Sometimes it's the Trees AND the Forest; Data Driven �� Falls

Purpose:
Under-performing 68% of the past 8 NDNQI quarters, we intensified our imperative to prevent falls. We also drilled into the 86% under-performance of risk assessment; only 16% of our patients who fell were "high fall risk". We established action plans to improve both process and outcome indicators.

Significance:
The impact of patient falls encompasses emotional and physical costs to patients, families, staff and organization in terms of morbidity, mortality, LOS, litigation and quality of life. The ability to identify high risk patients and intervene to prevent falls is crucial.

Strategy and Implementation:
While we had reviewed NDNQI data each quarter, it wasn't until we engaged front line staff, Administration/Board that Falls became a strategic goal. We incorporated EBP, partnered with families, conducted small tests of change/ research, embedded the Morse risk assessment scale and EBP interventions in E.M.R., added bed-chair alarms/minimal lift/ other technology, selected "Champions," and educated. Each fall was debriefed with RCA; under-performing units report to peers and Administration. We continue to test/ utilize best practices. While improving in overall falls/ injury (i.e. "the forest"), we were still not identifying patients at high fall risk and thus not initiating prevention (i.e. "the trees"). It became evident that the Morse scale was not well understood and we were inconsistent and under-scoring our patients. We modified the tool, piloted, and implemented in December 2011. Review of Morse scales from the E.M.R. pre and post scale revision showed dramatic improvement.

Evaluation:
Overall fall/ fall injury rate has �� by 20%/43%. We now out-perform 59% NDNQI fall rate comparison. We improved our scoring patients at risk by 45% during implementation. % of patients at risk to fall increased to 60% with 2x the number of patients placed on high fall risk precautions.

Implications for Practice:
We have applied our many "lessons learned" to other initiatives i.e. interdisciplinary oversight team, Executive sponsor, engage all levels: frontline-Board, embed in E.M.R., don't be afraid to modify Best Practices so they work for you, drill into data- not just outcomes, but the processes, too.