Background: Inpatient falls are highly prevalent in the United States (US), with about 700,000 and 1,000,000 falls annually. Inpatient falls are associated with severe injuries that result in extended hospital stays and increased health care costs, mental and physical health complications, or even death. According to Avanecean et al. (2017), US health care institutions experience a 3.53% fall rate for every 1000 patient days. The estimated cost of patient falls is $30,000 for every event. Antioch Medical Center has a fall rate of 2.52 per 1000 patient days in 2020.
Purpose: The specific health care improvement project (HIP) examined the effectiveness of the fall prevention program in the 48-bed of medical-surgical unit at Kaiser Antioch Medical Center. The purpose of the HIP was to create awareness of fall prevention strategies among nursing staff, reducing the prevalence and incidence of falls. It includes targeted assessment and increased communication around falls.
Implementation: A frequent rounder was initiated for all patients that are at very high risk for falls. The high risk for falls was determined by using the Schmid fall risk assessment tool to identify the patient’s safety risk with a score of >3. Utilizing the ABCS (age, bones, coagulation, and surgery recently) tool to assess patients at high risk for injury from falls. The responsibility is to ensure the 5 Ps (pain, potty, position, personal needs, and pathway) are met and environmental safety is being checked. In addition, baby video monitors were used in the high-risk patients' rooms to allow direct observation of multiple patients including those rooms that were not close to the nurses’ station. If patients engage in risky behaviors, such as attempting to get out of bed without assistance, the staff can intervene faster. The baby monitor was used to communicate with patients timely to redirect them to allow additional time for nursing staff to arrive in the room. Multiple studies have shown that video monitoring is effective as mentioned by Quigley et.al., (2022). Performance improvement studies were conducted to show the effectiveness of having bed alarms activated (Cuttler et. al., 2017). All patients with a Schmidt score of four or more during the huddle are identified on the assignment shift and coded HFR (high-fall risk). This is to alert everybody who is not just taking care of that patient and their definitive plan of care regarding safety. Most importantly, increase staff communication and education about the critical nature of fall prevention and the positive outcomes associated with reducing falls.
Evaluation/outcome: There was a significant decline in fall incidents in the Kaiser Antioch medical-surgical unit. Fall incident from 3/2020 to 3/2021 was 29, compared to 18 incidents from 3/2021 to 3/2022. All falls per 1000 patient days in the facility for 3/2020 were 2.52 down to 1.46 on 3/2022. 98% of the staff were retrained in regards to fall prevention. Part of new-hire orientation is training them in regards to fall prevention programs. Periodic evaluation and random audits are being done monthly for sustainability.
Evidence-based references 1. Avanecean, D., Calliste, D., Contreras, T., Lim, Y., & Fitzpatrick, A. (2017). Effectiveness of patient-centered interventions on falls in the acute care setting: a quantitative systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 15(1), 55–65. https://doi.org/10.11124/JBISRIR-2016-002981 2. Cuttler, S. J., Barr-Walker, J., & Cuttler, L. (2017). Reducing medical-surgical inpatient falls and injuries with videos, icons, and alarms. BMJ Open Quality, 6(2), e000119. https://doi.org/10.1136/bmjoq-2017-000119 3. Quigley, B., Renz, S. M., & Bradway, C. (2022). Fall prevention and injury reduction utilizing continuous video monitoring: A quality improvement initiative. Journal of Nursing Care Quality, 37(2), 123–129. https://doi.org/10.1097/NCQ.0000000000000582