Using Family, Patient Engagement to Improve Patient Safety Efforts

Driving family and patient engagement in hospital patient safety efforts, like reducing falls, can have positive results, according to a study published in JAMA Network Open.

Specifically, a patient-centered fall prevention program yielded a 15 percent reduction in patient falls before and after implementation of the program, the researchers concluded.

Patient falls are a serious patient safety issue, with falls resulting in hip fractures, bruising, or even death. Falls can result in a number of problems, not least of which include poor medical outcomes, a poor patient experience, and increased healthcare costs. After all, the researchers pointed out, most hospital falls are preventable, meaning the Centers for Medicare & Medicaid Services (CMS) won’t reimburse for any treatment needed to address the fall.

Some research has shown a multi-pronged strategy can help reduce the rate of hospital patient falls. The researchers previously developed a tool kit, titled the Fall Tailoring Interventions for Patient Safety (TIPS) tool kit, which outlined nurse-led bedside strategies to prevent a patient from falling in the hospital setting.

But although TIPS result in a 25 percent decrease in patient falls, the researchers observed little decline in patient injuries due to falls.

“A follow-up case-control study suggested that falls within the intervention units were largely attributable to patients’ nonadherence to their fall-prevention plan and that further strategies are needed for engaging patients in the 3-step fall-prevention process during hospitalization,” the researchers explained.

As part of this most recent study, the team partnered with other healthcare leaders in the area to determine how to make TIPS more patient- and family-centered, engaging non-clinical stakeholders in fall prevention and reduction. The tool was displayed as a laminated post, a tool kit within the EHR, and in a bedside screen display, the researchers said.

That approach, which leaned more heavily on patient engagement and education strategies than the original TIPS tool kit, yielded better results. The intervention resulted in a 15 percent reduction in overall patient falls, as well as a 34 percent reduction in patient falls that resulted in injury.

These findings underscore the importance of patient engagement in patient safety initiatives, the researchers said. The variable in this iteration of the TIPS tool kit was the patient and family involvement in patient safety efforts.

“Patients are prepared to carry out specific and actionable interventions recommended by health care professionals when they are engaged in the process,” the team said. “As shown in previous work, both high-tech and low-tech tools can facilitate patient engagement in the fall-prevention plan. Patient engagement in the 3-step fall-prevention process results in a partnership between the patient and care team and strengthens the Fall TIPS tool kit intervention.”

Central to that effort was involving the patient in the fall risk assessment and development of the fall prevention action plan, the researchers explained. This step activated the patient in her own patient safety efforts, empowered her as a member of the care team, and resulted in her seeing a larger stake in her own fall risk.

And as a result, the researchers specifically saw a dip in falls in younger patients.

“Interviews with younger patients revealed that they did not believe that they were at risk for falls in the hospital, especially those who were independent at home,” the researchers said. “We refined the tool kit to improve patient engagement in the 3-step fall-prevention process.”

These findings come as healthcare experts increasingly see patient safety, like patient fall rates, as not just a clinical quality issue but as a patient engagement and experience issue. Just as providers work to engage patients in chronic disease management and remote monitoring programs, they are recognize the role a patient can play in her own outcomes in the hospital setting.

According to Gary Yates, MD, a strategic partner at patient experience consulting firm Press Ganey, patients are important partners in the push for better safety.

“The organization needs to invite patients and families into the conversation to help create an environment where they can truly be partners,” Yates stated in a past interview. “Organizations can provide education on ways that patients can participate and encourage them to speak up, understanding that some patients and families may be reticent to speak up or ask questions to providers.”