Use of the Liberating Structures in Fall Reduction: Out of the Box Strategies

Purpose:
Fall reduction is a universal goal for hospitals across the U.S. Multiple factors contribute to falls; therefore, a multifaceted approach is required. The fall rate on a 35 bed step down unit in a Magnet hospital was consistently above the National Database for Nursing Quality Indicators (NDNQI).

Significance:
Patients who experience a fall while hospitalized can suffer adverse outcomes directly related to the fall. Falls can result in an increased length of stay, head injury or fractures.

Strategy and Implementation:
The unit used Liberating Structures, which are innovative and interactive efforts that make it possible for people and organizations to create novel methods to improve quality such as fall prevention. Staff were required to attend a one hour interactive competency session in a patient room on the unit. A combination of CNAs and RNs were assigned to each session. Session discussion began with general identification of patients at risk for falling. This was followed by an improv and TRIZ, two liberating structures where participants re-arranged the patient room and common equipment to facilitate or directly cause a patient fall. Staff were asked to create a space that could achieve the worst possible outcome for patient falls. These “reverse” exercises stimulated dialogue and discussion around problem solving. During the session, participants were asked to self-reflect on falls they had witnessed or identified as trends and communicate what could have been done to prevent them.

Evaluation:
Following the use of the Liberating Structures, the unit appreciated a 68% reduction in falls over a 9 month period. This unit is now consistently below NDNQI benchmark for step down units.

Implications for Practice:
Through the use of Liberating Structures and innovate educational practices individual units as well as organizations can realize a decrease in patient falls and an increase in patient safety.