Meeting the Challenge: Fall Minimization on a Neuroscience Floor

Purpose:
The fall rate on one 50 bed combined neurology/neurosurgery nursing floor has been consistently above the NDNQI benchmark for "Falls per 1000 Patient Days". The goals of intervention are to raise fall awareness and decrease the fall rate by at least 30 percent or to NDNQI target.

Significance:
Neuroscience nursing floors face challenges in keeping this high fall risk patient population safe and free from falls while in the hospital. A proactive, collaborative approach to fall minimization will effectively decrease the number of falls on a neuroscience nursing floor.

Strategy and Implementation:
In January 2010, the unit based shared governance council was challenged to develop an action plan detailing fall minimization interventions to be implemented above and beyond existing hospital and unit protocols. To describe the meaning of the fall rate, currently expressed as "falls per 1000 patient days", a large calendar was placed in the staff lounge indicating falls as they happen. A fall huddle team consisting of the CNS intern, Physical Therapist, clinical instructor, assistant nurse manager, staff nurses, and patient care nursing assistants was developed. This team huddles once weekly to discuss 4-5 patients' fall risk factors, current fall minimization interventions, and additional fall minimization strategies as recommended by the huddle team. Recommendations are reviewed by the night shift. Fall free time periods are rewarded. Communication of high fall risk patients has extended to include notification using the nurse call and Horizon Enterprise Visibility systems.

Evaluation:
The effectiveness of the intervention is measured using the falls per 1000 patient days data. A downward trend in the fall rate has continued during the intervention period. The monthly fall trend report shows a 50 percent reduction in falls within the first four months. Data is posted for viewing.

Implications for Practice:
Implications for nursing practice include improved patient outcomes, decreased length of stay, decreased financial burden to the organization, and increased staff satisfaction.