Do you recall the television commercial featuring a woman on the floor crying, “I’ve fallen, and I can’t get up”?1 Those are certainly not words you want to hear from a patient in your office. Patient safety is a high priority in healthcare settings, including your office.
Most fall prevention programs and statistics are skewed toward hospital falls and focus on the older population. However, falls can and do happen in physician’s offices, and the injuries sustained can be significant. Falls may result in fractures or injuries that affect mobility, daily activities, and quality of life. In 2022, CAP members reported 11 falls within their office settings, with eight of these falls serious enough to require medical treatment. Nine of the 11 falls occurred inside the exam room.
In all medical settings, slips, trips, and falls pose a significant risk to patient safety.2 Since we know falls are a risk, a fall prevention strategy should be included in the patient safety plan for all medical offices and ambulatory settings.2 Policies and procedures should include patient monitoring, exam room and general office safety, and staff education. “Interventions targeting multiple fall risk factors can reduce fall rates by 30–40%.”3 Staff training should highlight the three most common circumstances leading to falls: transferring to and from wheelchairs; immediately following venipuncture; and while patients are unattended on exam tables.2
The Centers for Disease Control (CDC) created Stopping Elderly Accidents, Deaths, & Injuries (STEADI), a fall prevention program for outpatient settings focusing on the older adult population. Healthcare providers can implement the three core elements of STEADI in an office setting: screening, assessing, and intervening, to reduce fall risk. STEADI offers these resources:4
The Coordinated Care Plan to Prevent Older Adult Falls
Evaluation Guide for Older Adult Clinical Fall Prevention Programs
PowerPoint training presentation for clinic staff on using the STEADI initiative to prevent falls: STEADI Our Staff for Fall Prevention
Along with training staff, there are other strategies you can put in place to improve safety in your office. Checking the environment of the office for hazards is a good place to start. ECRI (Emergency Care Research Institute) recommends environmental safety checks and risk reduction strategies for, but not limited to, the following areas:5
Exam Room Safety:
- Provide sturdy chairs with armrests. Do not provide chairs with wheels in or outside of the exam room
- Do not sit patients on the exam table while awaiting the physician and avoid high exam tables
- Provide a sturdy stepstool to get onto the exam table
- Allow a family member to accompany a patient to the exam room if identified as a fall risk
- Do not have sharp corners in the exam room
- Monitor patients after injections or venipuncture
- Remove all clutter from the exam room
Waiting Room, Bathroom, and Hallway Safety:
- Keep free of clutter
- Arrange furniture so it does not interfere with the traffic flow
- Ensure no equipment is blocking the hallways and/or doorway entries
- Provide call bells and safety bars in patient restrooms
Office practices should ensure they follow the Americans with Disabilities Act (ADA) requirements which can be found at this link:6 https://www.ada.gov/resources/medical-care-mobility/
Laws surrounding injuries sustained from falls in a medical office or surrounding area are intricate and complex. Falls may result in a premises liability claim against the property owner; in other cases, they may result in a medical malpractice case against the physician or practice. After a patient fall, it is imperative to complete a thorough investigation of the incident. The investigations should include the contexts surrounding the fall, witness statements, photos of the areas—including equipment involved, event reports, fall-focused medical exam, and thorough documentation. CAP recommends you notify your general liability carrier and your professional liability carrier if a fall occurs in your practice or the surrounding area. These entities can provide specific guidance on investigations and adverse event management.
Key Takeaways
- Establish fall prevention strategies and patient safety plans and incorporate them into your policies and procedures
- Identify factors in your practice that pose a risk to your patients
- Educate/train staff on fall prevention, risk identification, and fall management
- Establish clear procedures for fall investigations
In summary, to reduce the risk of a fall in your practice, be sure a component of your practice management plan includes a fall prevention strategy to ensure patient safety.
Your CAP Senior Risk and Patient Safety Specialist can be reached at CAP’s Risk Management Hotline (800)252-0555 to answer any questions and provide resources to help with preventing falls in your practice.
Rikki Valade is a Senior Risk & Patient Safety Specialist. Questions or comments related to this article should be directed to RValade@CAPphysicians.com.
References
1Wikipedia 2023; LifeCall television commercial, 1989, Actress Edith Fore spoke the catchphrase.
2Summey-Lowman, Rebecca. “Slips, Trips, and Falls in the Outpatient Setting: Strategies to Prevent and Address Patient Injury at Medical Offices.” Curi-Advisory Risk Solution Experts. January 13, 2022. https://curi.com/news/slips-trips-and-falls-in-the-outpatient-setting-k….
3Jones, Taylor S., Tista S. Ghosh, Kimberley Horn, Jane Smith, and Richard Vogt. "Primary Care Physicians Perceptions and Practices regarding Fall Prevention in Adults 65 and over, Accident Analysis & Prevention." Science Direct 43, no. 5 (2011): 1605-1609. Accessed August 24, 2023. https://doi.org/10.1016/j.aap.2011.03.013.
4STEADI-Older Adult Fall Prevention. “CDC” Centers for Disease Control and Prevention. June 23, 2021. https://www.cdc.gov/steadi/outpatient-care.html.
5“Physician Practice ENews.” ECRI. Emergency Care Research Institute. March 15, 2022. https://www.erci.org/components/physicianPracticeENews/Pages/Phys031522….
6Access to Medical Care for Individuals with Mobility Disabilities. June 26, 2020. https:///www.ada.gov/resources/medical-care-mobility/