Employee fall prevention program

It also describes the resources needed to implement and sustain fall prevention programs. This guide addresses questions that are important when implementing fall prevention programs such as:.

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Table of Contents Introduction Sample policy statement Training Housekeeping standards Seasonal issues Corrective maintenance procedure Workplace inspection policy and procedure Responsibilities Safety rules Accident investigation procedure Additional tools and resources Appendix A periodic inspection report Appendix B sweeping log Appendix C walking and working surfaces — self inspection checklist Appendix D accident investigation report Appendix E snow and ice control record 1.

Introduction Nationally, falls are the second leading cause of accidental death and a major cause of debilitating injuries. Sample policy statement The most effective safety program policy statements reflect your unique operations and environment.

Training Who must attend Slip, trip, and fall hazard awareness All employees Workplace inspections Employees conducting inspections Accident response and analysis Supervisors 4. Housekeeping standards Housekeeping plays such a critical role in the success of our slip, trip and fall prevention program that all employees must make housekeeping their top priority.

The following are minimum accepted guidelines: Work areas are to be kept clean throughout your shift and a thorough review and cleaning must be completed prior to leaving your shift.

Walkways will be kept clear of electric cords, hoses or any other potential hazards. If walkways cannot be kept clear then they need to be blocked off until the task is completed. Spill areas must be secured until the spill is removed.

Stock or finished goods will not be stored on stairs, in walkways or in such a manner that would be a hazard to anyone walking through. Seasonal issues The changing seasons create unique weather-related conditions for which the following procedures have been developed: Winter snow and ice removal. All building entrances will be cleaned of snow and ice, and will be treated with salt, one hour prior to the opening of business. Exterior walkways will be inspected hourly and treated as needed.

Parking lots will be inspected daily. Any snow or ice that has accumulated between cars will need to be removed. During the fall, daily inspections will be made and action taken as needed to ensure walkways are cleared of leaves. Corrective maintenance procedure When a hazard has been identified through inspection or our hazard reporting program, maintenance must be notified so that the problem can be corrected.

The following is the procedure to accomplish this task: Any problem needs to be communicated to the manager immediately. The maintenance manager will inspect the problem and communicate the best action to take. Workplace inspection policy and procedure Our goal is to ensure a safe, clean and hazard free environment for employees and customers. Inspections will be carried out by supervisors of their functional areas.

The manager will inspect common areas and all outside areas including the parking lot. Any deficiencies or hazards must be acted upon to remove the hazard, warn of it or close off the area in question.

Annual inspections Once a year an inspection team made up of representatives of the organization will do a wall-to-wall walk through inspection of the entire worksite. The results of this inspection will be used to: Eliminate or control obvious hazards. Target specific work areas for more intensive investigation.

Assist in revising the checklists used during periodic safety inspections. Evaluate the effectiveness of our slip, trip and fall prevention program. Change of operations surveys Changes include new equipment, changes to production processes or a change to the building structure or premises. Management responsibilities Ensure that sufficient employee time, supervisor support and funds are budgeted for safety equipment, training and to carry out the safety program. Evaluate supervisors each year to make sure they are carrying out their responsibilities as described in this program.

Ensure that incidents are fully investigated and corrective action taken to prevent the hazardous conditions from developing again. Set a good example by following established safety rules and attending required training. Supervisor responsibilities Supervisors must assure this program is adhered to and that all employees follow program policies and procedures. Ensure that each employee you supervise has received an initial orientation before beginning work.

Observe the employees as they work. Promptly correct any unsafe behavior. Do a daily walk-around safety-check of the work area and promptly correct any hazards you find. Set a good example for employees by following safety rules and attending required training. Investigate all incidents in your area and report your findings to management. Talk to management about changes to work practices or equipment that will improve employee safety. Employee Responsibilities Clean up spills and pick up debris to help ensure others are not injured on company property Report hazards to supervisors or managers promptly for corrective action.

Follow safety rules, safety standards and training you receive as described in this program Report all injuries and near miss incidents to your supervisor promptly regardless of how serious. Make suggestions to your supervisor or management about changes you believe will improve employee safety. Review floor cleaner data sheets to assure that no slippery floors are created. Must integrate the stair design requirements, uniformity of risers, and tread principles, ramp requirements and slope considerations into building design, and building modifications as appropriate.

