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One Organization's S.A.F.E. Toileting Campaign

Diverse Business Group Young Female Doctor
Thursday, June 7, 2018

Providence St. Joseph Health Mission Hospital—Mission Viejo and Mission Laguna Beach continues its journey to eliminate anticipated falls with harm. The Fall Prevention Taskforce analyzes unit-specific data on an ongoing basis to identify opportunities for improvement. When the hospital noted that toileting was a top contributing factor, a project using the Johns Hopkins Nursing Evidence-Based Practice Model was initiated and developed into a S.A.F.E. Toileting Campaign:

  • Scheduled toileting every two hours for high fall-risk patients.
  • Do not leave alone in the bathroom if patient has balance or cognitive problems—stay within arm’s reach.
  • Use the Patient Fall Prevention Agreement.
  • Use safe patient handling equipment and encourage early mobility.

Critical to the success of this campaign was engagement of the fall prevention unit resource nurses who are the local experts in fall prevention. Education around the S.A.F.E. Toileting Campaign included the patient care technicians in which interactive scenarios were discussed in small groups led by the clinical nurse specialist. These small group discussions would include how often a particular patient should be taken to the bathroom, as well as if the patient could be left alone in the bathroom. The core value of “dignity” made it very difficult for staff members to not leave the patient alone in the bathroom when the patient requested this. The rich discussions that ensued provided the opportunity to practice scripting to take forward in their real-life experiences with patients. The campaign was augmented with flyers, which included the definition of the S.A.F.E. Toileting Campaign and sample scripting.

The Fall Prevention Agreement is also used as a tool to partner with the patient and to assist patients in identifying their respective individualized risk for falling. It leads the patient through risks related to physical, medications, environmental, or patient perception components and how they relate to the increased risk of falling. Evaluation of these components provides the opportunity for dialog and teach-back.

For more information, please contact June Melford, MSN, RN-BC, CCRN, at