Stop! Collaborate and Listen: Fall Prevention Deserves Your Attention

Purpose:
The purpose of this project was to reduce falls on an acute neuroscience inpatient unit. A Stop! Collaborate and Listen: Fall Prevention Deserves Your Attention campaign was used to re-infuse existing fall prevention strategies and to implement new fall prevention interventions.

Relevance/Significance:
Between 700,000 and 1,000,000 patients fall annually. The neuroscience population has a high fall rate ranging from 8.9-17.1 falls per 1,000 patient days. Approximately 1/3 of inpatient falls can be prevented. Literature reviewed to find a fall risk assessment tool specific to neuroscience patients. Current institutional Fall Risk Assessment Scale (FRAS) found to be best available. Multiple alternatives to restraints, such as fall reduction chairs and weighted blankets were used to reduce falls.

Strategy and Implementation:
Exisiting interventions were reinfused: retrained on the Fall Risk Assessment Scale and automated audits in the electronic documentation system, reinfused the institutional falls prevention program including interventions specific to each risk factor on the FRAS. Partnered with the biomedical department to enhance usability of alarm equipment, retrained on the importance of integrating bed alarm & call light cables, and increased access to low beds and fall reduction chairs. New interventions implemented included: personal alarms for high risk patients when out of bed, implementation of a No Pass Zone: all staff answering all call lights all the time, proactive rounding, EBP project evaluating and implementing weighted blankets to provide deep pressure touch. A four phased process for implementation included: creating awareness and interest, building knowledge and commitment, promote action and adoption, pursue integration and sustained use.

Evaluation:
This project resulted in a 40% reduction in the falls rate from 2013 to 2014 (7.9 to 4.9 Falls/1000 Pt Days) and an overall decline in the linear trend over the past 2 years.

Implications for Practice:
This campaign was an effective method of capturing the attention of clinicians. Successful practice changes can be made with a phased implementation. Continued efforts aimed at staff awareness and implementation of fall prevention interventions will be ongoing.