Sustaining Low NDNQI Falls Rates in an Inpatient Rehabilitation Unit Using Innovative Falls Prevention Interventions

Purpose:
Patients on the inpatient rehabilitation unit are at high risk for falls due to their primary diagnoses and co-morbidities. The goal was to implement several strategies to decrease total falls and injury falls rates.

Significance:
Falls are the fifth leading cause of death in elderly patients and contribute to 40% of nursing home admissions. Falls outcomes include poorer quality of life, extended hospital lengths of stay, and increased resource utilization. Patient falls incur $20 billion in direct health care costs annually.

Strategy and Implementation:
To minimize total falls and injury falls rates in an inpatient rehabilitation unit at a community teaching hospital, nursing staff implemented several interventions to decrease patients' risk for falls. Every patient is placed on falls prevention protocol. Patients are not allowed out of bed without shoes. A change in the job description of patient sitters is being explored. Staff also implemented use of the Egress test, an assessment of patient stability and readiness to ambulate, on every patient. The assessment is done on admission and on every shift. The Egress test involves three steps: sit to stand, stationary marching, and stepping forward and backward. Because patients in rehabilitation unit settings tire easily, the test is individualized for patients.

Evaluation:
Success of implementing the rehabilitation unit fall prevention and assessment strategies was measured using NDNQI falls data. Total falls on the unit have remained below the NDNQI national mean for 7of the last 8 quarters. Injury falls have remained below the national mean for all 8 quarters.

Implications for Practice:
Nursing leaders in other inpatient units in the hospital are considering adoption of the Egress test for specific patient populations. A team of nurses and leaders are revising job responsibilities for sitters. Documentation of the Egress test may be added to the electronic medical record.