Standarization: The Key to Safety, Satisfaction, and Success!

Purpose:
We implemented a continuous quality improvement effort to reduce our Neuro Step Down unit fall rate, which was higher than NDNQI benchmarks. A program was initiated to standardize beds with bed exit alarms, and re-emphasize the need for appropriate bedside care for fall prevention.

Significance:
Falls are associated with increased morbidity, longer length of hospital stay, and can cost up to $24,962 per related injury (CDC); 19% of our falls resulted in some type of injury. Bed equipment on the unit was not standardized, which led to staff confusion and inconsistent use of bed exit alarms.

Strategy and Implementation:
The 4th quarter of 2009 was chosen as the test period, and a 90-day quality improvement project was initiated on the 22-bed Neuro Step Down Unit to test whether bed standardization would result in reduced patient falls and injuries, accompanied by increased nursing satisfaction. Falls were tracked on the unit as usual, with the addition of bed-exit alarm usage tracking at the time of a fall. Nursing staff were surveyed to measure competency and satisfaction with equipment standardization, and the fall rate was compared with previous quarters and NDNQI benchmarks. A Unit Champion and Super Users were selected to receive in-depth training and act as resources for all nursing staff on the unit at all times. All beds on the unit were standardized, tagged as Neuro Step Down beds only, and nursing staff received training on appropriate use of the bed and bed exit alarm system, and a fall prevention continuing education program.

Evaluation:
The fall rate reduced from 9.11/1000 patient days during 2nd quarter 2009 to 4.08 during 4th quarter of 2009, resulting in a relative reduction of 55%. The rate reduced again in the 1st quarter of 2010 to 3.45. 100% of nursing surveys revealed staff competency and satisfaction.

Implications for Practice:
Multiple types of equipment with the same purpose lead to staff confusion and can place patients at risk. Standardization of bed equipment and comprehensive education using quality improvement methods enhanced nursing bedside care and reduced the incidence of patient falls and related injuries.