Reducing falls with injury: Leveraging the EHR to improve patient safety while transforming practice

Purpose:
The purpose of the project was to reduce the rate of falls with injury at Sentara Norfolk General Hospital. This project utilized a collaborative nursing process to improve visual alerts within the electronic medical health record (EHR) resulting in better assessment, intervention and outcomes.

Significance:
A review of the literature reveals that between 2 and 17% of patients in the hospital have fall(s). Up to 50% of those falls result in injury. In addition to physical injury, falls are costly. In the Sentara Health System the average fall with injury claim costs the system $204,530.

Strategy and Implementation:
With implementation of an EHR at Sentara Norfolk General Hospital in March '09, several new stratgies were added to reduce falls with injury. Those strategies included: -changed from locally developed patient care protocol to nationally developed, evidenced based clinical practice content -history of falls appears in the patient header -pink banner in patient summary report for interdisciplianry communication -patient header shaded pink for high falls score -FYI alert for patients who have fallen on previous encounters -falls score visible on patient list as discrete properties Staff nurses requested these enhancements and were engaged in development/evaluation of several of these strategies through falls performance improvement committee and nursing user group.

Evaluation:
Following the implementation of staff suggested interventions within the EHR , Sentara Norfolk General Hospital demonstrated a decrease of 14% in their fall with injury rate (rate drop from 0.73 pre-implementation to 0.63 per 1,000 patient days post-implementation).

Implications for Practice:
Evidence based practice clinical content embedded in the EHR facilitates the preventio of falls with injury. Staff are empowered to suggest, implement, and evaluate tools for fall prevention to improve patient safety through enhanced situational awareness and elevated professional practice.