Development of the Obstetric Falls Risk Assessment System to Improve Patient Safety

Purpose:
The incidence for falls is low in obstetrics, but the risks can increase during hospitalization for childbirth. The purpose of the Obstetric Falls Risk Assessment system (OFRAS) is to improve safety among inpatient pregnant women using an assessment tool and scoring system to determine fall risk.

Significance:
Patient falls pose significant risks to hospitals. Prevention efforts have focused on geriatric and medical/surgical patients thus existing fall risk tools are not entirely appropriate for obstetric patients. A systematic risk assessment tool for pregnant women during hospitalization is needed.

Strategy and Implementation:
An innovative falls prevention guideline was implemented for obstetric patients focusing on nurses' assessment for readiness to ambulate, since 37% of inpatient falls occur during ambulation for toileting. Assessment as the basis for this guideline relies on nurses' judgment, which prior research suggests is more accurate than a fall risk tool. However, the judgment of less experienced nurses may be less accurate. OFRAS was created to be a systematic assessment tool for ante, intra and post-partum patients using a scoring system to quantify the patient's fall risk. An expert panel of obstetric nurses was consulted to identify obstetric fall risk factors. An extensive literature review helped validate these risk factors. A scoring system was created from the risk factors and stratified into 5 categories. A retrospective analysis of 7 obstetric patient falls and 12 near misses was conducted using the scoring system of OFRAS.

Evaluation:
Implementing the falls prevention guideline decreased falls from 6 to 1 in an 8 month period. Using OFRAS to assess fall risk in these patients retrospectively revealed additional risk factors which were incorporated to enhance validity and reliability. Additional psychometric testing is needed.

Implications for Practice:
Obstetric patients' risk for falls can be systematically assessed. Plans include an analysis of 100 epiduralized obstetric patients using OFRAS to measure patient's readiness to ambulate post anesthesia. Planning for a multi-site trial to measure validity and reliability is underway.