R E V I E W S & A N A LY S E S Falls in Radiology: Establishing a Unit-Specific Prevention Program ABSTRACT INTRODUCTION As healthcare facilities continually From 2005 through 2009, the number of Serious Events involving falls (i.e., falls look to strengthen their falls preven- resulting in patient injuries and requiring subsequent treatment) reported to the Penn- tion programs and respond to the sylvania Patient Safety Authority averaged about 1,300 a year.1 Patients in a care unit high-risk problem of persistent patient where a falls risk assessment has been performed and a high risk for falls identified falls, evaluation of falls events outside are protected by standard falls prevention strategies prescribed by nursing, such as low direct patient care, such as in radiology, beds, bed exit alarms, call bells, and floor mats. Patients transported to the radiology may provide additional opportuni- suite are not protected. In 2009, falls accounted for 10% of all Serious Events reported ties to address this organizationwide to the Authority and made up 8% of all events reported in radiology departments challenge. Analysis of reports to the statewide. The data suggests that although radiology staff may take precautions with Pennsylvania Patient Safety Authority in patients who obviously need assistance, radiologic technologists were less likely to 2009 revealed 602 falls events in radi- evaluate a patient’s ability to withstand radiologic positioning modes when a falls risk ology departments. Falls experienced is less apparent. by both inpatients and outpatients Evidence-based reviews have established that patients with a history of recent falls and throughout the department were com- with impaired mobility are predisposed to and at increased risk for falling.2 Patients monly associated with syncope; slips, with impaired mobility include those who require assistive ambulation devices, those trips, and loss of balance; and medi- who take psychoactive medications including sedatives, and those of advanced age with cation-related effects. Falls were from its associated frailties. Falls can also result from loss of consciousness due to syncope stretchers, procedure tables, or stools, from various factors.3 The physical design of the radiology department may create including during transfers. Many of the hazards that can cause patients to slip and trip.4 A unit-specific analysis of falls is an patients had affirmed to a radiologic opportunity to reduce the number and severity of injuries sustained within radiology technologist their ability to transfer departments, and implementation of risk reduction strategies could reduce the number either independently or with some assis- of falls overall and injury-related falls organizationwide. tance from a wheelchair or stretcher to an examination table, or to stand for RADIOLOGY FALLS REPORTED TO THE AUTHORITY the duration of an upright examina- tion. In these instances, technologists In 2009, 602 falls events were reported to the Authority from radiologic service areas, usually relied on verbal and nonverbal including breast health services, computed tomography (CT), diagnostic and interven- patient cues to assess the patient’s abil- tional radiology, magnetic resonance imaging (MRI), nuclear medicine, and ultrasound. ity to meet the physical demands of an Just over half the reported falls events were associated with the following issues: impending diagnostic study. However, — Syncope most of the reports described situations — Slips, trips, and loss of balance in which patient risks were not apparent, — Falls from stretchers, procedure tables, or stools, including transfer mishaps and radiology staff did not anticipate — Medication-related effects a fall. The adoption of standardized strategies to reduce falls risk—including In 2009, 5% of all reported falls in radiology departments were reported as Serious ongoing education about safe patient Events, compared to 4% of reported Serious Events involving falls from all depart- handling practices, nurse to radiologic ments. The demographics of the patients who fell in radiology were consistent with the technologist handoff communications, population served by hospital radiology departments, including ambulatory services and use of an assessment tool or check- with breast health services for women. Fifty-four percent of falls in radiology involved list—helps to identify patient risk factors patients age 65 or younger, compared to 44% of all reported falls; female patients rep- and could mitigate injurious patient falls resented 54% of radiology falls, compared to 50% of all reported falls. in radiology departments. (Pa Patient About half of reported Serious Events involving falls occurred in combined services, Saf Advis 2011 Mar;8[1]:12-7.) about a quarter in the angiography and special procedures service areas, and 10% in ultrasound areas; events were relatively evenly distributed throughout the