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The number of patients who have fallen at Wake Medical Center has tumbled since the facility began using a videotape to educate patients about the dangers of falling.

Last year, patient falls decreased 17% from 1995, said Jeannie Sedwick, director of risk management at Wake Medical Center.

The videotape, which was filmed and edited by a local production company using hospital staffers as actors, is shown in multiple runs each day over the medical center's in-house patient education channel.

Upon admission, patients and family members are given a letter that gives showtimes for the nine-minute video and outlines responsibilities they have in preventing falls.

The production was completed in July 1994, just in time for a difficult year for the hospital in terms of falls. "1995 was just not a good year for us as far as the number of falls," Ms. Sedwick acknowledged.

"We had a significant increase. But '96 was just as significant with a decrease."

None of the falls in either year resulted in serious injury, she said.

The video grew out of the work of the hospital's Quality Improvement Task Force, formed specifically to reduce the number of falls by patients. Ms. Sedwick provided the group with data on where falls occurred, causes, claim costs and other information. A review of the protocol in place at the time to prevent falls revealed several problems.

It was determined, among other things, that many falls occurred because patients were trying to perform some tasks themselves instead of using call buttons to summon assistance.

In addition, it became clear that patients didn't understand the risk of falling in the hospital and visitors were somewhat cavalier about lowering side rails on patients' beds.

Ms. Sedwick used data that showed the financial impact of claims from falls to justify a $12,000 allocation to produce the video.

The task force wrote a script outline and had the production company produce the final version in English and Spanish.

A generic version that did not include the name of the hospital in the film was produced and the hospital is considering marketing that version.

The final product is a professional-looking film that answers the task force's concerns on matters such as when patients should use the call button.

Patients, of course, aren't the only ones who are at risk of greeting the floor at the hospital. Visitors also have accidents.

The number of falls by visitors have also slid because of loss control measures, Ms. Sedwick said.

"Anytime you have a public area with people moving about 24 hours a day, seven days a week, you have the opportunity for people to have accidents," said Ms. Sedwick.

A review of several years of data showed that most falls were attributable to unsafe floor conditions. Most falls, for example, were in areas that were not carpeted.

In a pilot project, an area in one nursing unit was carpeted so falls under those conditions could be monitored.

When falls were eliminated in that area, the hospital placed carpeting in common areas throughout the facility or earmarked those spots for carpeting as renovations are made.

Other changes involved using more mats at entrances during inclement weather, moving major floor stripping and waxing to the night shift when fewer visitors are at the hospital and purchasing additional "wet floor" signs to alert visitors to floor conditions.

As a result of the changes, falls by visitors plummeted by 41% in 1996.