Taking Fall Reduction to the Next Step

Purpose:
Despite years of concentrated efforts to reduce fall rates, this institution continued to strive for fewer patient falls. Upon comprehensive analysis of our fall program, a psychometrically sound fall risk assessment tool was adopted and hourly rounding was standardized.

Significance:
Patient falls are the leading cause of fatal and non-fatal injuries in adults greater than 65 years old (CDC, 2010). Earlier strategies to reduce fall included fall huddles and a fall safety bundle were implemented but institutional falls data for the last 2 years was higher than benchmark.

Strategy and Implementation:
Extensive research has been conducted by the falls program coordinator to improve fall screening tools and to generate guidelines in the prevention of falls in older adults. After researching different evidence-based fall assessment tools, the Falls Committee adopted the implementation of the Morse Fall Scale (MFS). Each patient is assessed individually and the variables applicable to the patient are checked in the electronic assessment flow sheet. The computer automatically adds the score to determine if the patient is low, medium, or high risk of falling. Based on each risk score, a list of suggested nursing interventions are provided and can be implemented by the nurses without a physician order. Purposeful hourly rounding addressing the 3 P's(pain, potty, position) then executed with the fall risk score guides the nurse's interactions and interventions.

Evaluation:
The falls rate prior to the implementation of the MFS and purposeful rounding ranged from 2.26- 3.09. The national benchmark is 3.2. The rate of falls from the last two quarters after the implementation decreased to 1.85 -1.93, the lowest rate ever achieved. The fall rate was reduced by 30%.

Implications for Practice:
The MFS provides a valid and reliable screening tool for anticipated high risk fall patients. Purposeful hourly rounding ensures the nurses presence in the prevention of falls. Integration of the MFS in an electronic record provides accuracy with assessments and a method for data collection.