Reducing Falls Rates for Hospitalised Cognitively Impaired Patients: an inexpensive, easily replicated innovation

Purpose:
Hospitalised cognitively impaired patients are at high risk of falls and often require specialised nursing. To reduce falls, a nursing model was developed where at risk patients were co-located in a High Care Room (HCR). The aim was to demonstrate improved patient outcomes at reduced nursing costs.

Significance:
Prior to HCR, 70% of falls occurred in cognitive impairment. Strategies to reduce risk included 1:1 nursing; however this was costly and ineffective. The HCR approach facilitates both efficient and effective delivery of specialised nursing care, improving patient outcomes at reduced nursing costs.

Strategy and Implementation:
At risk cognitively impaired patients were relocated to the HCR, a tailored environment situated within the acute treating unit and resourced by specialist clinicians, at a 1:2 nursing ratio. The HCR's evidence based design provided specialised observation, Person Centred Care nursing, recreational activities and a quiet atmosphere contributing to a safer environment. Implementation of increased staffing was predicted to be offset by cost savings in reducing 1:1 nursing across the medical service. Criteria for HCR referral and admission were developed to help identify at risk patients and facilitate patient flow. HCR structural modification required installation of double glazed doors. Staff received focussed training in cognitive impairment covering communication, pain assessment, falls reduction and behavioural management. Collection of HCR patient length of stay data commenced at implementation whilst ongoing falls and 1:1 nursing data for the overall medical unit were monitored.

Evaluation:
Falls reporting and nursing hours were measured pre and post implementation. Falls in cognitively impaired patients reduced >30% p<0.001 and 1:1 nursing hours decreased 62.7% p<0.001. HCR patient length of stay hours showed an estimated saving in 1:1 nursing hours of 9744 hours for a year.

Implications for Practice:
Acute care facilities are constantly challenged to provide cost effective and safer care of cognitively impaired patients. The HCR innovation provides a solution. It is inexpensive, requiring minimal environmental and organisational changes and therefore can be easily replicated by other facilities.