Using Process Improvement Methodology to Decrease Total Fall Rates At A Large Academic Medical Center

Purpose:
The purpose of this project was to implement a novel approach to address inpatient fall rates on four surgical units that were consitently underperforming against NDNQI benchmarks.

Significance:
Falls in the inpatient setting are a critical safety issue. Falls cause injury, they increase length of stay and hospital care costs, and can lead to decreased mobility and quality of life. Falls are complex and multifactorial, requiring a novel approach to evaluate and understand the issue.

Strategy and Implementation:
In an effort to achieve a low rate of inpatient falls and achieve goals set by the Magnet Recognition Program®, nursing leadership supported an interdisciplinary group, led by a quality professional, whose charge was to dissect and evaluate the current falls prevention process and establish a sustainable and reliable intervention. The quality professional facilitated the implementation of a Six Sigma methodology known as DMAIC. In the define phase, a process map was established that included the voices of all stakeholders. The measure phase consisted of several points of measurement including charts of patients who fell and unit audits comparing documentation of risk and intervention.In the analyze phase, the highest priority problem areas were identified and mapped. The improve phase included identification of a structured countermeasure, "Proactive Rounding". It focused on high risk patients requiring an in depth assessment of risk and identification of individualized interventions.

Evaluation:
For the Proactive Rounding countermeasure, the following outcomes are being measured: total fall rate, injury fall rate and repeat falls. The team will also assess impact of specific interventions. As a result of focused effort, collectively, the four surgical units have reduced fall rates by 23%.

Implications for Practice:
The DMAIC process was valuable in the engagement of a team working through a complicated problem to develop a sustainable solution. The team was challenged to evaluate their respective practices (nursing, pharmacy, and therapy) and to develop a creative solution with a goal of sustaining results.