Risk Management Unfortunately, it has become necessary to address the issue of falls at the healthcare facility by whom I am employed (Facility A). Recently, there has been a rash of accidents all relating to patients falling. The healthcare facility is concerned not only about the injuries to the patients, but, also about the liability issues. For this reason, the facility has taken steps to assess the risks which pertain to falling and address those issues. For the purposes here, those steps will be discussed and the way in which the facility intends to remedy the situation. Further, a review of the existing literature will be conducted to identify methods used by other healthcare facilities to address the extremely common risk of falling in a healthcare facility. Finally, the steps being taken by the healthcare facility at which I am employed (Facility A) will be compared with the valid methods of risk management discussed in the literature review.

Initially, the administration at Facility A formed a team to review all the reports submitted by facility personnel regarding each and every falling incident over the last two years. In this review, the objective was to determine if there were commonalities associated with each of the falling incidents. The team reviewed each file and determined that there were indeed commonalities, but the review also led to the determination that additional fact finding methods were necessary. This was due to the lack of information in the reports and the unorganized means by which they were completed. It was found that the contents of the reports varied significantly depending upon who did the write-up after the accident. Therefore, it was determined that every employee who had initially made the report of a particular incident would be re-interviewed to determine if additional information could be obtained. The objective of the fact finding team was to chart each accident and track the place in which the accident occurred and examine the circumstances and environment surrounding the fall.

It was determined that by identifying commonalities, a list could be made which would allow the facility to identify the types of patients who are at higher risk of falling and take appropriate measures to reduce or eliminate that risk. Further, it would allow Facility A to identify high risk physical environments as well. After, reviewing the files and interviewing those who had witnessed the accidents or those who took the initial report, the team was able to structure a chart indicating the physical environment in which the accident occurred as well as the injuries sustained, and the physical condition of the patients prior to the fall. The factors were then separated out by physical environment, original physical condition of the patient, and finally, the condition of the patient after the fall. It was thought that this information would provide an insight into the most dangerous areas of the facility with regard to falls, identify which patients were at high risk of falling, and based upon degree of injury, offer a priority list for which areas needed to be addressed first.

It was thought that the easiest issues to address would be environmental issues. For example, if the team found that an inordinate number of falls occurred while in a specific corridor, the corridor would be assessed to determine what factor was contributing to these falls. If the factor was easily identifiable, such as an unmarked step, the problem would be addressed by marking the step clearly. Additionally, the functions performed in each area were examined to determine if the function of the area made the area a higher risk environment. For example, bathrooms were assessed to determine what made them high risk areas. It was determined that it was not that the bathroom was high risk because of its physical composition, but rather because of the functions performed within the bathroom, such as bathing and using the toilet. Since it was not the situation that simply putting a handbar in the shower was the issue (it was already there) the safety factor was centered on assistance given to patients in the bathroom.

As it turned out, Facility A developed a chart of risk identifiers for each patient being admitted. The list of factors on the list addressed various issues found to have been common characteristics shared by previous falling victims. Some of the things now being reviewed are the patient's age, the medication being taken by the patient, the lucidity of the patient, the ambulatory ability of the patient, and also the patient's history with regard to falling incidents. By identifying those patients at high risk, Facility A...

Each patient's medical file is clearly marked regarding their risk of falling so that all employees who may come into contact with that patient may take appropriate precautions.
Additionally, the degree of injury was thoroughly examined and charted to identify situations which created the most harm. Again, it was found that the bathroom tended to create the greatest amount of damage to the patient as the result of a fall. Facility A concluded that it was the nature of the composition of the environment which contributed to the seriousness of the injury sustained by the patient. For sanitary reasons, the bathrooms are composed of hard surfaces such as tile, porcelain, and stainless steel. It was that these hard surfaces resulted in more serious injuries from falls. Due to contamination issues, these hard surfaces could not be replaced with softer surfaces. As a result, additional safety bars were added to each and every wall surface in the bathrooms to enable those with ambulatory issues to hold onto a bar at every stage in the bathroom (sink area, bathtub, and toilet).The bars also afforded all patients an opportunity to break a fall in the event that it became necessary.

Along with these measures, it became apparent during the review that accident reporting was also an issue. Initially, the team was going to limit its initial investigation to the written reports regarding each fall. However, after finding sketchy reports in the files, the team found it necessary to actually interview people who had knowledge of the accident. In the interest of better record keeping, and perhaps better safety initiatives, the team developed a standardized form regarding falling injuries. This form must now be filled out by any and all employees or witnesses to an accident. It is thought that by keeping better records, areas of concern will become apparent and be addressed in a timelier manner.

A review of the risk management literature available has been extremely interesting. For example, Health and Safety Executive (HSE) (2011), states that the first step in eliminating risk is to "identify the hazards." The next step is to "identify who might be harmed and how" (HSE, 2011). The third step is to "evaluate the risks and decide on precautions" (HSE, 2011). "Record your findings and implement them" is the fourth step (HSE, 2011). The last step, according to HSE, is to "review your assessment and update as necessary (2011).

Yet another source, states that both intrinsic and extrinsic factors must be taken into consideration when reviewing fall risks (Pearson and Coburn 2011). Pearson and Coburn include 'chronic illness, confusion, the use of five or more medicines, urinary incontinence, age related changes in physiology, history of falls, fear of falling, and length of stay in a medical facility' as factors influencing the risk of falling (2011).

According to Pearson and Coburn (2011), extrinsic factors also determine risk level when it comes to falls. Included among extrinsic issues are "factors related to the physical environment such as grab bars, poor condition of floor surfaces, inadequate or improper use of assistive devices" (Pearson and Coburn, 2011). Additionally, Pearson and Coburn stress that education and communication across all levels of staff are extremely important in the prevention of falls (2011). Included in this communication and education is an extremely detailed means of reporting falling accidents (Pearson and Coburn, 2011).

A third source, Akyol (2007), agrees that the factors associated with falling risks are both intrinsic and extrinsic. Akyol, like, the previously mentioned source, strongly suggests the use of rigorous fact finding questionnaires to be completed on each patient to identify the level of fall risk associated with that patient (2007). Akyol also emphasizes the need for thorough environmental reviews to identify and correct physical issues which have a high degree of risk associated with them (2007). Like other sources, Akyol stresses that communication and education among healthcare professionals is essential to eliminating or reducing falling accidents (2007).

Upon review, it is clear that Facility A can do more to reduce the risk level of falling. Education, better communication, a more thorough patient review are among some things that can be improved upon in the risk assessment area. However, based on the literature surrounding the issue of fall related risk assessment, facility A has developed a fairly adequate means of addressing the…