Hardwiring a Multi-Factorial Fall Prevention Intervention into Nurses' Work to Reduce Inpatient Falls

Purpose:
The purpose of this investigation was to evaluate whether hardwiring fall prevention strategies into nurses' work on a step-down unit reduced falls.

Background/Significance:
Inpatient fall-related injuries cost more than $19 billion annually. Although multiple factors contribute to falls, nonadherence to safety instructions is a major contributor irrespective of cognition. Evidence supports multi-factorial interventions work best at preventing falls. However, interventions are complex and increase nurses' work, making them difficult to implement.

Methods:
A quasi-experimental design was used. This 3-phase project included: 1)collection of 12 months fall incidence data from a 34-bed nursing unit; 2)hardwiring a fall prevention program into admit/shift assessment that partners with patient/family; and 3)adding a patient behavioral contract into the prevention program that acknowledges fall risk and intent to comply with safety instructions. Phases 2 & 3 lasted 3 months each. Prospective daily data collection included: Fall risk score, presence of confusion, fall occurrence/reason,and audit of nurses' compliance with interventions. Data was analyzed descriptively,t-Test and Chi-square to test for differences between groups.

Results:
Data from 11,296 patient days (2009) and 5,823 patient days (1075 patients) during 6 months (2010) were included in analyses. Overall there was a reduction in falls from 5.4/1000 patient days (2009) to 2.4 during the 6-month period, which was significant when fall vs. no fall was analyzed, X2=(1, N=17,119)=8.17, p<.01. Fall rate was 1.5/1000 patient days (4 falls, 2 witnessed) when education alone was used and 3.6 (11 falls, 6 witnessed) when the contingency agreement was added as a strategy, X2=(1, N=5,974)=3.64, p>.05. There were no serious injuries in the 15 falls; 6 minor injuries; 9 due to toileting/noncompliance.

Conclusions and Implications for Practice:
Hardwiring fall prevention education reduced falls; however, no benefit was realized by having patients sign a behavioral contingency agreement. These findings may be related to partnering with patient/family in patient safety. Further study is warranted to evaluate longitudinal outcomes.