Little known is one of the University of Nebraska Medical Center’s (UNMC) patient safety project: CAPTURE = Collaboration and Proactive Teamwork Used to Reduce (CAPTURE) Falls Project. I have known about this program since it started 10 years ago. I found and searched their website frequently to keep an eye out for their resources and publications. However, I believe there are many clinicians among fall prevention programs who are not familiar with this the many resources they have provided. So, I am delighted to share about CAPTURE Falls with you.
In 2012, three interprofessional in Omaha, Nebraska teams joined together to create and implement a safe practice inpatient fall risk reduction initiative embraced by a culture of safety, hospital boards of directors, and hospital administration. Purposed to improve fall prevention programs, they embrace teamwork and learning. Their project was first funded by grants from the Agency for Healthcare Research and Quality (AHRQ) and the Nebraska Department of Health and Human Services, Division of Public Health, the Nebraska Office of Rural Health Flexibility Program, and University of Nebraska Medical Center College of Medicine Summer Research Scholarships. Within the first two years, they established an interdisciplinary research team from four organizations: UNMC (the largest membership group), University of Nebraska Omaha Center for Collaboration Science, Nebraska Medicine, and Methodist Hospital. And their work began, focusing mostly with critical access hospitals (CAHs).
They launched their program with CAHs with the foundational concepts that the etiology of falls is multifactorial, requiring a multifactorial/inter-professional approach for prevention, an interprofessional team (vs. nursing only strategy), and use of benchmarks are associated with sustained improvement; and, effective teams are the fundamental structures for learning in organizations. With committed focus on effective teamwork, they implemented TeamSTEPPSTM to most of these facilities, integrating clinical fall risk reduction skills with teamwork skills, detailed here at CAPTURE.
8 Rights of Fall Risk Reduction
In 2016, the CAPTURE Falls Project was instructing hospital staff about the 8 “rights of fall risk reduction”
The 8 rights are:
- Right Frame of References: Why do patients fall? System factors, Patient factors, Biomechanical factors
- Right Team: Core, Coordinating, Contingency Teams
- Coordination of Program
- Risk Assessment
- Event Reporting / Learning Systems
- Response to a fall… Post Fall Huddle
To learn about each of these 8 rights, a power point presentation is available at: CAPTURE Falls: The Eight “Rights” of Fall Risk Reduction
To highlight their recommendations, they addressed fall reduction as a program that must involve three interdisciplinary teams – the core direct care clinical team, a contingency team who manages emergent events and conducts the post fall huddle, and a coordinating or oversight team to monitor program implementation and outcomes towards scorecard and organizational goals (Jones, et al., 2019, p. 3). Also, they assert that a sound validated tool with psychometric properties – an assessment tool, not a screening tool – should be used, just as I do. I encourage to review this presentation on the link above.
Like the VA’s National Center for Patient Safety’s (NCPS) National Falls Toolkit Organizational Assessment Tool (NCPS, 2016), the CAPTURE Falls Project has an organizational assessment tool or scorecard, when completed by the team identifies program gaps, barriers to innovation, tasks for reinvention, resources available, proposed outcome, responsible parties and timeframe. From this analysis, a strategic action plan will guide program enhancement and redesign.
CAPTURE Educational Resources
Over the years, they have conducted research, offered educational webinars, and created a library of tools and video resources available to you. I have highlighted these resources through my work with the AHA Health Research and Education Trust Hospital Innovation and Improvement Network (HRET HIIN) to give them national recognition, and now, I share these with you.
Please visit this resource inventory: Tools and Mobility Training Videos.
Many tools are available for your use, such as fall risk reduction team tools, post fall huddle tools, mobility assessment tools, nursing assessment and patient education tools, and more.
The many educational videos are mobility training videos. All these videos are great. The two that I use most widely are Gait Belt Usage and Falls with Assistance to the Floor.
I recommend integrating these video training programs into your nursing safe mobility and fall prevention education programs.
