Minnesota Hospital Association Resources
Safe from Falls Roadmaps
Special Focus: Behavioral Health Units
Over the last year, the unexpected and unprecedented impact of the COVID-19 pandemic has generated our resiliency and resolve to strengthen prevention, protection and support efforts for each other, our families, communities and clinical institutions. This resiliency and resolve remains visible in Curbell Medical’s depth and breadth of national and international influence across hospitals, healthcare systems, and post-acute care settings to implement leading edge population-based technology needed in fall prevention programs.
Curbell Medical is also a resource to you for leading edge interactive nurse call systems and movement sensor technology — all to help you expand your population-based fall and fall injury prevention toolkits, such as those with dementia or spinal cord injury. One of the most difficult populations is behavioral health patients. Many technology solutions in your fall prevention program toolkits are contra-indicated for behavioral health units because of the risk to self-harm or harm to others. The Minnesota Hospital Association (MHA) realized their hospitals’ increased patient falls in acute care and behavioral health units and the need for tools to help their organizations. I have previously introduced to MHA’s toolkit to improve bathroom environments to reduce falls.
In brief, for over 10 years, MHA has lead fall program redesign for hospitals and healthcare systems through their development, implementation and evaluation of Falls Road Maps. Their road maps provide hospitals and healthcare systems a structured approach to implement and monitor key program attributes that are evidence-based recommendations and standards for fall prevention programs that align process improvements with quality outcomes.
A tiered framework of fundamental and advanced strategies are detailed based on the evidence, guidance from professional organizations, and regulatory agencies. Fundamental strategies are those that all organizations should have in place; and if not, should be prioritized for implementation. Advanced strategies are recommended above and beyond the fundamental strategies when program outcomes are not improving. Within each road map linked resources are available to help with implementation of best practices.
Two falls road maps available to you are the Falls Road Map located here and the Behavioral Health Falls Road Map located here. Other organizations have developed hospital fall prevention toolkits (the VA and AHRQ), but only MHA has developed a fall prevention toolkit for Behavioral Health Units. Thus, my special focus for you is the Behavioral Health Falls Road Map. As you read through the below examples of this tool, you will realize the alignment with best practice recommendations to reduce preventable falls (accidental and anticipated physiological falls), create a safe environment, and adding precision to your program implementation and evaluation, again, specific for Behavioral Health Units and Patients:
- Build and expand infrastructure (p. 1-2), i.e. at the fundamental level, “ensuring mental health representation on your fall and fall injury prevention program and unit-based falls champions on mental/behavioral health units”. At the advanced level, “organizational leadership in mental behavioral health remaining appraised of innovations in non-disruptive/non-intrusive real-time surveillance technology to improve patient safety and reduce falls and fall-related injuries”
- Implement universal fall prevention strategies, all at a fundamental level (p. 2-3), i.e. “a process in place for staff to perform fall prevention checks as part of their rounding process; use of low beds and mats for appropriate patients per assessment and all patients on antithrombotics; institute “Within Arm’s Reach” with toileting and ambulation for appropriate patients per assessment”.
- Fall and fall injury prevention interventions (p. 4-5), i.e. at the fundamental level, “assess patients for injury risk on admission (fall injury history, history of hip fracture, osteoporosis, anticoagulation, head trauma, etc.); fall and injury reduction interventions are identified and implemented into the individualized care plan (Capri length pants with Velcro waist; bedside mats on safe bed exit side while patient is resting in bed. At the advanced level, comprehensive environmental assessment conducted to identify environmental injury risks in mental/behavioral units (sharp edges, sources of trauma)” (p.5)
- Reduce accidental falls — all fundamental strategies (p.5) (i.e., “ensure pant length is above the ankle; consider appropriate footwear; units assessed on regular basis for slip/trip hazards, sturdy furniture at optimal height….”
- Act on root causes of unanticipated physiological falls (p. 8).
This Road Map separately addresses and emphasizes anticipated physiological fall risks known to this population :
- Medications (antipsychotic, antidepressant, benzodiazepines, and selective serotonin re-uptake inhibitors), and
- Impaired cognition.
Fundamental and advanced strategies are detailed for each area. If missing, actions are detailed for your hospital and Behavioral Health falls team to consider for implementation.
I hope you will take the time to review both of these road maps, especially the Behavioral Health Falls Road Map, which is the only such resource for this specialty population. Examine the fit of your behavioral health program with these fundamental and advanced strategies, consider suggestions to fills those that are missing in your program, and tap into the resources included in this resource.
You can find more Minnesota Hospital Association Fall Prevention resources here.
Curbell Medical, Inc., is dedicated to assisting you and supporting your resources for fall prevention. So, I hope these resources are helpful to you and your organization.
Thank you for reading this message and in advance for sharing this information with your Fall and Injury Prevention Committee and Behavioral Health Clinical Teams.
Patricia A. Quigley, PhD, APRN, CRRN, FAAN, FAANP, FARN
Minnesota Hospital Association. (2021). Falls Road Map. Available: https://www.mnhospitals.org/Portals/0/Documents/patientsafety/Falls/Falls%20Road%20Map.pdf
Minnesota Hospital Association. (2021). Behavioral Health Falls Road Map. Available: https://www.mnhospitals.org/Portals/0/Documents/patientsafety/Falls/Behavioral%20Health%20Falls%20Road%20Map.pdf
Dr. Patricia Quigley is a Nurse Consultant, Nurse Scientist, Former Associate Director and VISN 8 Patient Safety Center of Inquiry. She is both a Clinical Nurse Specialist and a Nurse Practitioner in Rehabilitation, and her contributions to patient safety, nursing and rehabilitation are evident at a national level, with emphasis on clinical practice innovations designed to promote elders’ independence and safety. She is nationally known for her program of research in patient safety, particularly in fall prevention. The falls program research agenda continues to drive research efforts across health services and rehabilitation researchers.