Protect Your Patients From Injury

Floor Mats Do Reduce Impact Severity: They Work!

Colleagues,

Protecting patients from injury when they falls requires different interventions than preventing them from a fall. The main intervention to reduce impact when patients fall from be is the Floor Mat placed at bedside when the patient is in bed.

We know that physical trauma, blunt force trauma, results in a serious injury to the body. One source of physical trauma due to blunt force is when the body falls onto the floor.. Such impact causes hematomas, lacerations, concussions and/or fractures. The burden of trauma requires that interventions are implemented to protect patients by reducing the risk of such physical trauma when they fall. Over 10 years ago, Oliver et al., 2010, recommended that we reduce injury when a patient falls. We cannot prevent all falls, but we can protect our patients from injury. We also know that when patients fall onto padded flooring, such as carpet or high impact absorbing flooring, the force of impact is reduced. The force of trauma sustained is very different than falling the same way onto concrete or tile flooring.

However, hospitals, long term care facilities, and assisted living facilities are not going to invest in high impact absorbing flooring. It is too expensive. Still, evidence exists that impact absorbing flooring is effective. Gustavsson, et. al., (2015) investigated the fall-injury reducing effect of impact absorbing flooring among female nursing home residents when they fell on regular flooring compared to 12mm thick composite absorbing tile flooring. Briefly, 254 residents fell onto regular flooring and 77 falls on impact flooring. “The injury fall rate was 30.3% for falls on regular flooring and 16.9% for falls that occurred onto impact absorbing flooring. … The impact flooring significantly reduced the relative risk of injury by 59% (RR 0.41 (95% CI 0.20 to 0.80)) (Gustavsson, et al., p. 320). Colleagues, the impact absorbing flooring is protective, so are floor mats.

While we hope and wait for hospitals to replace flooring with impact absorbing flooring, our next best intervention is the floor mat placed at the bedside. Floor mats, pads placed on the floor at the bed or chair side, have been implemented in many veterans’ administration medical centers and LTC settings since 2004 (National Center for Patient Safety [NCPS], 2014). The floor mats have been shown to reduce the risk of severe head injury from approximately 40% for falls occurring at the normal bed height over the rail onto unprotected flooring to approximately 1% for falls from a low bed position onto a floor mat (Bowers et al., 2008), as measured by head injury criteria. For years, floor mats have been included in national toolkits and resources, including the Institute for Healthcare Improvement (Boushon et al., 2012) and national guidelines for hospital fall prevention programs (NCPS, 2014; Ganz, et al., 2013; Pearson, et al., 2011).

If floor mats are available in an organization, floor mat use is dependent on nursing staff. The leading barrier to floor mat use is their concern about trip hazards. So, it is our responsibility together to reduce these barriers, so that patients are protected when they fall from bed or chair — severity of injury is reduced.  To promote the nursing staff or anyone from tripping when walking onto a floor mat, all floor mats should have a beveled edge. All staff should be instructed to exercise caution when walking onto a floor mat. To help you further, colleagues, I am referring you to resources still available on the Department of Veterans Affairs (VA) National Patient Safety Falls Toolkit – the Floor Mat Implementation Guide and Fall Mat Examples.

Floor Mat Implementation Guide. Since 2014, a Floor Mat Implementation Guide has been available to you hereThis implementation guide provides you with implementation tips and tricks to increase staff adoption and reliable use of floor mats by the nursing staff. The floor mats should only be on the floor by the bedside when the patient is resting in bed. They should be placed on the floor on the safe bed exit side for the patient. When not in bed, many staff store the mats underneath the bed. Again, should a nurse choose to leave the floor mat beside the bed when approaching and walking onto the floor mat, the nurse should exercise caution, pick up toes when stepping to decrease the risk of tripping. All nursing staff on a unit should know when patient’s care plan includes a floor mat at the bedside. Included in this guide is patient selection criteria for bedside floor mats. Not all patients should have a floor mat at the bed side. Floor mats are suggested for those patients who you worry will get up without calling for help, are able to move in the bed, try to get out of bed without you, and are at risk for injury, such as anticoagulated, osteoporotic or fracture risk, or have fracture history. These patients should have a floor mat at their bedside. The VA’s criteria for floor mat use have remained consistent over the years. Floor mat use is not selected because a patient is “high risk for falls”. Floor mat selection is based on clinical criteria as described.