Application of Practice: Gait Belt and Assisted Falls Training Videos
Just this week, I was speaking with an interdisciplinary fall prevention committee, whose falls are on the rise. I was asked a question by a nurse about use of gait belts by nurses, who then shared that their nurses did not use gait belts at all. Their rehabilitation therapists used gait belts in their practice, but nurses did not. This one question by one nurse created an opportunity for me to share the importance of continuity of care, which includes safe assisted mobility techniques among nurses and physical therapists. I also shared that gait belts are one of the interventions included in safe patient handling and mobility programs for all clinicians, not just rehabilitation therapists. While physical and occupational therapists see a subset of all patients that nurses care for, there are many patients that nurses mobilize that require gait belts and contact guard assist for assisted transfers and mobility — patients with balance and gait issues, orthostasis, syncope and other mobility coordination deficits. Then, I shared these very two CAPTURE Training Programs with the members of their falls team: Gait Belt Usage and Falls with Assistance to the Floor. I continued to share with colleagues, as I am sharing with you, about a 2019 research study published by the CAPTURE Falls Team Project: Venema, et al, (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: An observational study. BMC Geriatrics, 19: 348. Available here
The purpose of this study was to identify risk factors for unassisted and injurious falls in rural hospitals. Analyzing seventeen rural hospitals’ reported 353 falls over two years, the falls were categorized falls by type (assisted vs. unassisted) and outcome (injurious vs. non-injurious). I encourage you to read this study. What they found from their analysis was that the “odds of falling unassisted was 2.55 times greater for a patient aged ≥65 than < 65 (95% confidence interval [CI] = 1.30-5.03); 3.70 times greater for a patient with cognitive impairment than without (95% CI = 2.06-6.63), and 6.97 times greater if a gait belt was not identified as an intervention for a patient than if it was identified (95% CI = 3.75-12.94)” (Venema, 2019, p. 1)
The odd of a fall that resulted in injury revealed that, “with all other factors being equal, the odds of an injurious fallswas 2.55 times greater for a patient ≥65 than < 65 (95% CI = 1.32-4.94), 2.48 times greater if a fall occurred in the bathroom vs other locations (95% CI = 1.41-4.36); and, 3.65 times greater if the fall occurred when hands-on assistance was provided without a gait belt, compared to when hands-on assistance with a gait belt (95% CI = 1.34-9.97).” Venema, 2019, p. 1)
Again, to emphasize the major to patient outcome findings revealed that when ambulating a patient using a gait belt as an intervention decreased the odds of patients falling unassisted, and that during an assisted fall, the gait belt decreased the odds of an injury.
These findings from this study changed my practice. This study provided evidence that indeed, use of gait belts were/are protective. As a result of this study, I added gait belts to my list in interventions to protect patients from injury when they fall, because the patient was assisted during the fall descent. Still to be researched is the risk of injuries to our clinical staff while assisting a patient during a fall, with and without a gait belt.
I hope that you will access the resources that I shared in this message, and that this message provides evidence to change to your practice. I hope that you will use the CAPTURE training videos to teach your staff about use of gait belts and how to assist a patient during a fall, in this care, a fall while standing. I know this information changed the practice of the nurse who asked me about gait belts!
Thank you for reading my message. I welcome your comments. I would love to hear back from you.
All my best,
Jones, K.J., & Snide, J. (2016) CAPTURE Falls: The eight “rights” of fall risk reduction. Located: CAPTURE Falls: The Eight “Rights” of Fall Risk Reduction
VHA. National Center for Patient Safety, Department of Veterans Affairs. (2016). Injurious fall prevention organizational self-assessment questionnaire. Available at https://www.patientsafety.va.gov/professionals/onthejob/falls.asp
Venema, D.,M. Skinner, A.M., Nailon, R., Conley, D., High, R., & Jones, K.J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: An observational study. BMC Geriatrics, 19: 348.