Where are We Falling Down? Development of a Hospital Falls Database for Local Clinical Intelligence

Purpose:
This 525-bed teaching hospital has invested heavily in evidence-based falls prevention efforts yet struggles to beat NDNQI benchmarks. A new Falls Database innovatively turns detailed RN fall reports into actionable nursing clinical intelligence data to facilitate targeted falls prevention.

Significance:
Like all NDNQI hospitals, we review and report every fall. Despite maintaining extensive qualitative reports on every fall, we lacked a means of analyzing these 2000+ falls quantitatively to develop insight into contributory causes and barriers particular to specific units and the local context.

Strategy and Implementation:
The new Falls Database creatively uses Microsoft Access to combine multilevel, interprofessional qualitative data from frontline fall reports with expert opinion recorded by a nursing quality improvement specialist. The database can generate a wide array of reports looking at dozens of variables, either alone or in combination, to assist leadership decision-making. This presentation describes the challenges the database development team tackled, explains how the final product came together, and showcases the reports it generates to provide “practice-based evidence” for nursing clinical intelligence. A key challenge was establishing data fields or categories narrow enough to be useful yet broad enough to be powerful for guiding prevention efforts by frontline RNs. The presentation additionally depicts how the database retains the original nursing fall report while also providing an opportunity for an expert reviewer to re-characterize data fields for the fall as needed.

Evaluation:
The Falls Database facilitates a wide array of custom analyses to examine falls by unit in fine-grained detail such as time of day, staffing at the time of the fall, and key contributing factors. It also improved timeliness and efficiency in falls reporting for both internal and external purposes.

Implications for Practice:
Lessons learned from this hospital's experience can guide others in creating falls clinical intelligence data. A database captures the value of resources already being invested in falls event reviews to establish practice-based evidence for improved strategic targeting of falls prevention.