Tapping into the power of benchmarking: using NDNQI data to reduce patient falls on an Inpatient Rehabilitation Unit

Purpose:
The purpose of this presentation is to demonstrate how an interdisciplinary team used NDNQI Fall data to improve patient safety on an acute inpatient rehabilitation unit.

Significance:
Costs of falls in hospitals have been reported to include extended length of stay, added diagnostic procedures and/or surgery, and litigation. Research shows that the patients who are most at risk to fall are confused or impulsive and have limb weakness, characteristics of a typical rehab pateint.

Strategy and Implementation:
In 2004 the fall rate on our inpatient rehabilitation unit was 13.4/1000 pt days. The unit culture accepted that falls were a part of rehab, and data was sporadically shared. When it was, we compared ourselves to ourselves. In 2005 our hospital applied for Magnet status and began to utilize NDNQI data. The average fall rate for units like ours was 7/1000 patient days. The ability to benchmark opened our eyes. We began with an interdisciplinary team to evaluate the unit's falls. They implemented new processes, equipment and education. The team concentrated on individualizing the interventions. They worked to ensure all disciplines “speak the same language." They involved the patient's family. Because the team is unit staff, they held their peers accountable as the unit tried new ideas or equipment. Data was shared regularly. As our fall rate declined, the culture on the unit changed. The team continues to meet and identify areas for improvement.

Evaluation:
Our fall rate in 2009 was 2.6/1000 patient days. If not for NDNQI benchmarking, we might have still held to the belief that 13.4/1000 patient days was just fine.

Implications for Practice:
An interdisciplinary team made of direct care practitioners given the relevant data and the autonomy to make practice decisions and put them into place can be a powerful change agent.