Using an Innovative Staff Development Model to Reduce Patient Falls

Purpose:
The purpose of this innovation is to increase staff engagement to produce and sustain a reduction in patient falls by accurately assessing risk, consistently completing fall prevention interventions, and utilizing unit-based experts for monitoring and peer feedback.

Significance:
The hospital is at the NDNQI 50th percentile for inpatient fall rates. With a goal of decreasing the number of falls per 1000 patient days below the 25th percentile, innovative strategies of continuous performance improvement are paramount to achieve consistency in performance.

Strategy and Implementation:
The shared commitment, cultivated expertise, and participation of professional nurses are critical to fall reduction. A staff development model was established to address nursing sensitive outcomes. The model includes four components – nursing grand rounds, an intensive workshop, unit-based in-services and monitoring. The objectives for nursing grand rounds included the identification of contributing factors, identification of fall prevention interventions and a review departmental fall rates compared to NDNQI cohorts. The workshop supports the development of unit-based experts by discussing evidence-based practice and fall prevention initiatives, application of the Hendrich II© Falls Risk Assessment Model, and role-playing unit-based in-services to build accountability at the bedside. The staff experts complete unit-based in-services, share data, and complete monthly observations to track consistency in adhering to the fall prevention program and to track unit fall rates.

Evaluation:
The evaluation plan includes both process and outcome measures leading to a reduction in fall rates to the NDNQI 25th percentile; comparing NDNQI CY08 and CY09 quarterly data, completion of monthly audits for accurate assessment of fall risk, and staff communication of data in unit meetings.

Implications for Practice:
With patient safety, reimbursement, and reputation at stake, a comprehensive and patient-focused approach reduce patient falls is imperative. Frontline experts engaged in the reduction of falls can utilize that competency to improve quality in other nursing sensitive hospital acquired conditions.