(withdrawn) Using the NDNQI to Drive a Multi-faceted Approach to Fall Reduction

Purpose:
Our in-patient fall rate with injury was 1.0/1000 patient days from October ‘10-March '11, with a spike to 1.39 for March '11. This project was geared toward reducing falls by simultaneously initiating multiple interventions, using the NDNQI data to target challenging areas.

Significance:
Of 37 million patients hospitalized annually, 2-3% fall, resulting in 1 million falls. 1/3 of these result in injury. Evidence-based interventions for fall prevention in acute care are limited, but include fall risk assessments and review, patient tailored interventions, and purposeful rounding.

Strategy and Implementation:
When our fall rate spiked, fall interventions were not consistently followed and there was not an institutional focus on falls. We created an executive falls team to involve leadership in fall reduction and added focused interventions: web based education, debriefing tool, documentation and practice audits and mandatory bed alarms 24 hours/7 days a week. We also required units with frequent falls or moderate/major injury to complete a root cause analysis. Other system wide change included: revision of the fall risk tool, a risk for fall injury assessment, regular rounds by the fall team chairs, and quarterly feedback on NDNQI benchmarking. The bed alarm policy was changed to the first 24 hours and patients with: confusion, impaired mobility, and history of falls. NDNQI data was used to identify units with high fall rates and a purposeful rounding pilot was initiated. Approaching falls from many different angles lowered our rate.

Evaluation:
In first 4 months of the multifaceted approach to fall reduction, our fall with injury rate decreased by 51%; from 1.0 (October'10-March'11) to 0.49 (Apr'11-Jul'11.) The fall rate for FY '12 is 0.58, the lowest we have ever been. 16 of 24 units are within the NDNQI mean for falls with injury.

Implications for Practice:
A multifaceted approach successfully reduced our rates. Increased awareness through education, the use of fall prevention tools such as bed alarms and audits, and leadership involvement and accountability all had an impact. NDNQI data continues to drive quality efforts and improve outcomes.