Evidence & Practice: A Fall Reduction Program Using Implementation Science

Purpose:
Oncology unit fall rates (2010) were higher than NDNQI mean Magnet Facility benchmarks despite standard fall reduction initiatives. The project goal was to decrease fall rates below benchmark using Implementation Science (IS) as the framework for developing a fall reduction action plan.

Significance:
Patients with a cancer diagnosis have multiple compounding factors which place them at high falls risk. Implementation Science provides a framework for targeted interventions, i.e. determinants for knowledge, cognition, attitudes, routines, social influence, organization, and resources.

Strategy and Implementation:
The oncology unit-based council developed an action plan using Implementation Science. Fall risk scores were added to the census board (IS Determinants: knowledge, cognition, attitudes, and routines). Communication contract/checklist was developed to identify high-risk (>5 Hendrich II) patients and assess fall prevention interventions. The contract/checklist was initiated on the night shift and used at change-of-shift handoffs to update fall risk information and prevention initiatives. Checklist was signed by oncoming nurses and patient-care technicians, and processes were reinforced by nursing director (IS Determinants: attitudes, routines, social influence, and organization).

Evaluation:
Fall rate 4th quarter 2011 showed a 79% decrease compared with 1st quarter 2010. Fall rate initially was greater than 90th percentile NDNQI Magnet Facility benchmark and improved to less than the 25th percentile NDNQI Magnet Facility benchmark.

Implications for Practice:
Implementation Science (IS) can facilitate evidence-based practice implementation. IS determinants are guides for developing innovative multifactorial approaches to patient safety issues (falls).