Is your patient Extreme? The Extreme Risk to Fall Program: Reducing Patient Falls in the ICU

Purpose:
The creation, testing and analysis of: •an innovative assessment tool designed to selectively identify ICU patients at increased risk for fall •specific nursing interventions to decrease the occurrence of falls in ICU patients meeting this assessment criteria.

Significance:
Falls are costly in terms of pain, risk for injury and increased LOS. Financial implications are more evident with the inclusion of falls and trauma as a HAC no longer eligible for CMS reimbursement. The high acuity and critical nature of ICU patients compounds the risk of fall-related injury.

Strategy and Implementation:
NDNQI data revealed increased fall rates in our ICUs. Lit review identifed a lack of resources related to identification of fall risk and implementation of fall reduction strategies specific to ICU patient population. As a public safety net facility, DH has a challenging ICU population. The project team included: safety/quality, nursing leadership, and front line ICU staff. A drill-down was performed on recent MICU falls. Analysis of these findings together with multidisciplinary input led to the creation of the Extreme Risk for Fall Assessment tool, including precautions to be implemented if the patient met the criteria. Feedback was continually solicited from staff during the pilot roll-out. Based on this feedback and analysis of “near fall” events, the tool was modified to optimize the specificity and sensitivity of fall risk identification and implementation of effective, realistic interventions. Creative data display boards increased staff motivation and promoted program success

Evaluation:
Process •Specificity/sensitivity of assessment-identify patients at risk,while preventing inclusion of all •Validation of intervention effectiveness-near fall event analysis •Staff Survey-ease of use/relevance to practice Outcome •Fall free days •Degree of injury •Rates:overall/with injury

Implications for Practice:
Critical nature of ICU pts leads to increased risk of fall-related injury.Common factors(altered mental status,ETOH withdrawal,high-risk meds)increase this threat.The challenging nature of these pts paired with lack of ICU-specific fall prevention resources amplifies the significance of this project