Partnering to Prevent Falls: Utilizing a Multi-Modal , Multi-Disciplinary Approach

Purpose:
The system fall rate at our facility was above the MIDAS benchmark of 2.85/1000 patient days. Most units were also above their NDNQI benchmarks. An organizational goal to decrease the fall rate was initiated using a multidisciplinary approach with strategies involving all departments.

Significance:
In 2000, falls among older adults cost the U.S. healthcare system over $19 billion dollars. With the population aging, both the number of falls and the cost to treat fall injuries have increased. More importantly, falls result in significant morbidity and mortality to our patients.

Strategy and Implementation:
Led by nursing, a multidisciplinary Integrative Fall Committee was initiated. Identified issues/interventions: a)Need a more consistent fall assessment during hourly rounds; b)Engage all staff in assuming responsibility for fall prevention; c)Utilize post fall huddles that includes ancillary staff. The most innovative strategy was the Friday Fall Review. At these meetings, Nurse Managers presented each fall that occurred to determine causes and potential preventive measures. Representatives from the allied health and ancillary departments were instrumental in these discussions. Issues identified and addressed: a) Correct identification of falls; b)Order sets that included sleeping pills were changed, requiring deliberate orders by the physician. Lowest dosages of the sleeping pills were recommended if ordered; c)Q12 hour diuretic administration times were changed from 9A/ 9P to 6A/ 6P to avoid having patients out of bed at night; d)Data reported monthly at System Management meetings.

Evaluation:
The system fall rate was below the MIDAS benchmark for the last four quarters (Q2 2010-Q1 2011). NDNQI data were below the median 63.5% of the time, and below the mean 67.8% for the same time period. The process was very effective in engaging staff outside of nursing to help protect our patients.

Implications for Practice:
Next phase in the Fall Reviews will include staff nurses presenting the fall cases. Humpty Dumpty Fall Tips sent out regularly to update staff on any preventive measures. The process was so successful that Quality Management adopted it to review any Core Measure indicators that are non-compliant.