Purpose: The purpose of this quality improvement initiative is to prevent falls and allow safe passage of our medical-surgical patients. This initiative will introduce an auditing tool that will be used to ensure evidence-based practices are in place to help prevent these falls from occurring. The patient population on Baylor Scott and White’s fourth floor 36-bed unit includes orthopedics, stroke, surgical, and cardiac catheterization. This unit realized that there was an opportunity for improvement after determining the unit fall ratio was greater than the NDNQI benchmark of 3 falls per thousand patient days. The project was undertaken as a quality improvement initiative reviewed by IRB. It was determined IRB oversight was not required for this project.
Description: During the prior 12 months, the fourth floor had a total of 40 falls in which 11 patients were injured. In the month of September 2020, the fourth-floor leadership began auditing all patients scoring moderate or high on the Johns Hopkins Fall Risk Assessment Tool (JHFRAT). According to research, having a fall bundle and daily auditing tool in place decreases the number of falls by educating and partnering with patients (Loresto, Grant, Solberg, & Eron, 2019). The fourth-floor falls committee created an evidence-based fall bundle audit that includes daily patient education, updated fall risk sign on door, gait belt in room, bed in lowest position with alarm activated, fall risk band, yellow non-skid socks on patient, room clear of all tripping hazards, and patient possessions within reach. After completing the daily audit, the leader coaches the nurse and care technician on any missing components. This coaching occurs in real time and allows the team to come together to ensure all aspects of the fall bundle are in place moving forward. In addition to one-on-one coaching, the results of the shift fall audit are discussed during safety huddle which occurs once per shift. Any barriers found during huddle are elevated to interdisciplinary department leadership. As this project unfolded, there was an opportunity to partner with other clinical areas to align facility goals and best practices. As a result, a facility falls committee was created which includes front-line staff from other inpatient units, radiology, physical and occupational therapy, physicians, quality department, and the vice president of patient care.
Evaluation: Prior to creating the fall bundle audit, the fourth floor had a total of 14 patients fall, 3 with injury, in the 5-month period of April to August 2020. This translates to an overall fall rate of 3.04 and fall with injury rate of 0.43. In the 5-month period post-intervention, the fourth floor had a total of 8 falls, 1 with injury. The overall fall rate was 1.59 and fall with injury rate was 0.21. Therefore, the fall rate decreased by 47.7 % and fall with injury rate decreased by 52.32%. Through interdisciplinary collaboration, we are continuing to work towards zero harm by decreasing patient falls.