other service areas. (See Figure.) Of the reported patient injuries sustained, 39% included fractures, 42% of which were of the hip; 52% included lacerations, 69% of which were of the head; and 6% included serious head traumas, such as subdural and subarachnoid hem- orrhages and frontal and parietal hemorrhages. Page 12 Pennsylvania Patient Safety Advisory Vol. 8, No. 1—March 2011 ©2011 Pennsylvania Patient Safety Authority Syncope Figure. Radiology Service Areas Reporting Serious Events to the Pennsylvania Patient Safety Authority, 2009 Patients in radiology service areas may be predisposed to syncopal or near-syncopal 3% 3% episodes due to factors such as fasting, blood donation, chemotherapy, and lying Magnetic resonance imaging supine. In 2009, 17% of radiology falls 23% 10% reports described syncopal events. About 3% Computed tomography half of the patients fainted or nearly 3% fainted when standing for an upright Ultrasound study (e.g., chest radiograph, mam- mogram), such as the following report Nuclear medicine describes: Diagnostic with angiography Prior to a chest x-ray, an elderly patient appeared “wobbly” but stated Combined services she could stand for the study. When 55% MS11027 Angiography/special procedures the patient stood, she passed out and was lowered to the floor by the technologist. The patient was taken to the ED [emergency department] for evaluation. Apparently the patient Slips, Trips, and Loss of patient stepped backwards, lost her bal- had just donated a unit of autolo- Balance Falls ance, and fell back, hitting her head on gous blood in advance of a planned Fifteen percent of radiology falls reports the chair before falling to the ground. operation and she had an orthostatic described patient slips, trips, or loss of Bathrooms, dressing rooms, and waiting episode. balance events. In these situations, patients rooms also were common locations for Syncope-related falls also occurred after who were able to bear weight, either falls with serious consequences. Patients insertion of an intravenous line and independently or with an assistive device, with a history of falling or at probable risk during or immediately after a breast lost their footing and fell, even with staff for falling were left alone in these areas biopsy. Although in most instances assistance. Slip and trip falls occurred and subsequently experienced fractures, radiology staff helped patients safely throughout the radiology department and lacerations, and extensive bruises. The to the floor, staff was not always close were not limited to examination rooms. following report is one example: enough or able to support falling The use of walking aids (e.g., canes, walk- An elderly patient presented to a patients. In such situations, injuries ers) contributed to several patient falls. hospital-based radiology center for commonly occurred when patients hit The failure to use such aids also contrib- x-rays of the abdomen and chest. The their head on the floor or against other uted to patient falls. In one event, a patient patient was offered assistance with objects, as in the following case: fell and hit the back of her head on the undressing and dressing but stated he A patient was standing in front of floor after attempting to walk to the bath- did not need help. Following the x-ray, an x-ray table and waved to get the room without using her cane, sustaining a the patient was in the dressing room technologist’s attention and fainted. head laceration. and yelled out. He was found on the The patient fell to her side and hit Slips, trips, or loss of balance incidents floor and stated he hurt his left arm. her head on the floor. She had been occurred in all radiologic service areas. For X-rays were obtained [and revealed] standing for approximately 10 minutes instance, in mammography, patients tended a fracture. for an upper gastrointestinal test and to fall backward on release of the compres- Loss of balance also occurred when a had been fasting. The patient became sion device as they loosened their grip on patient’s clothing or shoelaces became immediately coherent and was alert the mammography unit’s support handles, entangled in transport vehicles (e.g., and oriented; however, she sustained as exemplified in the following report: wheelchairs, carriers), medical equipment a laceration to the forehead. After mammography compression was (e.g., scales), or waiting room furnishings (For more information, see “Preventing released, the radiologic technologist and carpet. Three patients slipped on wet Syncope-Related Falls: A Clinical Study.”) told the elderly patient she could step floors, two as a result of incontinence and away from mammogram machine. The one who slipped on a small quantity of Vol. 8, No. 1—March 2011 Pennsylvania Patient Safety Advisory Page 13 ©2011 Pennsylvania Patient Safety Authority R E V I E W S & A N A LY S E S Preventing falls from procedure tables PREVENTING SYNCOPE-RELATED