms. Dave Auten, Bed-Check’s general manager, says this information can be downloaded to a PC or laptop for further analysis; it can also be used to assess the fall risk of new patients or long-term care residents and to determine a patient or resident’s daily routine so staff can respond appropriately.
The No Falls Program from Hill-Rom (www.hill-rom.com), Batesville, Ind., includes beds and surfaces with integrated patient monitoring systems that have multiple bed exit and fall alert options for various patient populations. The company’s Versa Care and TotalCare Bed systems feature a floor-to-surface height that can be lowered to 18 inches, foot controls that enable caregivers to use both hands in assisting patients out of bed, a firm perimeter patients can grip for extra support and dual-locking casters. The TotalCare bed can be positioned like a chair, so patients may egress from a supported, seated posture at the foot of the bed.
Hill-Rom’s NaviCare Patient Safety software application has a No Falls module that “links the bed directly to the caregiver,” says Penny Gilbert, CPHQ, director of clinical outcomes, Hill-Rom. The system is designed to monitor and automatically alert staff about patient movement or changes in bed status, such as whether the side rails are engaged, and to work with a facility’s IT system to record this information.
The No Falls Program was used at St. Joseph’s/Candler Hospital, Savannah, Ga., to redefine safety protocols and use technology to reduce patient falls. Hill-Rom reports that in the first four months of the program, the hospital’s average fall rate decreased from five to 1.4 falls per 1,000 patient days.
Environmental factors
Nu-Safe’s Sestito notes that health facilities are generally good at assessing patients for fall risks, but often come up short when considering environmental factors that can reduce falls. “If you have a fall program in place that takes a look at your patients and how they’re doing,” he suggests, “let’s take a look at the environment.”
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This article first appeared in the June 2009 issue of HFM.
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