Fall Prevention and The Safety Facilitator

Purpose:
In 2009 the Inspira Fall Rate was 3.53/1,000 patient days, well above the NDNQI Mean. Hourly rounding was in place but not goal directed or purposeful. The existing fall risk assessment tool was found to not be evidence based. The Fall Risk Team was charged with improving fall prevention efforts.

Significance:
Research has indicated that approximately one-third of elderly adults experience a fall each year. Hospitalization increases a fall risk sue to enviroment and underlying medical conditions. A fall can lead to a downward spiral of reducing mobility, increased length of stay and injury.

Strategy and Implementation:
The Fall Risk Team is an interdisciplinary group comprised of Staff Nurses, Nurse Aides (CNA), nursing leaders, advance practice nurses and ancillary/support staff. After a literature review, the team selected the evidenced based Morse Fall Risk Assessment Tool for use across the system. A product fair was held that invited vendors and the bedside nurses to identify key products and interventions to implement. Chair alarms, torso belts, low beds and hourly rounding with a purpose were among the selected interventions which were implemented. Purposeful rounding was found to be an evidence based practice. Inspira developed a safety facilitator (SF) role. The SF is a CNA who performs hourly purposeful rounds on all acute patients. The SF does not have a dedicated patient assignment. The SF has additional customer service training and ensures all required safety devices are in place. The SF is very visible to patients and assists with many basic needs and requests.

Evaluation:
After a trial on one unit, the SF Role showed a positive impact on patient satisfaction and fall rates. The role was replicated on all acute areas in the hospital. Inpsira fall rates have remained below the NDNQI mean of 3.25 since implementation. The current rate is 1.82, a 48% decrease.

Implications for Practice:
Support from senior leaders to promote safety, quality and patient satisfaction was vital to the success of implanting the SF role in all acute care units across the system. The SF role can easily be adapted to other care settings and patient populations and potentially other nosocomial risks.