"Every time they come in, first thing is you have to talk to them about fall prevention and how to call for assistance for getting out of the bed," says Hariel. "We encouraged family members to stay with the patients, and identified high-risk patients and placed them closer to the nurses' station."
The initiative to reduce falls took shape gradually and was a learning process, especially as many of the methods implemented to prevent falls came from staff input during reviews of previous falls-Hariel and his team conducted training with the entire unit every time a fall occurred.
"We learned a lot of things that way, by getting their feedback," says Hariel. Call lights became high priority, and conducting hourly rounds for high-risk patients became routine. "We also found out that we had some rolling chairs for the nurses that sometimes found their way into patient rooms, and obviously removed those," he says.
The organization installed new bed alarms and provided education about those alarms, particularly for nursing assistants who weren't entirely sure how to turn the alarms back on or adjust them when patients got back into bed. That education was made a part of the annual competency training.
Despite initial staff resistance, they became the well of knowledge and ideas for positive change.
Hariel emphasizes the importance of staff feedback, as many of the initiatives implemented came directly from the staff. "They take care of the patients, they're with them all the time, so they had a lot of great ideas," he says.
"Staff is always somewhat resistant to change at first," says Hariel. "But once we put out a chart that was updated every month, after a couple months when it was clear the rate was really going down, and they were really improving and it could really be done, things changed."