FALLS: A CLINICAL STUDY can be a challenge. For example, MRI examination tables have no bedrails, Peterson and Berns conducted a retrospective review of falls incidents within the clinic although it may be possible to use straps system of the University of Wisconsin Medical Foundation and found that fainting was to secure and stabilize patients. In the the single largest cause of falls. A review of incident reports revealed that the pro- pensity for falls due to fainting had increased from 21% in 2002 to 36% in 2003. A absence of stabilization, patients could clinical task force established a two-step plan to significantly reduce the annual num- incur significant injuries (e.g., traumatic ber of fainting-related falls. The plan included safe care guidelines for patients with a brain injuries) in longer falls from history of syncope and mandatory education on the management of syncopal events elevated tables.5 Caregivers also can be for all staff in areas where patients are at high risk for fainting. Staff was trained to injured when straining to prevent patient ask patients about previous fainting, and patients were encouraged to report difficul- falls. While a table is still in the lowered ties with procedures. Positive patient histories were then communicated throughout position, the technologist can verify that the clinic, including the laboratory and the radiology department. Staff monitored the patient is well situated and ready for patients for signs of syncope and informed patients not to fast for more than 12 hours the table to begin moving. The patient before laboratory testing and to drink water while fasting. Practice changes included not only must be carefully observed, drawing blood with at-risk patients in a supine position and offering juice and crack- immobilized, or secured before the table ers afterward. Implementation of the fainting prevention plan resulted in a decrease in falls rates from 36% in 2003 to 12% in 2004-2005. is moved, but he or she also must know what to expect before movement starts.6 Source: Peterson R, Berns S. Prevention and education to decrease patient falls due to syncope. J Nurs Care Qual 2006 Oct-Dec;21(4):331-4. On several occasions, a patient on a stretcher who was positioned for a pro- cedure (e.g., lateral decubitus position) against the image receptor fell between hand sanitizer. Footwear, including socks, transport stretcher, wheelchair, radiologic the receptor and the stretcher. Either the also contributed to these types of falls. procedure table, or stool. Of these events, stretcher was unlocked or, in one event, Several patients in stocking feet sustained 12% resulted in serious injury, equally a locked stretcher moved away from the fractures during transfer between a wheel- divided between hip fractures and head image receptor as a patient forcefully chair and a procedure table or stretcher, injuries. Most of the head injuries were pushed against it in repositioning. Similar as in the following report: lacerations; however, one patient suffered falls occurred when patients were trans- A patient was finishing a radiology a cerebral hemorrhage. Injuries occurred ferred from a stretcher to a procedure exam when he slipped getting off largely when patients tried to get off a table or vice versa. Although staff may the x-ray table. The radiologic tech- stretcher or table for toileting, reposition- have been in place, gaps between pro- nologist had instructed the patient ing, or transferring or when patients cedure tables and stretchers allowed for to wait while she got his wheelchair inadvertently rolled off the table. Many patient falls. closer to the table. The patient was patients fell while attempting to get up by A radiology staff was preparing to sitting at the edge of the table when moving to the foot of the stretcher, tipping transfer an elderly patient to a gur- he attempted to get off himself. it over. The following example pertains to ney. The patient turned on his right [The patient’s] slip resistant slipper a fall from a procedure table: side with two technologists present on was noted to be twisted to the side, A patient was placed on a procedure each side of him. There was a space not affording the slipper to provide table in the supine position. Her right between the x-ray table and lead maximum grip. The technologist had arm was placed out to the side in shield. Despite a technologist stand- the wheelchair between her and the preparation for peripheral insertion ing close to the patient, there was a patient and could not reach patient of a central catheter line. The nurse gap and the patient slid to the floor. in time [before he fell]. and radiologic technologist were at the The patient’s head hit a foot pedal. patient’s right side. Her right arm was Falls during repositioning also occurred as Stretcher and Examination lifted for placement of a sterile towel patients were seated upright on stools. An Table Falls as per