Decreasing Falls in the Heart Failure Population

Purpose:
Our Heart Failure unit identified that our Fall rate was extremely high. We investigated the falls that had occurred to seek out a solution. We determined that by changing our patient's diuretic schedule, we could decrease our fall rate.

Significance:
Heart Failure is a common disease of the elderly. A mainstay of treatment is diuretic therapy. Many falls occur because patients fall while going to the bathroom, especially at night. Falls can increase length of stay, cause morbity and even death.

Strategy and Implementation:
After investigating the nature of the frequent falls that occurred, we determined that diuretics were being adminstered on a 10a and 10p schedule. The majority of our falls were occurring shortly after midnight. We decided to change the 10p dose to 6p. We implemented this stategy in several different ways. We gained support of our physicians. We determined that our staff were unaware of our fall rate. Therefore, we now publish our fall numbers on a monthly basis on the unit. This has incresed awareness. The staff now have a vested interest in this project. We discussed this on a daily basis during clinical rounds with our nurses. Eventually the staff automatically changed the dose schedule. We then changed the standard selections in our computer system to eliminate a standard 10pm choice for intravenous diuretics. This system change along with daily staff interaction caused our rates to decrease dramatically in a short period of time.

Evaluation:
We were able to decrease our falls from an average of 13.75 falls per quarter in 2008 to 6 falls per quarter in 2009. Our rate dropped from 5.08/1000 patient days to 2.91/1000 patient days. This progress was measured through our nursing unit and nursing division performance improvement department.

Implications for Practice:
This innovative performance improvement project has demonstrated dramatic success in providing a safe patient environment for the fragile Heart Failure population. It has motivated our staff to provide excellent and safe care to our patients.