Abstract 3487: Back To Basics: A Revised Approach To Fall Prevention In The Right Brain CVA / TBI Patient

Abstract

Background and Purpose: In December 2009, Mercy Medical Center’s Acute Inpatient Rehabilitation unit suffered an unprecedented rise in the number of patient falls to an unacceptable level of 17.3%. The national benchmark for falls on an acute rehabilitation unit is 8-10%. Of the 10 patients that had fallen, 9 had been admitted for post CVA rehabilitation, and of that number, 7 of them had a right brain sided injury. This caused us to question what it was that made this particular patient population so susceptible to falling. We looked into what effect on behavior a brain injury would cause. Based upon the area that was affected, either right or left brain, there were definite behaviors that would characterize the patients in either category. Left brain injured patients have physical deficits on the right side of their bodies, they may have speech or swallowing disorders and because of disorganized thinking they act very slow and cautiously when approaching tasks. They are the type of patient that needs constant feedback to participate in rehabilitation therapies, so they do not constitute a higher then normal fall risk. The patient with a right sided brain injury has left sided physical impairments, poor impulse control, spatial-perception difficulties and is more prone to having left body sided “neglect” where they are not aware of anything on their left side¼including their own body. This type of patient is at an exceptionally high risk for falling. Method: Based upon the behavioral characteristics of the right brain injured patient, we developed a new safety program for all right brain injured patients, whether from a traumatic brain injury or a CVA. An immediate staff inservice was initiated on how a brain injury affects behavior. In addition to our usual hourly rounding, bed and chair alarms became mandatory for these patients to alert the staff that the patient is trying to get up unassisted, they wear a different color of slipper sock to differentiate them from the other patients at a glance, their “falling star” fall risk star room sticker now has a “Happy Face” drawn on it. As an added benefit all of these interventions, with the exception of the chair alarms, did not cost the unit anything extra to implement. Results: By identifying these right CVA patients as being at exceptionally high risk for falls upon admission, making it easy to differentiate them from the other rehabilitation patients and initiating our new fall prevention program, our falls have decreased significantly in this patient population, down 27% in January 2010. Conclusion: A focused approach to fall prevention based upon behavioral characteristics of the right brain injured CVA patient has been highly successful in reducing the number of patient falls in our acute inpatient rehabilitation unit for this particular patient population.