Published: Nov. 30, 2010
Updated: Nov. 30, 2010
Hip fractures, traumatic brain injuries, lacerations and bruises -- they sound like the aftermath of a severe accident.
In fact, a "simple" fall experienced by vulnerable populations is exactly that, severe enough to cause significant trauma.
Falls are the leading cause of injury deaths in adults 65 and up, often lead to hospitalization and loss of independence after discharge, and are projected to reach $54.9 billion in direct and indirect costs by 2020.
Any one of these negative outcomes would be enough to promote falls prevention as a priority, and hospitals and public health agencies across the nation are doing so. At Duke, prevention efforts have been under way throughout the health system, beyond the traditional inpatient hospital setting.
"On average the North Duke Street clinic sees between 3,500 to 4,000 patients in a month; it's the third-highest patient volume in the private diagnostic clinic," says Carolyn O'Connor. O'Connor is the health center administrator of Duke Health Center at North Duke Street, a freestanding outpatient clinic with a varied patient population mix.
The adult multi-specialty clinic conveniently offers cardiology, gastroenterology, general and vascular surgery, gynecology, ophthalmology, orthopaedics, physical and occupational therapy, radiology, and respiratory medicine services under one roof, but it's also an environment where the combination of patients heightens the falls risk.
"A cardiology patient with an oxygen tank, or an elderly patient with poor vision, or a rehab patient in a wheelchair -- these are all people who are especially vulnerable to falls, and these are the patients we see," says O'Connor.
In April 2009, a three-month pilot program called Ambulatory Falls Prevention -- addressing falls in the outpatient setting -- offered O'Connor, along with clinical nurses Pam Biggs, RN, and Ann King, RN, a novel opportunity to improve the clinic's falls rate.
Its success launched a new rollout of falls prevention initiatives for FY10, including formalized safety reporting system policies, a "falls champion" representative at each PDC location and hospital-based clinic, and monthly meetings of the Ambulatory Falls Committee.
"We review particular falls incidents or situations, environmental factors in the facilities, like carpeting and exterior curbs, so we can take corrective action," says Biggs, a member of the committee. "Falls are also an agenda item at every monthly staff meeting, so we can discuss issues that are specific to the practice."
Heightened awareness and observation from the staff are also parts of the falls prevention equation, according to King. "Is the patient dizzy from a prescription or a combination of prescriptions? Did they just have their blood drawn and are they woozy as a result? Is there a piece of equipment, like a wobbly chair, that needs maintenance? The staff is alert for these signs," she says.
Electronic patient records and consistent falls alerts also help to highlight the patients who may need an extra hand off the exam table or out of the wheelchair.
When a patient checks in, the encounter form is flagged for falls risk and logged into the patient's records. That same alert follows the patient throughout the health system, no matter the location of the clinical visit.
The efforts are paying off at Duke Health Center at North Duke Street, which experienced a decrease in falls: from six to zero in one fiscal quarter. Biggs, King, and O'Connor are enthusiastic about the results, but remain vigilant in keeping falls prevention front and center for the entire clinical team.
"We are all responsible for the safety of our patients when they are visiting our clinic. Through observation and reporting, systems monitoring, and communication, we have been successful in reducing the number of falls as well as provide a safe environment for our patients, visitors, and staff,” says O'Connor.