Data Driven Change in a Fall Prevention Program

Purpose:
RN hours/patient day & percent RN hours at Quillen Rehab continued to fall below the NDNQI national mean. Also, total falls/1000 patient days were higher than mean. Goals were to increase RN hours and begin a comprehensive fall prevention program decreasing falls to less than 10/1000 patient days.

Significance:
By meeting the goals, we hope to improve patient outcomes, and patient/staff satisfaction. Additionally, we would provide a safe care and work environment; positively impact the emotional factors associated with patient falls and loss of independence; and decrease length of stay and cost.

Strategy and Implementation:
Based on data review and compliance with the fall risk assessment tool, strategies were developed to increase RN hours, and to improve understanding of the fall prevention program. RN hours were increased by replacing vacant LPN positions with RNs. Review of the literature helped to organize the fall prevention strategies into three categories. A procedural strategy included identifying an inter-disciplinary fall task force. An environmental strategy was the purchase of a low bed for those at highest risk for falling. An individual strategy included teaching effective bed/chair/toilet transfer techniques. Additionally, all disciplines were engaged and educated to help meet the goal of decreasing patient falls by implementing the interventions based on the risk assessment. Weekly transfer training was provided by physical therapists for all staff. Education regarding intentional rounding to include evaluation of pain, toileting needs, and positioning was provided to all team members.

Evaluation:
Success was measured by the improvement in the quarterly NDNQI RN hours/patient day, the percent of RN hours, and the total falls/1000 patient days. As of June 30, 2009, the average fall rate for Quillen Rehab was 9.90, meeting the goal of having a fall rate less than 10/1000 patient days.

Implications for Practice:
The staff recognized that the current tool was not very useful, and volunteered to participate in a trial of another tool. It was identified that maintaining momentum with intentional hourly rounding, and effective collaboration with other disciplines was important to decreasing patient falls.