Catching Quality Before It Falls: Preventing Falls and Injuries in the Adult Emergency Department.

PROBLEM: Although hospital falls and injuries are a significant patient safety concern, research is limited regarding falls and injuries in the emergency department. The purpose of this quality improvement project is to identify and implement evidence-based interventions to prevent patient falls and injuries in the emergency department. METHODS: Literature was reviewed to identify best practices for fall prevention in the emergency department. Data sources included Journal Storage, PubMed, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Database of Systematic Reviews. A retrospective chart review and root cause analysis was completed on fall-related risk reports over a 19-month period at a specific emergency department. Multifactorial fall prevention interventions were implemented in March 2017, which included nursing educational sessions, patient education handout, and high-fall-risk patient identification signs. RESULTS: Post-implementation, zero falls were sustained in April 2017. The average number of falls between April and December 2017 was 5.2 falls/month. Completion of the fall-risk assessment tool ranged between 47 to 90 percent. The patient education handout was provided up to 40 percent of the time. The use of fall risk signs outside patient rooms occurred up to 43 percent of the time. DISCUSSION: The emergency department is a unique environment with complex patient populations. Multifactorial interventions should be used to identify and prevent patient falls and injuries. Multiple change strategies and leadership support are essential to sustain changes. Future research should be conducted regarding the use of fall risk assessments and fall prevention strategies specific to the emergency department.

"Add It to the Parking Lot": Safe Patient Handling and Mobility in the Emergency Department.

Nelson and Baptiste noted that a standard approach to safe patient handling and mobility (SPHM) cannot be generalized to all patient care areas because the unique, high-risk tasks of each area require specific intervention. Matching the SPHM program to the setting, tasks, and roles is important in developing a program that will prevent harm. However, there is little evidence related to the use of SPHM programs in nontraditional care environments, such as emergency departments (EDs). A such, there is no standardized method for training ED nurses in safe patient handling. An SPHM challenge unique to the ED is extricating patients out of vehicles. There are several ways to extricate patients from vehicles, with some requiring more resources, people, and equipment than others. These resources vary depending on the patient's level of activity and acuity. The purpose of this article is to articulate the importance of SPHM programs in EDs and the unique challenges and workflows that complicate implementation in this chaotic environment through a review of manual and equipment-assisted methods of extricating patients from the vehicle.