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New Sentinel Event Alert Focuses on Preventing Patient Falls
Preventing patient falls and fall-related injuries is the focus of the new Sentinel Event Alert: Issue 55 released by The Joint Commission.
The new alert examines the contributing factors to patient falls and includes suggested solutions to be implemented by health care organizations to help reduce patient falls and falls with injury.
An analysis of falls with injury reported to The Joint Commission Sentinel Event Database from January 2009 through October 2014 showed the most common contributing factors include:
- Inadequate assessment
- Communication failures
- Lack of adherence to protocols and safety practices
- Inadequate staff orientation, supervision, staffing levels, or skill mix
- Deficiencies in the physical environment
- Lack of leadership
The suggested actions in the Sentinel Event Alert address all of the identified contributing factors to patient falls. Listed resources in the alert include links to toolkits and research on falls prevention, and it introduces the Joint Commission Center for Transforming Healthcare’s Preventing Falls Targeted Solutions Tool®.
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