protocol. The patient was slowly example of this is the following: Another significant cause of injury was rolled onto her left side and [fell] off the table [sustaining an] approximate A patient walked into an x-ray room patient falls from transport vehicles and for a hand x-ray. The technologist procedure tables or chairs. Twelve per- three-foot fall [to the floor]. asked the patient to sit on a stool. cent of the reports described falls from a The patient sat on the stool while the Page 14 Pennsylvania Patient Safety Advisory Vol. 8, No. 1—March 2011 ©2011 Pennsylvania Patient Safety Authority technologist turned to get film. The patient became nauseated and was or internal bleeding. Although in 75% patient tried to readjust his body on given a glass of water and was asked of these events there were minor or no the stool and slipped off, striking his to sit with her daughter while her subsequent injuries, facilities may not head on the floor. films were reviewed by the radiolo- be reimbursed for these studies; in addi- gist. She asked to go to the bathroom. tion, there may be long-term risks to the Medication-Related Effects When she was coming out of the involved patients from the additional Sedatives and medications for anxiety bathroom, she looked weak, so the radiation exposure.8 and depression can affect cognitive and technologist and the daughter went to physical function, such as blood pressure, assist her. Before they reached her, she Implement Unit-Specific Falls balance, and awareness. Four percent of went down to her knees on the floor Prevention Strategies the reported radiology falls events identi- not losing consciousness. She said she Radiologic technologists have not been fied medication as a contributing factor. was not hurt, but was weak because immune to liability lawsuits. In a survey Almost 75% of these events were related she did not eat. The patient did not of 415 radiology-related lawsuits, technolo- to the use of opiates for pain control, and want to be seen in the ED. She was gists were most often called to court in the remaining 25% were related to the very nervous about the results of her cases of patient falls. As in the reports effects of benzodiazepines used for the test and she took approximately two submitted to the Authority, technologists treatment of anxiety or claustrophobia. Valium® before the test. were found to be negligent in leaving Most patients experienced dizziness or patients unattended without properly syncope during an upright examination or PRIORITIZING FALLS securing them or in performing a study fell from a procedure table. Although most PREVENTION IN RADIOLOGY with a patient in an upright position when patients were not injured, two needed Despite efforts by healthcare facilities to the patient should have been in a horizon- follow-up CT scans for further evaluation revamp and strengthen their falls preven- tal or seated position.9 of the head and cervical spine, and one tion programs, many nonfatal injuries To minimize the chances of injuring a sustained a leg fracture. sustained in radiology departments are patient, radiologic technologists, as well Reported events that exemplify medica- caused by patient falls. The lack of medical as all radiology staff, can take the proper tion-related falls include the following: literature specific to falls in radiology care precautions when entrusted with a areas suggests that little is known about or patient’s care. Knowledge of falls A patient was asked if she had been has been done to address such occurrences prevention strategies before performing out of bed since surgery. She replied, in these care areas. Falls may result from a procedure is paramount to ensuring “Yes, this morning.” Her stretcher factors such as a patient’s cognitive state, the safety of patients in this service area. was parked next to the x-ray Bucky. prescribed medications, the physical envi- Consider the following risk-reduction The patient stood and shuffled her ronment, and infrequent staff education strategies in the implementation of a feet. She was asked, “Are you able to about recognizing patient falls risks. Careful unit-specific falls program. walk?” She said “that’s why I had review of a patient’s physical condition and the surgery; my feet are numb.” The Offer falls prevention training. Staff associated environmental factors can help patient was standing with her back education is an important component of radiology departments set priorities for to the Bucky while the radiologic falls prevention. All radiology staff who prevention by adopting strategies that can technologist was talking to her. She interact with patients, from a clerical reduce the risk of patient harm from falls. became unresponsive and started to to a clinical capacity, can participate in slide down the Bucky. The technolo- In addition to injury prevention, there are training to meet the department’s falls gist could not fully