Resources for Fall Prevention in the Emergency Department

• Scott, R. A., Oman, K. S., Flarity, K., & Comer, J. L. (2018). Above, Beyond, and Over the Side rails: Evaluating the New Memorial Emergency Department Fall–Risk-Assessment Tool: JEN. Journal of Emergency Nursing, 44(5), 483-490. https://doi.org/10.1016/j.jen.2018.01.007

This resource is a validated fall risk assessment tool specifically designed for use in the ED. It includes a comprehensive set of risk factors and assessment criteria specific to the ED to help nurses identify patients at high risk of falling during the triage process. The fall risk assessment tool is highly valuable for nurses, and emergency room staff as it allows them to evaluate patients' fall risk and prioritize preventive interventions based on the identified risk factors. The fall risk assessment tool should be implemented into the ED triage process and during the initial patient assessment to determine the appropriate level of fall prevention interventions required.

• Ziebart, C., Dewan, N., Tuazon, J., & MacDermid, J. (2021). Development of the Home Fall Hazard Checklist. Rehabilitation research and practice, 2021, 5362197. https://doi.org/10.1155/2021/5362197

Since there is little literature regarding falls in the ED, we must adopt other successful interventions that are being utilized. This article describes environmental checklists that are used in patient’s home after a fracture or injuries that affect mobility. These checklists can be adapted into the ED by using the same framework but adjusting it to the ED environment. By assessing and addressing environmental factors that contribute to falls, the checklist helps reduce patient safety risks. It ensures that the ED environment is optimized for fall prevention, minimizing the chances of incidents. The environmental safety checklist should be used regularly by staff to inspect the ED environment for potential fall risks. Any identified issues should be promptly addressed, such as fixing loose handrails or clearing cluttered areas.

• Michalcova, J., Vasut, K., Airaksinen, M., & Bielakova, K. (2020). Inclusion of medication-related fall risk in fall risk assessment tool in geriatric care units. BMC geriatrics, 20(1), 454. https://doi.org/10.1186/s12877-020-01845-9

This source explains the importance of integrating medication review into the fall risk assessment. This focuses on a geriatric unit, but we can adopt this tool into the ED. Most of the patients that do fall in the ED are over the age of 65 so these tools would be very useful. By conducting medication reviews using this tool nurses can identify medications that may contribute to falls and implement interventions for fall prevention. This promotes medication safety and reduces the chances of fall-related adverse events. The medication review tool should be implemented into the ED medication management   processes. It should be followed when assessing patients' medication lists, identifying       high-risk medications, and making appropriate recommendations to providers.

• Acosta, D. , Rinfret, A. , Plant, J. & Hsu, A. (2022). Using Patient Simulation to Promote Best Practices in Fall Prevention and Postfall Assessment in Nursing Homes. Journal of  Nursing Care Quality, 37 (2), 117-122. doi: 10.1097/NCQ.0000000000000599. 

This research promotes staff involvement regarding education. In this article they perform patient simulated falls with the staff. They provide background information on the patient and then give that patient a ranking from the fall risk assessment tool that they use in the department. Then the simulation has the patient fall, in which the staff assists the patients then perform a post fall huddle. The researchers concluded that staff were more willing to adhere to the new fall improvement plan after these simulations. Staff adherence is the number one priority when implementing any new policy or strategy. Staff-based activities like this example should be used in all the EDs.

• Brundrett. (2020). Implementation of a Multicomponent Fall Prevention Program: Contracting With Patients for Fall Safety. Military Medicine., 185(Supplement_2), 28–34. https://doi.org/10.1093/milmed/usz411

This article discusses the importance of a patient-staff safety contract that should be made with every patient in the department. It also discusses the crucial aspect of staff and patient education regarding fall risks and preventions. The patient-staff safety contract needs to be an understanding between the nurses and the patients on when to and how to request assistance. Most of the falls are resulted from patients attempting to toilet or ambulate, which a nurse or staff member could assist them to prevent a fall. Most patients do not like losing their independence but it’s the staff’s responsibility to make sure the patient understands all the risks involved. I believe using this safety contract with coherent patients in the ED would be essential to the improvement plan.

• Heng, H., Kiegaldie, D., Shaw, L., Jazayeri, D., Hill, A. M., & Morris, M. E. (2022). Implementing Patient Falls Education in Hospitals: A Mixed-Methods Trial. Healthcare, 10(7), 1298. https://doi.org/10.3390/healthcare10071298

This article addresses the need for adequate patient education regarding fall prevention. The research shows that most nurses do not fully educate patients about the importance of fall prevention or take the time to discuss it at all. The improvement plan should take these idea regarding patient education and develop resources for nurses and staff to hand out to patients and family members. Patient and family education materials are valuable for nurses and staff who interact with patients and their families. They serve as educational tools to empower patients and encourage their involvement in fall prevention efforts. By providing patients and their families with educational materials, nurses can promote knowledge and awareness of fall risks. Patients become active participants in their own safety by implementing recommended strategies and modifying their home environments and are made aware of the risks in the hospital setting as well. The patient and family education materials should be readily accessible in the emergency room and distributed to patients at risk of falling or with a history of falls. Nurses should engage in discussions with patients and their families, using these materials to enhance understanding and promote adherence to fall prevention measures.

