Preventing falls in the hospital and at home

By Carol Harbers

A fall happens in a split second, yet the effects can last a very long time. Like a row of dominoes, the first tumble can be only the beginning.

“It’s especially a concern with the elderly,” says LaVerne Mullin, RN, of Duke HomeCare & Hospice (DHCH). “If an older person falls, they lose mobility. That can lead to eating less, circulatory problems, blood clots -- a series of health problems.”

Mullin thinks about falls a lot, as do the six members of the DHCH falls committee. They work to keep falls prevention top-of-mind for all staff and to develop tools to identify patients at greater risks for falls.

Home safety checks are one of the most important ways the DHCH staff helps reduce falls. In a patient’s home, the staff looks for poor lighting, throw rugs, and uneven or slippery floors or steps. Rushing to the phone, getting from bed to bathroom, and taking certain medications also create risk, as pointed out by the informational brochure (PDF) given to every patient.

DHCH staff also helps patients become more sure-footed after illness or surgery by working with them one-on-one in their homes. Wrote one patient about his physical therapist, “She helped me regain my physical strength by teaching me specific exercises that gradually gave me to confidence to walk without fear of falling.”

In April 2009, a new reporting system for patient falls went live across Duke Medicine and promises further improvement through easier reporting and the ability to input more detail about a fall.

“A lot of information which we haven’t had in the past can be pulled out of the reports,” says Mullin. “We can track falls for each patient, for locations, time of day, etc.

“We need this data, we use this data,” she says. “We are actively engaged in following up on falls and going back to see what has been done to reduce the future risk.”