support her, and financial incentives for implementing and prevention goals. Ongoing education will lowered her to the floor and called for monitoring strategies to reduce patient keep technologists apprised of methods help. Staff responded and assisted in falls in radiology. As of October 2008, for assessing patients and identifying lifting a now coherent patient onto Medicare and some other payers may no conditions in which a modified approach the table. The patient said that it longer reimburse hospitals for the cost to examination may be needed to avoid probably happened because she hit the to treat injuries from falls if the injury patient injury. Departmental in-service button on her morphine pump, just occurred during the patient’s hospital stay sessions can offer practical training on before being brought into the room. or an outpatient visit.7 In approximately body mechanics and basic patient move- 5% of the total reported radiology falls ment techniques that promote safe patient A patient presented for an outpatient events, a postfall CT scan was needed to transfer between transport vehicles and bone scan. Following the test, the evaluate the patient and rule out fractures procedure tables. In addition, transport Vol. 8, No. 1—March 2011 Pennsylvania Patient Safety Advisory Page 15 ©2011 Pennsylvania Patient Safety Authority R E V I E W S & A N A LY S E S staff can be trained to lower stretchers — Inquire about toileting needs and to other internal care providers. The before leaving a patient unattended. assistance, especially of those patients hospital’s process for handoff communica- Assess falls risk. Although radiology with impaired gait and mobility due tion must allow for discussion of patient departments receive inpatients that have to functional deficits and those who information.10 A pretransport tool, such been assessed by nursing for falls risk, may experience drug side effects (e.g., as SBAR (Situation, Background, Assess- assessment protocols of ED-referred Valium taken for claustrophobia). ment, Recommendation),11 can be used patients and outpatients for whom — Assess the patient’s position or need by nursing and radiology to ensure that radiologic studies are ordered may not for repositioning on a transport vehi- patients who cannot be left unattended, be as standardized. Similar to prevention cle, examination table, or stool before who may be a difficult transfer, or who programs initiated in other patient care leaving the patient’s side. have experienced a fall will be safe while off settings, the development and use of a — Question the patient or family about the patient care unit. The transport form unit-specific falls risk assessment can help patient fall tendencies or behaviors. would address any falls risk issues, such as radiology staff predict and prepare for a language barriers and medication use that — Be an active participant in patient fall possibility that otherwise may have affects alertness, and any implemented falls handoff discussions. (See the section been overlooked. Consider the following prevention measures, including proper “Communicate Patient Risks.”) elements in the assessment process and footwear, recent toileting, use of a personal Involve patients and families. Patients alarm, and patient and family safety educa- in the development of an assessment tool and their families play a significant role as (also see the “Radiology Falls Risk tion. Handoff and receiving personnel collaborators in the care process; however, could jointly review the form.12 In addition, Assessment Tool,” available online at they may not always understand their http://patientsafetyauthority.org/ transport procedures can list the steps for personal risk and may refuse assistance. receipt in radiology of a patient at high EducationalTools/PatientSafetyTools/ Allowing patients and their families to Pages/home.aspx): risk for falls and the steps for return of the candidly speak with the radiology team patient, including required checkpoints of — Assess patient mobility and deter- about falls risk and tendencies allows the staff interaction. mine if the patient will need to be department to take appropriate actions to accompanied to the department, ensure their safety. Displaying a poster (e.g., Assess Environmental Safety the type of transport the patient will “Are you at risk for falling?”) in patient waiting areas and in examination rooms is Facilities can provide and encourage need, and if the patient may encoun- patients to wear footwear with slip-resistant ter fall or transfer problems. If a one way to alert patients to the most com- soles. Footwear is a safety factor that will patient is identified as at risk for falls, mon falls risks and may encourage them to require ongoing inspection; footwear that enlist patient care aids familiar with speak up about their own risk factors. has twisted on the patient’s foot or that the patient’s needs to accompany the