It Takes A Village: Reducing Patient Falls in the Hospital Setting

Purpose:
Preventing patient falls, and falls with injuries, is an important safety focus for hospitals across the country. The goal of this presentation is to describe a comprehensive, multidisciplinary team effort which has resulted in a dramatic decrease in patient falls within our institution.

Significance:
Identified as a nurse-sensitive indicator of care quality and safety, patient falls can contribute to increased length of stay, complications due to injuries, or even death in hospitalized patients. Patient falls can result in decreased quality ratings and reduced reimbursement for hospitals.

Strategy and Implementation:
A comprehensive, multi-disciplinary approach was used by a team charged with identifying and implementing strategies to reduce patient falls in our organization. An extensive review of research and evidence-based practice led to 25 recommendations for reducing patient falls. Some of the strategies implemented and hard-wired across the organization included: employee, patient, & family education; intentional rounding every 2 hours; electronically generated fall risk assessments; use of alarm devices on all at-risk patients; a "ticket to ride" hand-off tool identifying fall risks; team huddles following every fall; implementation of a paid "companion" (sitter) program; review and analysis of all falls by the multidisciplinary team to identify gaps in performance, and patient-specific and organizational strategies for fall prevention; monthly reporting of unit level performance via an electronic quality "dashboard"; and quarterly performance reports to our board-level Quality Committee.

Evaluation:
As a result of these efforts, our fall rates have decreased from 11% in December 2008 to 2% in July 2010, outperforming the benchmark for Magnet organizations as reported to the National Database for Nursing Quality Indicators. Gains have been sustained with an ongoing focus on fall prevention.

Implications for Practice:
Innovative strategies which can be duplicated by other organizations include the development of electronic triggers, hand-off tools, and generated reports; strategies around intentional rounding; and strategies to enhance peer accountability and enhance organizational focus on quality and safety.