Round, Round, Don't Let your Patient Down: A Falls Prevention Project

Purpose:
In 2008, 5 Park, a 24 bed neuroscience unit, had the distinction of having the highest fall rate in the hospital. The rate also exceeded similar units within the NDNQI database. Staff took ownership and developed a falls reduction plan to improve the quality and safety of care on their unit.

Significance:
5 Park is a challenging unit to successfully implement a falls prevention program. Frequently treating conditions such as stroke, post-op brain surgery and Transient Ischemic Attacks, all patients are considered high falls risk with varying degrees of cognitive impairment or impaired balance.

Strategy and Implementation:
According to the evidence, one of the most successful strategies in reducing falls and improving satisfaction is purposeful rounding. For our project, a team of unit champions developed a rounding process and served as role models. The team provided action oriented competencies to introduce staff to the concept and offer tools for success. Initial training included education on responsibilities, critical thinking and formal scripting. Next, the team developed specific rounding guidelines. Nurses rounded on even hours and assistants on odd. A rounding log was developed to help hardwire the process. The initial draft of the log was piloted and staff was surveyed about the process. Revisions were made to simplify the practice and reduce duplication. It was important to reinforce the impact rounding would have on patient safety and empower staff with tools for effective rounding. Consistent reminders were provided at staff meetings, via e-mails and signage posted throughout the unit.

Evaluation:
Quarterly NDNQI comparisons were used to monitor success. At the end of 2009 there was a 50% reduction in the number of falls on 5 Park and another 26% reduction in 2010. These rates outperformed the NDNQI mean. Both patient satisfaction and nurse satisfaction increased during the same time period.

Implications for Practice:
This project demonstrates how empowered staff can employ best practice and impact patient safety. It also reflects a journey to improve outcomes through shared governance and staff level leadership. The unit now has an ongoing rotation of rounding team members to cultivate more unit champions.