Share event analysis results. Communica- displays worn treads can no longer protect patient and to take an active role in tion of actual and near-miss falls events and a patient and may not prevent a fall. providing transfer and positioning the factors that contributed to these events Facility policies should include a spill-con- assistance before, during, and after can be shared with radiology staff as part of trol program. Wet floors are more slippery the procedure. the falls prevention program. Investigate the than dry floors; the test of good flooring — Note any visual clues that might causes of unit-specific falls and develop cor- indicate a patient is at risk (e.g., color- is how slip resistant it remains while wet. rective interventions to prevent future falls. The slip resistance of flooring products coded identifier, ambulatory assistive devices, socks without grips, untied on a wet floor can be evaluated during the Communicate Patient Risks selection process. Environmental hazards shoelaces). Patients have fallen because of the lack in radiology may include changes in floor — Assess a patient’s pain level and of interdepartmental communication. surfaces, bold carpet patterns that obscure consider his or her physical ability to Visual identifiers, including armbands, objects, and abrupt changes in lighting withstand positioning and to follow stickers, and colored socks, can be used from bright to dim.4 Keeping patient and directions. Determine whether an to communicate falls risk; however, if the alternative approach would be safer staff traffic patterns free of equipment can radiology department is not aware of this also be a challenge in radiology. Frequent (e.g., sitting versus standing). component of the falls program, patients patient safety environmental rounds can — Review medications and incorporate transported to this area will be at risk. The be an effective way to monitor safety and a list of high-risk medications in the Joint Commission requires that hospitals assess compliance with the falls preven- assessment tool. have a process in place to receive or share tion program. Regular leadership rounds information when a patient is referred that include engaged radiology staff are an Page 16 Pennsylvania Patient Safety Advisory Vol. 8, No. 1—March 2011 ©2011 Pennsylvania Patient Safety Authority important strategy for maintaining visibil- — Complaints of headache or vomiting where a fall occurs, radiology facilities are ity of falls prevention initiatives.13 after a possible head injury to implement and follow postfall processes — Obvious signs of trauma (e.g., frac- that include appropriate medical evalua- Evaluate and Document ture, deformity, laceration, bruising, tion, documentation, and disclosure. Falls Injuries redness, swelling, point tenderness) Because patients may not remember hav- Evaluation and treatment of a potentially CONCLUSION ing fallen, information provided from injured patient may be limited when Although most injurious falls occur in radiologic technologists or other witnesses a fall occurs in offsite or independent direct patient care areas, patients can to the event can provide valuable diag- radiology centers instead of in hospital- sustain falls injuries in any location of the nostic information to the ED, especially affiliated departments. The patient may facility that provides patient care services. for mild traumatic head injuries and require further clinical workup after Radiology departments must set clear syncopal episodes. The American College assessment by the center’s radiologist or unit-specific priorities for falls prevention of Emergency Physicians has published other medical professional. Depending and implement interventions that reduce evidence-based recommendations for these on the circumstances and severity of the the likelihood of patient harm. Prevention two conditions that depend on an accurate patient’s injuries, options include contact- ideally begins before a patient leaves the patient history. Documentation by radiol- ing the referring or primary care provider patient care area, through nursing to radi- ogy staff of the following observations in to consult on the patient’s medical history ology communication of a patient’s risk the medical record can be very helpful:5,14 and the need for additional radiologic for falls. In the emergency or ambulatory studies; activating the emergency medi- setting, radiology staff can identify patient- — Distance a patient falls from a fully cal system; sending the patient to an ED, specific risk factors by using an assessment raised stretcher or procedure table and having the patient follow up with his tool or checklist and by engaging the — Loss of consciousness or her physician. Hospital-based radiol- patient and his or her family. Ongoing — Loss of memory about the event ogy departments are to follow hospital monitoring of a falls prevention program — Position when syncope occurred (e.g., policies; most facilities reported calling is essential to identifying successes and standing, sitting, reclining) the hospital’s rapid response team for problems and will help radiology profes- assistance or transporting patients to the sionals continue to prevent falls. ED for further evaluation. Regardless of NOTES 1. Pennsylvania Patient Safety Authority. 