Falls Reduction in a Restraint Free Inpatient Rehabilitation Unit

Purpose:
The purpose of our initiative was to provide our challenging acute inpatient rehabiiation patient population with improved safety and satisfaction by reducing our fall incidents while remaining restraint free and not increasing nosocomial skin breakdown.

Significance:
The challenges of providing safe, high quality care to patients who are brain injured, have spinal cord injuries, or multiple medical problems are significant. These patients are best served in an environment that provides for freedom of movement without falls and injury.

Strategy and Implementation:
Rehabilitation nursing poses unique challenges in caring for patients with physical, mental and cognitive disabilities necessitating intensive therapies and nursing care in order for the patient to return to a quality of life similar to what they had prior to admission. Our thirty nine bed inpatient rehabilitation unit, as part of a Level 1 trauma center has a significant number of stroke and brain injury patients whose behavioral issues had been managed through restraint use. As we became restraint free, we needed to ensure our patients not only remained free from falls, but free from injury as well. After analyzing the data, meeting as a team and putting evidence based practice for hourly rounding, the use of Hendrich II falls risk assessment tools, and post fall assessments into our practice, we have found that our falls have dramatically decreased from 88 total patient falls for 2008, to less than 20 thus far in 2009.

Evaluation:
Staff participation in research, education and implementation of our fall reduction program has resulted in significantly improved patient outcomes. The use of the NDNQI data for monitoring and analyzing our progress shows us we have successfully reduced our falls nearly 78% in one year.

Implications for Practice:
The implications for improving patient safety and quality outcomes by implementing evidence based practice to decrease falls while maintinaing a restraint free environmnet has proven to be extremely successful. We have high quality patient outcomes, low falls, intact skin, and satsified patients.