Patient-Centered and Interprofessional Approaches to Falls Prevention

Purpose:
The overall purpose of this initiative was to reduce inpatient falls through development and implementation of a patient-centered evidence-based falls prevention bundle focused on active patient engagement, partnerships with staff, educational materials, and interprofessional collaboration.

Relevance/Significance:
Hospital falls are associated with longer lengths of stay, increased hospital costs, and loss of autonomy. There is conflicting evidence on the effectiveness of multicomponent falls programs and little data exist regarding patient-centered approaches to reduce falls. After noting an upward trend in falls, an interprofessional working group was formed to increase awareness about falls prevention, with an overall goal of reducing inpatient falls.

Strategy and Implementation:
A falls quality improvement initiative was conducted using the Model for Improvement to guide the work. Interprofessional teams were formed and “SMART” aims were established to reduce falls by 25% and falls with injury by 50% by September 30, 2015. Falls data (current state process maps, fish bone diagrams, descriptive data and run charts) were reviewed and ideas were shared in biweekly meetings. Patient-centered strategies specific to the target population were implemented, including use of “call, don't fall” signs in patient rooms, patient sitter check-lists, falling star reminders on doors and charts, implementation of daily interprofessional huddles, falls safety discussions on admission, and improved interprofessional communication. Qualitative comments were also captured to assess patient, family and healthcare staff awareness of the initiative. Interventions were initiated on February 1, 2015 and data are currently being monitored for post-implementation effectiveness.

Evaluation:
Thus far, there has been a reduction in falls on all units. Common implementation themes across units included the creation of patient partnerships, awareness-raising via unit bulletin boards, and “contracting” with patients to call for assistance. Qualitative themes centered on patient-initiated communication of specific individual needs to enhance safety.

Implications for Practice:
A patient-centered approach of engaging patients, families and interprofessional staff in falls prevention may assist in preventing falls. Continued data analyses and review of lessons learned will inform which interventions are sustainable and most useful for spread to other units.