5. 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Situation, background, a neurology practice for risk of falls (an Patient Safety Listserv, National Patient assessment, and recommendation (SBAR) evidence-based review). Report of the Safety Foundation [http://www.npsf.org/ toolkit [online]. [cited 2010 Sep 2]. Avail- Quality Standards Subcommittee of the psf]. 2010 Aug 13. able from Internet: http://health.mil/ American Academy of Neurology [online]. 7. ECRI Institute. List of CMS hospital- dodpatientsafety/ProductsandServices/ 2008 Feb 5 [cited 2009 Dec 2]. Available acquired conditions expanded under Toolkits/SBAR.aspx. from Internet: http://www.guidelines. new final rule [special advisory online]. 12. HCPro. Patients can help you prevent gov/summary/summary.aspx?doc_id=129 2008 Oct [cited 2010 Sep 3]. Available falls. Brief Patient Saf 2007 Jul;1(7):4-5. 41&nbr=006655&string=assessing+AND from Internet: https://www.ecri.org/ +patients+AND+neurology+AND+practic 13. Patient safety rounds called key Documents/Patient_Safety_Center/ strategy. Healthc Risk Manag 2007 e+AND+risk+AND+falls. CMS_New_Final_Rule.pdf. Sep 29(9):106-7. 3. Peterson R, Berns S. Prevention and 8. National Cancer Institute. Cancer risks education to decrease patient falls due 14. Huff JS, Decker WW, Quinn JV, et al. from CT scan use in the US [online]. American College of Emergency Physi- to syncope. J Nurs Care Qual 2006 Oct- [cited 2010 Sep 3]. Available from Inter- Dec;21(4):331-4. cians. Clinical policy: critical issues in net: http://dceg.cancer.gov/reb/research/ the evaluation and management of adult 4. Check the slip resistance of floors to ionizing/16. patients presenting to the emergency prevent falls. Healthc Risk Manag 2005 9. Fox NM, Vanderford V. Avoiding patient department with syncope. Ann Emerg Med Jan;27(1):4-6. falls in radiology. Radiol Technol [online]. 2007 Apr;49(4):431-44. 2000 Sep [cited 2010 Jun 8]. Available Vol. 8, No. 1—March 2011 Pennsylvania Patient Safety Advisory Page 17 ©2011 Pennsylvania Patient Safety Authority PENNSYLVANIA PATIENT SAFETY ADVISORY This article is reprinted from the Pennsylvania Patient Safety Advisory, Vol. 8, No. 1—March 2011. The Advisory is a publication of the Pennsylvania Patient Safety Authority, produced by ECRI Institute and ISMP under contract to the Authority. Copyright 2011 by the Pennsylvania Patient Safety Authority. This publication may be reprinted and distributed without restriction, provided it is printed or distributed in its entirety and without alteration. Individual articles may be reprinted in their entirety and without alteration provided the source is clearly attributed. This publication is disseminated via e-mail. To subscribe, go to http://visitor.constantcontact.com/ d.jsp?m=1103390819542&p=oi. To see other articles or issues of the Advisory, visit our website at http://www.patientsafetyauthority.org. Click on “Patient Safety Advisories” in the left-hand menu bar. THE PENNSYLVANIA PATIENT SAFETY AUTHORITY AND ITS CONTRACTORS The Pennsylvania Patient Safety Authority is an independent state agency created by Act 13 of 2002, the Medical Care Availability and Reduction of Error (“Mcare”) Act. Consistent with Act 13, ECRI Institute, as contractor for the Authority, is issuing this publication to advise medical facilities of immediate changes that can be instituted to reduce Serious Events and Incidents. For more information about the Pennsylvania Patient Safety Authority, see the Authority’s An Independent Agency of the Commonwealth of Pennsylvania website at http://www.patientsafetyauthority.org. ECRI Institute, a nonprofit organization, dedicates itself to bringing the discipline of applied scientific research in healthcare to uncover the best approaches to improving patient care. As pioneers in this science for nearly 40 years, ECRI Institute marries experience and independence with the objectivity of evidence-based research. More than 5,000 healthcare organizations worldwide rely on ECRI Institute’s expertise in patient safety improvement, risk and quality management, and healthcare processes, devices, procedures and drug technology. The Institute for Safe Medication Practices (ISMP) is an independent, nonprofit organization dedicated solely to medication error prevention and safe medication use. ISMP provides recommendations for the safe use of medications to the healthcare community including healthcare professionals, government agencies, accrediting organizations, and consumers. ISMP’s efforts are built on a nonpunitive approach and systems-based solutions.