Will supply deicer in buckets along with scoops at building entrances during inclement weather. Check floor surfaces as requested for slip or trip hazards, determine any needed corrective action and notify appropriate party to correct the problem. Housekeeping Must use barricades when the floor they are working on is slippery or presents a tripping hazard. Barricades will be removed as soon as the hazard is corrected. Place non-skid mats at building entrances during inclement weather.

Inspect mats periodically or as needed to ensure they are properly controlling the hazard. Safety rules The following basic safety rules have been established to control slip, trip and fall accidents.

Always take the proper safety precautions before doing a job. If a job is unsafe, report it to your supervisor. We will find a safer way to do that job. What fall prevention practices go beyond the unit?

How do you put the new practices into operation? How do you manage the change process at the front line? How do you pilot test the new practices? How do you get staff engaged and excited about fall prevention? How can you help staff learn new practices?

Implementing Best Practices: Locally Relevant Considerations Implementing best practices requires attention to detail. Some issues that may need to be sorted out at your hospital include: Education of clinical and nonclinical staff: Reaching all nurses with fall prevention education, particularly night shift and weekend staff. Providing fall prevention training for professional disciplines beyond nursing staff and rehabilitation services e.

Communication of fall risk: Developing mechanisms for the emergency department to communicate a patient's risk factors for falls to the admitting department. Improving handoff tools between departments and between shifts. This section will address these types of challenges. Return to Contents 4. What roles and responsibilities will staff have in preventing falls? In Tools and Resources, you can find a worksheet to use in deciding how responsibilities will be assigned in your organization Tool 4A, "Assigning Responsibilities for Using Best Practices" together with a summary page illustrating how responsibilities might be organized Tool 4B, "Staff Roles".

What role will members of the Unit Team play? Nurse: Completes and documents fall risk assessments. Monitors progress or changes in medical condition. Documents care and prevention practices. Reports patient problems to medical provider. Obtains consults and medical orders as needed. Educates patient and family as appropriate. Supervises aides. Nurse aide: Evaluates the safety of the patient's environment during care tasks.

Performs appropriate care plan tasks. Reports task completion to the nurse. Reports any changes in the patient's condition to the nurse. Treating medical provider: Reviews need for specific types of rehabilitation therapy.

Writes orders for specific interventions, including activity orders. Reviews medications for fall risk and makes changes to medications as needed. Pharmacist: Reviews medication list of patients at high risk based on medication profile. Suggests alternative medications or dosing regimens to medical provider.

Physical or occupational therapist: Provides skilled therapy to patient to improve ability to perform activities of daily living, such as ambulation and transfers or bathing and dressing. Makes recommendations for assistive devices or adaptive equipment. Trains patient in safe use of assistive devices or adaptive equipment.

Define the roles for all members of the Unit Team. Worksheet 4A in Tools and Resources may help in this process. You may need to tailor roles to accommodate differences in staffing and practices in different units.

Develop a plan for orienting and monitoring temporary staff. Be sure staff roles you have developed are in compliance with your State practice acts. Highlight which of these responsibilities will differ from the Unit Team members' current roles and therefore will require changes in practice.

These will require special attention as you manage implementation of the new set of practices described in section 4. If you anticipate barriers to unit staff filling the defined roles, highlight them for use in planning your change strategies described in section 4. Look for these characteristics in your Unit Champions and resource staff: Satisfactory level of performance. Excellent communication skills. Effective linkage to other staff members. Respect from their peers.

Enthusiasm for patient safety. A demonstrated positive image of their unit. Good problem-solving skills. Knowledge of the benefits and process of fall prevention.

Ability to collaborate with all key stakeholders in the improvement process. How should the fall prevention program be organized at the unit level? What paths of ongoing communication and reporting will be used? How will fall prevention be integrated into ongoing work processes?

Strategies for building prevention into ongoing processes include: Making certain procedures universal so that staff do not have to decide which patients they apply to such as the universal fall precautions discussed in section 3 , Integrating communication regarding fall risk into regular communication, such as shift handoffs, and Creating visual cues or reminders in physical locations, such as logos indicating elements of the fall risk care plan e.

Examples of How Change Can Be Incorporated Into Routine Care A newly admitted patient automatically triggers a medication review using the pharmacy risk scale Tool 3I to determine whether a full pharmacy evaluation of the medication list should occur.

A standard order set is used for all patients to institute appropriate mobilization protocols Tool 3K. Patients noted to have a change in mental status automatically receive the standard Delirium Evaluation Bundle Tool 3J to determine the need for increased supervision and further medical evaluation.