Floor Mat Examples. Also located on the National Center for Patient Safety’s National Falls Toolkit website is a resource list of floor examples, available here. Most of these floor mats have beveled edges. You will learn about each product’s properties such as slip resistance, width and length dimensions, along with cost information from 2014. You will see pictures of the floor mats and other product information about thickness. Floor mats with glow-in-the-dark strips around the mat’s edges are available. The strips increase visibility of the bedside floor mat for staff and patients at night, which also may decrease the trip hazard.

These floor mat resources are available at your finger-tips, all designed to help you, your staff, your organization by providing the evidence, selection criteria, and strategies for implementation.

The Egg Drop Video. The Egg Drop video has been very effective in convincing nursing staff about the protective properties of floor mats. When a raw egg is dropped onto the floor mat, it does not break. Here is the website for this video:

https://www.youtube.com/watch?v=cATSmo1QS4g

Help your nursing staff appreciate the amount of trauma a floor mat can absorb and reduce the trauma experienced by a patient upon floor impact.

Engage Your Nursing Staff. Working with many nurses and falls committees across this great country, I have suggested strategies to engage nursing staff in their fall injury prevention programs, as leaders in protecting patients from fall-related injuries. One such strategy is for the hospital Falls Committee to conduct a floor mat selection fair. Working with the nursing staff, review the listing of floor mats on the resource guide; select 3-4 floor mats from the list; contact the vendor for a sample; and have a floor mat fair where the nursing staff can see them, walk on them, move them, and select one.

For those of you already using floor mats but experiencing issues with reliable use, I suggest conducting floor mat rounds on your unit. During my rounds with nurses, we together reviewed patients on the units who had a floor mat included in the care plan, when to the room to see that the floor mat was down. Often the floor mat was on the floor but needed placement adjustment – such as relocating the mat to protect the head and the torso, not the feet. Sometimes we found patients that should have a floor mat, but it was not present. We then went to find one – to storage or supply area – got the floor mat. Yes, we joyfully placed the floor mat together at the patient’s bedside. Do inspect your floor mats. If the beveled edges are curling or cracking, make sure they are replaced. All efforts to protect patients from injury are a team effort.

I also hope this information is helpful to you. I have so much confidence that you will be successful, to integrate floor mats into your fall injury prevention program. And if you are using them already, to expand your use and increase floor mat use to protect your patients from experiencing a serious fall-related injury while in your care. You know some patients are going to get up from bed without you. If they do and start to fall, I know you would rather a patient fall onto a floor mat and protect them from injury. Creating a safe environment to protect from injury is our responsibility and an essential component for fall injury prevention programs.

Please contact me if I can be of assistance to you.

Thank you,

Pat

Patricia A. Quigley, PhD, APRN, CRRN, FAAN, FAANP, FARN

Nurse Consultant

030621

References

Boushon, B., Nielsen, G., Quigley, P., Rutherford, P., Taylor, J., Shannon, D., & Rita, S.

(2012). How-to guide: Reducing patient injuries from falls. Cambridge, MA: Institute for

Healthcare Improvement.

Ganz, D.A., Huang, C., Saliba, D., Shier, V., Berlowitz, D., Lukas, C.V., .. . Neumann,

1. (2013). Preventing falls in hospitals: A toolkit for improving quality of care.

Rockville, MD: Agency for Healthcare Research and Quality. AHRQ Publication No.

13-0015-EF.

Gustavsson, J., Bonander, C., Anderson, R., & Nilson, F. (2015). Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results. Injury Prevention 21(5), 320-4.

National Center for Patient Safety (NCPS). (2014). Falls Toolkit. Floor Mat Resource and Implementation Guide. Washington, DC: Author. Available: https://www.patientsafety.va.gov/professionals/onthejob/falls.asp

Oliver, D., Healey, F., Haines, T. (2010) Preventing falls and fall-related injuries in hospitals. Clinics in Geriatric Medicine, 26:645-692

Pearson, K.B., & Coburn, A.F. (2011, January). Evidence-based fall prevention in critical access hospitals. Policy Brief #24. The Flex Monitoring Program. ResearchGate. Available: https://www.researchgate.net/publication/261097465_Evidence-based_falls_prevention_in_Critical_Access_Hospitals