Development of a post-fall multidisciplinary checklist to evaluate the in-patient fall

Presented at Society of Hospital Medicine, 05/13/2011, Dallas, TX. J Hosp Med 2011;6(Suppl 2):S125. SEE ALSO: Pierce JR Jr, Kearney D, Cumbler E. Using a checklist to evaluate hospitalized patients who suffer a fall. POGOe - Portal of Geriatric Online Education; 2011 Available from: http://www.pogoe.org/productid/20749Background: Falls suffered by hospitalized patients are an important reportable event. Approximately 4 - 6 % of inpatient falls result in serious injury. Recurrent falls or delayed recognition of injury can harm patients and represents a medico-legal risk. In 2010, our tertiary-care academic medical center reviewed current practice regarding falls prevention and assessment to develop a comprehensive falls prevention program. The committee found that there was no consistent practice in the assessment by nurses or physicians of inpatients who had fallen, either for injury or for conditions which might have led to the fall. A new systematic checklist for evaluation of the hospital faller was developed by a team consisting of nursing, hospitalists, and a medical unit director. Purpose: To develop an evidence-based multi-disciplinary checklist to facilitate evaluation, implementation of secondary prevention interventions and documentation following a hospital fall. Description: The hospitalist and the general medical unit director reviewed relevant literature, consulted national experts, and drafted a multidisciplinary checklist, the UNMH Post-Fall/Huddle Tool, to be used by nurses and physicians in post-fall patient evaluation. The checklist was reviewed and revised with further input from key stakeholders including hospitalists, housestaff, and the adult Medical/Surgical Shared Governance Committee. It was implemented as part of a comprehensive falls prevention program 3 month pilot. The checklist prompts a three step process: (1) an initial 7-item assessment by nursing staff to determine factors which would necessitate immediate evaluation by cross-covering physicians versus deferring evaluation to the primary team; (2) a 5-item focused physical examination to be performed by a physician to assess the likelihood of injury and suggested diagnostic tests based on this examination; and (3) an interdisciplinary face-to-face meeting between the evaluating physician and nurse to review 7 specific possible precipitating events and implement potential interventions. The UNMH Post-Fall/Huddle Tool will be adapted into the electronic health record after pilot completion and evaluation. An educational presentation about falls and how to use the checklist was developed for residents and hospitalists. Use of the checklist was implemented in November, 2010. To date, nurses and residents report that the checklist is easy to use and that it facilitates a timely, multidisciplinary evaluation of patients who have fallen in the hospital. Conclusion: A multi-disciplinary post-fall checklist facilitates a consistent and evidence-based evaluation and treatment of patients who have fallen in the hospital