Getting it in writing:
Getting it in writing: Every patient in the Orthopaedic Hospital formally agrees to call for help anytime they need to get out of bed, or even when they just need to reach for an object.

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Nursing Innovations

08. Prevent falls with signed patient agreements.

Janiel Wright, nurse manager at our Orthopaedic Hospital, can remember the moment when the light bulb for her creative nursing idea came on. “We’d already had a bad month with a few heartbreaking falls,” she says. “Then one of my nurses came to me and she was extremely upset.” They’d had another fall, even though the nurse had spent extra time with the patient, talking about the risks. So what, exactly, had the nurse said to her patient at the end of their falls prevention chat? Call me if you need anything.

That’s when Janiel knew it was time to get creative. And specific. Instead of simply telling patients to call for help, her team created a Patient Assistance Agreement document—and they asked each and every patient on their unit to sign it prior to receiving any medication or going into surgery. With this simple action, patients formally acknowledged that they’d call for help anytime they needed to get out of bed or even when they just needed to reach for an object.

“Talking just doesn’t have the same impact as actually signing something,” says Janiel. “Our patients took the agreement seriously, because we were taking their safety seriously.”

“We can get so caught up in our fear of offending the patient, that we miss opportunities to keep them safe.”
—Janiel Wright, Nurse Manager, Orthopaedic Hospital

Can signed patient agreements really prevent falls? The answer is an unequivocal “yes.” Since implementing Patient Assistance Agreements in August 2009, there have been only two falls at the Orthopaedic Hospital.

Involving patients, families and staff.

Before implementing the Patient Assistance Agreement, fall prevention ideas had been limited to putting highrisk patients in grippy socks or taping falling leaves to their doors. Asking all Orthopaedic patients to sign an agreement was a bold shift in falls prevention—and some worried that patients would be offended. But it was an idea whose time had come. “It’s okay to be firm with patients when it’s for their own protection,” says Janiel.

2 years, 2 falls.

After implementing Patient Assistance Agreements, the Orthopaedic Hospital went seven months without a single fall. And in the two years that the program has been in existence, there have been only two falls, one of which was an assisted fall. The agreements have been so popular and successful, that they are now being used by other units within our hospital, including the surgical post-op unit.

Committing to safety.

The prevention process doesn’t end after the agreement is signed. Patients and families are verbally reminded of their commitment throughout their hospital stay—and the agreements are posted conspicuously in patients’ rooms. Info posters with the message “Please call, don’t fall” are also hung in each room. And when a patient does call, nurses drop everything to go to their bedside. “Everyone takes ownership and commits to holding up their end of the bargain,” says Janiel. “Patients, families, staff … we all hold each other accountable.”