Clinical Observation: Safety & Fall Prevention

• Site conducted

  Select

• Prepared by

• Conducted on

  Date

• List names of Employees being observed

• Observer

• Total Time Observed

Environmental

• Does the clinic appear clean and free from clutter?

  Yes

  No

• Are all hallways, treatment areas, corridors, and exits free of obstruction?

  Yes

  No

• Is the floor/carpet clean, dry, and free of holes or tripping hazards?

  Yes

  No

• Is the furniture and equipment in good repair?

  Yes

  No

• Does the placement of equipment meet manufacturer's guidelines/requirements? For example, the Lifestyle cable column has a clear three-foot radius.

  Yes

  No

• Is the gym equipment properly placed for safety when in use?

  Yes

  No

• Was the gym equipment properly stored after patient use to ensure staff and patient safety.

  Yes

  No

Clinical

• What precautions were used by the therapist to ensure safety when treating a patient at risk for falls? Select all that apply.

  Select

• Did you observe the therapist using a gait belt on patients who are at risk for falls?

  Yes

  No

  N/A

• Did the therapist use proper set up of the exercise to ensure safety? i.e., free of hazards; providing patient assist to reduce complexity and load.

  Yes

  No

• Did the therapist ensure safety with the intervention performed by the patient? i.e., providing proper instruction of the exercise and observation of the return demonstration of the exercise; provide proper supervision of the patient based the observation of the return demonstration of the exercise.

  Yes

  No

• Did the therapist use clinical judgement to alter the complexity of an exercise to improve safety?

  Yes

  No

• Was the Physical Therapy Aide used in the supervision of a patient at risk for falls? If yes, describe supervision.

  No

  Yes

  N/A

• Did you observe the physical therapy aide providing exercise instruction to a patient that has not previously completed that exercise?

  No

  Yes

  N/A

• Did you observe the physical therapy aide altering treatment to reduce complexity, increase complexity, and/or improve safety without consultation with the treating therapist?

  No

  Yes

  N/A

• Did you observe any near misses in the clinic?

  No

  Yes

  N/A

• How many?

• Did you witness any unsafe events in the clinic? If yes, please describe.

  No

  Yes

  N/A

Administrative

• How many patients were seen in the clinic during your observation hours?

• How many patients during your observation were deemed fall risk?

• Were patients scheduled appropriately to ensure safety and reduce fall risk?

  Yes

  No

• If the patient was deemed a fall risk, was there a falls assessment completed on the patient within the last 30 days?

  Yes

  No

  N/A

• If precautions were used by the therapist to improve the safety of the patient, did the therapist document the precautions in the daily note?

  Yes

  No

  N/A

Plan

• Based on the observation; was best practice followed to ensure the safety of the patients/visitors/staff?

  Safe

  Unsafe

• What are your recommendations?

• Follow up actions

• Date for actions to be completed:

  Date