A postfall assessment note Tool 3O is created as a structured electronic template or paper progress note to guide nurses through the appropriate care processes. Hourly rounds Tool 3B are used to assess toileting needs alongside other concerns.

Environmental rounds occur on a regularly scheduled basis by a hospitalwide team to ensure environmental safety go to Tool 3C for checklist. For hospitals that have electronic records, questions to consider include: What information about fall risk factors is already part of the patient record?

Are data already in the system that can be used as part of a new process to assess fall risk factors? Suggestions for Building Fall Prevention Into Electronic Documentation Systems Features that can be added to electronic documentation systems include: Automatic consults to physical therapists for mobilization as directed by a mobilization protocol, or to occupational therapists for patients who need retraining to perform an activity of daily living.

Automatic consults to pharmacists if medication risk score exceeds a threshold. Patient education booklet linked to the documentation system so that it is readily available if needed. Fall prevention guidelines or quick reference text integrated into the computer charting system.

Fall risk factor report that summarizes which patients on the unit have specific risk factors. Working from the process map for fall prevention and gap analysis you developed for your organization in the redesign process section 2. Lines of oversight and accountability. Documentation that is needed and people to whom it is submitted. Strategies for integrating fall prevention into ongoing work processes.

These rules should include not only regular activities, but also contingencies, such as plans for supervising very high risk patients if a sitter is not available. Consistent with those decisions, complete the worksheet provided as Tool 4A in Tools and Resources to assign specific individuals or groups to each task.

Determine which changes in practice, if any, will require changes in formal hospital policies and procedures. Important questions to ask regarding handoffs include: When patients are transferred from the hospital ward to radiology for a test, is the person doing the transport alerted to the patient's fall risk? What is the strategy for handling patients who are admitted through the emergency department because of a fall? On discharge, do patients and families have input into the postdischarge care plan?

Are they given information about how to prevent falls in the home, and are referrals made for additional services and supports, such as home physical or occupational therapy, as needed? To guide the changes that will be needed, you should consider four questions: How do you manage the change process at the front line? Therefore, to make the needed changes: Ensure that staff understand their new roles, know why the new roles are important, and have the knowledge and tools to carry out their roles.

Help reduce resistance to change by ensuring that staff understand the reasons for change and agree that change is needed. To help staff accept the new set of practices fully, ensure that they understand that those practices offer promising strategies for providing high-quality care for patients and that such care is a priority for their supervisors.

Identify and minimize practical barriers to using the new practices, such as inadequate access to supplies or equipment. For example, assistive devices, low beds, and floormats should be stored on or near the unit for easy availability. At all levels, engage staff to gain their support and buy-in to the improvement effort and help tailor the practices in fall prevention. Involving staff, clinicians, and middle managers At the unit level, it will be important to involve not only frontline nurses and support staff but also nurse managers and physicians.

Monitoring implementation progress The Implementation Team and Unit Champions should develop a process for ongoing monitoring of implementation progress. Sustaining management support Above the unit level, the Implementation Team should continue to keep senior leaders and middle managers regularly informed about progress with the fall prevention program to sustain their early support for the improvement effort.

These individuals' support will be needed during implementation in multiple ways: Leaders and managers are important sources of communication. Their expressed support for improving fall prevention will reinforce its importance and thus increase the impetus among staff to adhere to the new practices. Leaders and managers can help remove barriers across departments.

While the Implementation Team by design should include all divisions affected by fall prevention, some issues may not be resolved within the Implementation Team but need to be taken to a higher level of authority.

This will be particularly important if your organization does not have a strong history of quality improvement that gives staff and managers on the improvement team authority to change procedures as needed. Senior leaders may need to authorize resources for the prevention initiatives. In the pilot and early implementation phases, the Implementation Team may need, for example, to negotiate with administration and unit managers to secure release time for Unit Champions and for staff training.

Management's financial support will be needed, for example, if new equipment e. You initially considered resource needs for fall prevention in section 1. Consider reviewing this list and updating it if needed.. Building on the work from earlier sections, refine your Implementation Plan to outline the details of your strategies, including lead responsibility and timelines, for managing change at the front line.

Clarify the roles of the Implementation Team and Unit Champions for the implementation period. Communicate those roles to frontline staff and leadership. Confirm management support for the resources needed for hospitalwide implementation in terms of among other things : Expressed support for the initiative.

Additional months for Implementation Team to work.