1. Falls Prevention and Injury Reduction from Falls
(Safer Healthcare Now! 2013, p. 22)
The Getting Started Kit provides a Fall Prevention/Injury Reduction Intervention Model with the following five components:
- Prevention: Universal Fall Precautions (SAFE: Safe environment, Assist with mobility, Fall risk reduction, Engage client and family).
- Multifactorial risk assessment.
- Communication and education about fall risk.
- Implementation of interventions for those at risk of falling.
- Individualize interventions for those at high risk of fall-related injury.
2. Promote Alternative Approaches to the Use of Restraints
The Registered Nurses' Association of Ontario offers a model, Promoting Safety: Alternative Approaches to the Use of Restraints (RNAO, 2012, p. 20). This outlines an approach towards a restraint free environment and includes the following three components:
- First focus: Prevention, alternative approaches and assessment.
- Second focus: Use crisis management & de-escalation Interventions.
- Last focus: Restraint use as a last resort.
3. Perform a Clinical and System Review (see details below)*
Healthcare associated accidents are both complex and multifactorial and identifying contributing factors and preventative measures requires clinical and system reviews as described below. For a list of potential contributing factors and recommended mitigation strategies refer to Appendix A for burns and Appendix B asphyxiation.
Clinical and System Reviews
Occurrences of harm are often complex with many contributing factors. Organizations need to:
- Measure and monitor the types and frequency of these occurrences.
- Use appropriate analytical methods to understand the contributing factors.
- Identify and implement solutions or interventions that are designed to prevent recurrence and reduce the risk of harm.
- Have mechanisms in place to mitigate consequences of harm when it occurs.
As a means to develop a more in-depth understanding of the care delivered to patients, chart audits, incident analyses and/or prospective analyses can be helpful in identifying quality improvement opportunities. Links to key resources for analysis methods are included in the section Resources for Conducting Incident and/or Prospective Analyses.
Chart audits are recommended as a means to develop a more in-depth understanding of the care delivered to patients identified in the hospital harm measure. Chart audits help identify quality improvement opportunities.
Useful resources for conducting clinical and system reviews: