The Stakes are High, Reduce the Chance of Falls with these Winning Interventions

Purpose:
The purpose of this project was to reduce the overall incidence of falls within our organization, with a specific focus on falls with moderate and major injury as defined by the National Database for Nursing Quality Indicators (NDNQI).

Significance:
Patient falls are a leading cause of death in hospitalized patients over the age of 65. The most common injuries sustained by patients who fall are head injuries and hip fractures. Of those with hip fractures, 40% are never able to return to independent living and 25% die within one year.

Strategy and Implementation:
Our steadfast focus on fall and fall with injury prevention began in July, 2009 with the commitment of our entire nursing leadership team, including our CNO, to meet on a weekly basis regarding patient falls. Additionally, we included direct care nurses and nursing assistants on our team. In November, 2009 we implemented a pilot project to reduce patient falls with injury on our Cancer Nursing Unit. The interventions included: 1) mobility signs indicating the number of staff required to ambulate/transfer patient on door frames, 2) red signs indicating risk for fall-related injury based on the ABCS assessment, 3) reinforcement of fall prevention education for all staff, and 4) daily huddles to include communication regarding patients at highest risk for fall-related injury and other fall-relate issues. By February, 2010 the interventions were implemented on all adult inpatient units along with changes to our Fall Prevention Policy and documentation flow in the electronic medical record.

Evaluation:
We measure our success through data reported to NDNQI. We've successfully reduced falls and falls with injury by 50%. We use a fall tracker to communicate days without fall/fall with injury at the unit level every week and recently celebrated two units achieving 365 days without a fall with injury.

Implications for Practice:
The mobility and red risk for injury signs have provided an effective tool for communicating with healthcare providers, patients, and visitors. Additionally, the collaboration between leaders and direct care providers on a weekly basis has helped us constantly focus on keeping our patients safe.