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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:

  1. Measure and monitor the types and frequency of these occurrences.
  2. Use appropriate analytical methods to understand the contributing factors.
  3. Identify and implement solutions or interventions that are designed to prevent recurrence and reduce the risk of harm.
  4. 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: