Patient falls with injury are a major safety concern. These injuries add cost, detract from patient experience, and at worst cause pain and in extreme cases, even death. We sought to reduce the incidence of injuries sustained from falls with a goal of a 50% reduction from the previous year.
The national average for inpatient falls is two per minute. Related injuries range from minor to fatal, and even a minor fall can increase length of stay and related costs. The literature demonstrates the mean cost of a fall-related injury is greater than $6,600, with the average length of stay following a severe injury to be an average of 38 days longer.
To achieve a patient-focused approach, an interprofessional team was formed including members of Nursing, Pharmacy, Physical Therapy, as well as a patient/family advisor. A literature review was completed using the Johns Hopkins Evidence Appraisal Tool. Common themes focused on the availability of fall and injury prevention measures and consistent application of measures already in place. With this information, the team created a tiered bundle which initiates basic interventions for every patient and increases measures based on fall risk. Once clinical staff was educated on the use of the new bundle, interventions were put into place. Patients and family members were educated regarding individual patient fall risk each shift. The team began auditing bundle implementation once a week, but found compliance was less than desirable and increased auditing to twice a week. This included real-time coaching with staff when indicated fall prevention measures were not in place.
Our initial goal was to reduce injuries from falls by fifty percent from the same six-month period in the previous year. We exceeded that goal with zero injuries. Since then, we have maintained an overall reduction of injuries from falls by sixty percent, including a reduction in our fall injury rate, from .70 to .28 per thousand patient days.
We found several points relevant to further discussion and collaboration. A Fall Safety Bundle is an effective intervention for prevention of injuries. Discussing individual fall risk with patients and families each shift is crucial. Auditing bundle compliance and coaching staff in real-time was necessary to ensure accountability.