Tripping Over Our Falls: A Program for Reduction and Prevention at Hahnemann University Hospital

Purpose:
To strategize our attack on falls, a multidisciplinary team applied a collection of problem solving techniques, literature reviews, and best practice interventions, forming an official Fall Prevention Team in May 2011 with a goal to reduce patient fall rates to less than three percent.

Significance:
Falls with injury cause emotional and physical stress on the patient, such as bone fractures, mobility limitations, depression, and isolation. The American Nurse Association (ANA) added falls as a nurse sensitive indicator, meaning that nurses have a direct influence in preventing falls.

Strategy and Implementation:
The Joint Commission's (TJC) National Patient Safety Goal (NPSG) 09.02.01 challenges healthcare organizations to reduce and prevent patient falls and patient falls with harm. A gap analysis moved the organization to establish a formal Falls Prevention Team addressing weaknesses and creating an organization-wide awareness of falls. Support from Nursing Administration allowed for the unique opportunity to change the Care Delivery Model to an RN Care Delivery Model across all inpatient units. The RN Care Delivery Model not only increases skill mix, but also supports an opportunity to decrease RN to patient ratios. A pilot of the RN Care Delivery Model supported the theory of increasing skill mix improving nursing-sensitive patient outcomes. Other strategies include: consistent weekly falls meetings, increase use of mobility alarms, and unit-specific action plans aimed at reducing falls based on trends.

Evaluation:
The mean fall rate in 2010 is 3.65. The falls reduction program began in second quarter 2011. HUH's fall rate decreased to 2.98 at the end of the fourth quarter 2011. The fall rate calculated for the first quarter 2012 reveals a significant decrease of falls to a rate of 2.2.

Implications for Practice:
Nurses are empowered to improve their practice, especially when their practice directly affects patient outcomes. Creating a culture of patient safety and quality improvement using innovative strategies allows the front-line staff to have control of the problem to promote better solutions.