J Emerg Nurs. 2020 Mar;46(2):225-232.e3. doi: 10.1016/j.jen.2019.11.010.
Falls in the emergency department pose an important challenge for patient safety. Multifactorial fall prevention bundles have been associated with a reduction in patient falls in the inpatient setting. The purpose of this project was to tailor and implement a comprehensive fall prevention bundle in our emergency department.
Fall bundle components for this intervention were selected on the basis of a review of fall prevention research and included fall risk assessment, safe ambulation, safe toileting, staff communication, early warning, and patient education. The fall risk assessment was tailored to the emergency department through an appraisal of select inpatient fall risk assessments, literature search for ED-specific fall risk factors, and a site-specific chart review, after which pertinent fall risk factors were integrated into a modified screening. Fall prevention materials that were both practical and applicable to the emergency department and facilitated patient safety along each bundle domain were selected for implementation at our site.
The tailored fall prevention bundle was championed by the interdisciplinary ED Fall Prevention Team and implemented over the course of 5 months in 1 emergency department. Education on fall prevention equipment was delivered in a peer-to-peer format, and an online module was designed to guide staff through the new fall risk assessment. The fall prevention bundle was adopted into clinical practice after staff education was completed, and the fall risk screening was merged into the electronic medical record.
ED fall prevention requires a comprehensive bundled approach, which includes a fall risk screening and multifactorial interventions that are tailored to the ED setting. Successful implementation relies on the involvement of front-line staff from the design through the delivery of the bundled fall prevention measures. Continued inquiry and innovation in ED fall prevention will help provide a safer health care environment and improve patient outcomes.
急诊科的跌倒事件对患者安全构成了重大挑战。多因素跌倒预防措施已被证明可降低住院患者的跌倒率。本项目旨在为我们的急诊科定制和实施全面的跌倒预防措施。
本干预措施的跌倒预防措施是在对跌倒预防研究进行审查的基础上选择的，包括跌倒风险评估、安全活动、安全如厕、员工沟通、早期预警和患者教育。通过评估特定于住院患者的跌倒风险评估、针对 ED 特定跌倒风险因素的文献检索以及特定于地点的图表审查，对跌倒风险评估进行了调整，之后将相关的跌倒风险因素纳入修改后的筛查中。选择了实用且适用于急诊科并能在每个预防措施领域促进患者安全的跌倒预防材料，以在我们的地点实施。
该量身定制的跌倒预防措施得到了跨学科急诊科跌倒预防团队的支持，并在 1 个急诊科实施了 5 个月。以同伴对同伴的形式提供了关于跌倒预防设备的教育，并设计了一个在线模块来指导员工完成新的跌倒风险评估。在完成员工教育后，将跌倒预防措施纳入临床实践，将跌倒风险筛查合并到电子病历中。
ED 跌倒预防需要全面的综合措施，包括针对 ED 环境量身定制的跌倒风险筛查和多因素干预措施。成功实施依赖于一线员工从设计到实施预防措施的参与。ED 跌倒预防的持续研究和创新将有助于提供更安全的医疗环境并改善患者的预后。