• Jones, K. J., Crowe, J., Allen, J. A., Skinner, A. M., High, R., Kennel, V., & Reiter-Palmon, R. (2019). The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project. BMC health services research, 19(1), 650. https://doi.org/10.1186/s12913-019-4453-y

         This article discusses the impact that post-fall huddles have on reducing future falls. It describes certain factors that should be discussed in the huddles, such as the patient’s risk factor score, what was the patient doing at the time of fall, where staff was located during the fall, how could the staff have prevented the fall, etc. Also, the article discusses the importance of creating a positive safety culture and encouraging staff participation.   Having a positive safety culture, especially in the ED, promotes staff engagement and results in positive patient outcomes. The post-fall huddles should be implemented into the EDs standard procedures. Nursing leadership and staff should conduct post-fall huddles in real time so that they can adjust the interventions in place for that patient and improve safety outcomes.

• Campbell, D. & Dontje, K. (2019) Implementing bedside handoff in the emergency department: a practice improvement project. Journal of Emergency Nursing, 45(2), 149-154.https://doi.org/10.1016/j.jen.2018.09.007

This article discusses the importance of implementing bedside handoff report in the ED. Bedside handoff report in the ED not only would reduce medical errors and improve patient involvement but would help reduce falls. Increased communication between staff at handoff would help them communicate the patient’s fall risks and interventions that are in place. When you have staff visualize the patients in handoff that allows them to identify fall risks and ensure the continuity of fall prevention interventions in place. The ED should implement bedside report handoff with a focus on patient safety and fall prevention.

•  Pop, H., Lamb, K., Livesay, S., Altman, P., Sanchez, A., & Elizabeth, M. (2020). Tailoring a comprehensive bundled intervention for ed fall prevention. Journal of Emergency Nursing, 46(2), 225-232. https://doi.org/10.1016/j.jen.2019.11.010

This article is the base of the improvement plan and brings all the factors of fall prevention together. This research proposes a six factor fall prevention plan that includes    risk assessment, safe ambulation, safe toileting, staff communication, patient education, and usage of early warning alarms. It describes the best practices to utilize for each of the six factors, and how to implement them in the ED. This article takes strategies that are already in use in other acute care settings and applies them to the ED specific needs. This is a theme with research regarding fall prevention in the ED since we must adapt to the unique design and environment that each ED can have throughout the country. This six factor fall prevention plan should be a basis for any ED that is implementing a new safety improvement plan into their everyday best practice.

• Lee, S. J., Lee, Y. M., Seo, E. J., & Son, Y. J. (2021). Impact of Hospital Nurses' Perception on Clinical Alarms and Patient Safety Culture on Alarm Management Practice. International journal of environmental research and public health, 18(8), 4018. https://doi.org/10.3390/ijerph18084018

This article discusses the importance of the nurses’ perception of clinical alarms and addresses alarm fatigue. Simply put, nurses might not place an alarm due to the fact they do not want to be bothered by the constant “false” alarms. Along with the fall alarm, most patients in the ED also have cardiac alarms, blood oxygen level alarms , respiratory alarms, etc. that can easily be alarmed if the patient moves or if the equipment is malfunctioning. This research expands on the importance of decreasing these unwanted “false” alarms so that when the patient centered alarms are activated the nurse is more aware and prompted to assist the patient immediately. This is a huge factor in the prevention of falls because early warning and helps the nurse to assist the patient before they actually fall out of the bed or chair.

• Rose, A., Carter, N., Vann, C., Lloyd-Penza, M., & Andrusko, M. (2022). Implementing Bedside Mobility Assessment Tool to Improve Patient Outcomes and Staff Communication. Medsurg Nursing, 31(1), 32-36.http://library.capella.edu/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly -journals%2Fimplementing-bedside-mobility-assessment-  tool%2Fdocview%2F2630949976%2Fse-2%3Faccountid%3D27965

This article addresses the need for a bedside mobility assessment tool (BMAT) in the hospital setting. The research discusses the procedure of completing the BMAT and how to implement it in a department. It shows the benefits of utilizing this tool regarding not only falls but pressure ulcers and other injuries caused by immobility. The BMAT is highly valuable for nurses and physical therapists involved in assisting patients with mobility limitations. It provides guidance in choosing the most suitable mobility aid to enhance patient safety. By using the BMAT, staff can ensure that patients receive the most appropriate mobility aids, reducing the risk of falls and promoting safe ambulation.

• Argañarás, J. G., Wong, Y. T., Begg, R., & Karmakar, N. C. (2021). State-of-the-art wearable sensors and possibilities for radar in fall prevention. Sensors (Basel, Switzerland), 21(20), 6836. https://doi.org/10.3390/s21206836

This article discusses the need for wearable technology to help reduce and prevent falls. It elaborates on the wearable technology already in use, but also identifies needs that are still being addressed to provide the best possible product. I included this article in the improvement tool kit so that we can learn about the advances to come related to fall prevention technology. If the leadership stays informed of the new technological advances to come, then they can provide staff with the newest and best equipment available.