Implementing Meaningful Quality Improvement in a Pediatric Ambulatory Care Network: Falls Reduction Project

Purpose:
The issue of concern was to identify causes of patient falls in a pediatric/adolescent ambulatory care setting. The goal was to develop and implement a nurse led interprofessional role approach to fall reduction in 30 primary care practices and 12 specialty care centers located in 2 states.

Significance:
Falls are the most common unintentional injury in children 14 years and younger. About two thirds of all falls (pediatric and adult) are preventable. There are no published benchmark data for pediatric fall in ambulatory care setings.

Strategy and Implementation:
Team of lead RN's, a family representative, a practice manager, a registrar, and nursing practice specialists used the quality model of PDSA to create the Ambulatory Falls Reduction Program (AFRP). Team utilized project management methodology to create timelines and communication designs. Needs assessment of staff conducted via survey. Tools were designed using a poster for awareness, a patient coloring sheet with safety tips for parents, scripts for clinical and non-clinical staff to use with patients and their families, educational program for staff about AFRP and incident reporting, and a monitoring plan. A systematic and consistent approach for content of key teaching points and methods of application were standardized. Lead nurses were trained at a bi-monthly management meeting or via webinar. Over the next month, the 40 lead nurses trained the 300 nurses, 100 UAP's,100 registrars, and the 40 site managers.

Evaluation:
Monthly falls are trended & compared to 2012 baseline data of reported falls in the ambulatory network. Each lead nurse trends their site's data & shares these metrics as well as network metrics at monthly staff meetings. Reported falls have increased as expected. Near misses are being reported.

Implications for Practice:
Ambulatory fall reduction in a business model of care delivery requires a patient focused, standardized, role based intervention. Having a team of stakeholders who fully participated in designing the tools facilitated the implementation of the program and monitoring of the fall metrics.