Interprofessional Teamwork Helps to Prevent Patient Falls

Nineteen hospitals in Nebraska are collaborating on an interprofessional, evidence-based approach to decreasing fall risk, reports FierceHealthcare, and they are seeing results.

"We had no process, no structures in place to decrease our fall risk," said Carol Kampschneider in a video posted on Hospitals & Health Networks (H&HN) Daily. Kampschneider is a registered nurse and vice president of clinical and regulatory services at St. Francis Memorial Hospital in West Point, Nebraska.  Prior to joining the collaboration, only falls that resulted in broken bones or head injuries were identified as serious at her hospital and no fall risk assessment was completed during patient admissions.

Through an Agency for Healthcare Research and Quality grant, the 19 hospitals became involved in the Collaboration and Proactive Teamwork Used to Reduce Falls (CAPTURE Falls) program, and began to see improvements. For example, the fall rate at St. Francis dropped from 7.31 per 1,000 patient days to 1.41 per 1,000 patient days, Kampschneider said.

As part of the program interprofessional teams collaborate and use tools to understand risks associated with inpatient falls. If a fall does occur, the teams will conduct a "post-fall huddle" to determine how they can prevent the patient from falling in the future.

INQRI grantees Patti Dykes and Blackford Middleton created a tool designed to prevent patient falls by translating an individual patient's fall risk assessment into a decision support intervention that communicates fall risk status, and creates a tailored plan that is accessible to care team members (including patients and family members).

The team constructed the Fall Prevention Toolkit (FPTK), and conducted a randomized controlled trial to examine whether the FPTK led to a decrease in the incidence of patient falls and a decrease in the incidence of patient falls with injury. The use of their toolkit did significantly lower the incidence of falls in the intervention units and several units wished to continue using the tool after the conclusion of the study. By establishing links between nursing fall risk assessment, risk communication and tailored interventions to prevent falls, Dykes and Middleton hope to raise awareness of fall risks for patients, nurses and other providers and to lower mortality and morbidity for potential fall victims.

 The H&HN Daily video is available here.

Detecting and Controlling Significant Pain in the ICU through Assessment Tools

Significant pain is very common in critically-ill adult ICU patients and patient self-assessment is not always the best way for nurses to record, report or treat their patients’ needs, according to an article on Advance Healthcare Network for Nurses.

To address this issue, nurses and other medical professionals need to have the right tools, including validated, standardized pain assessment plans, according to nursing experts quoted in the article. The most common verbal scale tool for adult ICU patients is the Verbal Numerical Rating Scale, where pain is rated on a scale from zero to 10. Non-verbal scales consist of patients pointing to a number on a board or paper, and nurses asking the patient to shake their head yes or no while following their facial expressions and vital signs for indications of pain. Another tool is the mnemonic OLDCART:

•    O = onset
•    L = location
•    D = duration
•    C = characteristics of the pain on a 0-10 scale
•    A = aggravating factors
•    R = relieving factors
•    T = treatment

Tools for patients who are not able to communicate at all are also outlined in the article.

The INQRI funded study: SPEACS 2: Improving Patient Communication and Quality Outcomes in the ICU examined the value of a nurse-generated and nurse-led innovation on ICU patient care outcomes, including pain symptom management.