It Takes A Village: An Interdisciplinary Approach to Fall Reduction Through Innovation and Practice

Purpose:
The Center for Rehab(CRWH) fall rate increased above NDNQI's national mean/1000 patient days. CRWH caused 34% of Wilmington Hospital's falls. The goal was to reduce CRWH falls below the national Rehabilitation mean by May 2013 with an interdisciplinary team & Patient/Family Centered Care practices.

Significance:
Patient (pt) falls cause physical & emotional harm & patient discontent; raised costs, workload, resources, & staff stress. Falls w/ major injury increased cost $27,000, without injury $3500*. Falls w/ major injury increased LOS. Higher fall rate on CRWH due to activity & more brain injury patients.

Strategy and Implementation:
Evaluated fall data for 1 year: > falls occurred before/after meals in Rehab dining room, > falls on weekends, most have a stroke dx, males > females, > climbed OOB or fell from wheelchair, > on evening shift. An interdisciplinary Falls Champion Team was initiated with nursing, therapies, escort, dietary, pharmacy, and housekeeping. Mandatory Falls education held for all, staff owns it was the message. Real-time phone calls to Nurse Manager required. Bedside shift report for nurses and techs, & no vital signs at that time. Hourly rounding was monitored, & electronic tasks added. Voice & tone alarms allowed bed & chair to connect to nurse call system. Fall huddles before each shift discussing pt at high risk for fall/high risk of injury if falls. A post fall huddle with RN, pt, therapist held & assessment added to the medical record. Reusable gait belts placed in each room. All pts on alarms for 24 hours post admission. Transparency of fall rate,& falls analyzed at all staff meetings.

Evaluation:
Achieved a 29% reduction in the CRWH fall rate over 1 year, and the Wilmington hospital contribution from CRWH was down by 53%. CRWH fall rate has been below the NDNQI mean since September 2012. 4Q12 CRWH=3.88 & NDNQI mean=5.91. 0 falls in month after education, April 2013 only 1 fall.

Implications for Practice:
Education & transparency keeps issue at forefront. Fall huddles make everyone aware of high risk patients. Alarming chairs and beds through nurse call prevented falls per families. Interdisciplinary Falls Champion Team gives all in contact with patient ownership. Hourly rounding prevents falls.