The goal of this project was to decrease the fall rate and increase patient safety by developing a standardized hand off template using an acronym to help with recall and guide the interaction between RN and UAP.
Our inpatient units had exceeded the fall rate target of 2.1 per 1,000 patient days. Post-fall analysis showed that most causes were due to poor communication between registered nurses (RN) and Unlicensed assistive personnel (UAP). It was determined that the majority of UAP taking care of a patient were not aware of the interventions that the RN had set for the patient to reduce fall risk or the symptoms the patient was experiencing that might lead to a fall. Joint Commission called for a structured handoff for RNs, but the communication between RNs and UAPs was lacking.
Gutierrez and Smith (2008) found that greater than half of RNs surveyed who had a patient fall in the previous year did not communicate the fall risk level at report or during transfers. When UAP were asked what information they felt they needed to provide safe care, they ranked medical diagnosis, cognitive status, ambulation status, and fall risk among the most important (Glynn, Saint-Aine, Gosselin, Quan, Chute, 2017). Torres (2009) determined that there was a positive relationship between fall prevention and a standardized handoff communication, citing communication issues as one of the top causes of fall related events
A multidisciplinary approach was used involving management, bedside nurses, and UAP. The acronym SAFE was created to guide handoff communication between RN and UAP. A yellow pocket card was made to provide a reference. This lists symptoms that would increase risk of fall, activity and level of assist needed, fall risk interventions that the RN has determined are needed based on assessment, and effects of medications that the UAP should watch for. Fall policy changes regarding toileting were also included on the card. A schedule of communication standards was also implemented governing the time for RN to PCNA SAFE script to occur. This happens three times during a twelve-hour shift.
Over a three-month period, our fall rate dropped by 38%. The pre-implementation data shows a fall rate of 5.22. After three months of using SAFE script in RN to UAP handoff communication, our rate decreased to a rate of 2.02.
Consistent and accurate handoff reporting will highlight the areas on which RNs and UAPs need to focus to keep patients safe. By understanding criteria for fall risk and communicating expectations at the start of shift, mid-shift, and the end of shift, fall rates can be decreased. Using the acronym SAFE helps to bring attention to important patient information and helps to share the plan for interventions to decrease fall risk.