Development of the Obstetric Falls Risk Assessment System an Innovation for Patient Safety

Heafner, Linh Hoang

Saturday, 29 October 2011

Linh Hoang Heafner, RN, BSN¹
Deborah Suda, RN, MN¹
Nicole M. Casalenuovo, RNC, BSN¹
Anna Gawlinski, RN, FAAN²
Linda Searle Leach, PhD, RN³
(1)Department of Nursing, Ronald Reagan UCLA Medical Center, Los Angeles, CA
(2)Department of Nursing at the UCLA School of Nursing, Ronald Reagan UCLA Medical Center, Los Angeles, CA
(3)School of Nursing, University of California Los Angeles, Los Angeles, CA

Learning Objective 1: Discuss the significance of developing a specific obstetric falls prevention program.

Learning Objective 2: Describe evidence-based factors than have been shown to increase the risk of fall for hospitalized perinatal patients.

Current practices among perinatal units for falls risk assessment of the obstetric patient utilize existing fall risk tools created for geriatric and/or medical surgical patients. The purpose of the Obstetric Falls Risk Assessment System (OFRAS) is to improve safety for hospitalized obstetric patients using an assessment scoring tool and correlating fall prevention interventions.

This poster will describe the phases of development and implementation of an evidence-based OFRAS.

In Phase I, an obstetric falls prevention guideline was developed and implemented. Guideline assessment was based upon obstetric fall risk factors identified by expert perinatal nurses and validated through literature review. Guideline interventions focused on assisting patients to the bathroom. Following guideline implementation falls decreased from 6 to 1 in an 8 month period. The concern with the guideline was that determination of falls risk relied upon nursing clinical judgment. Literature suggests clinical judgment has comparable accuracy to a fall risk tool but judgment of less experienced nurses may be less accurate. Bias in assessment accuracy due to nursing experience became the rationale for the development of the OFRAS Phase II. Stratification of obstetric fall risk factors across 5 categories structured the fall risk assessment tool. Retrospective analysis of obstetric falls patients using the tool revealed additional risk factors, therefore a sixth category was added and the guideline was amended with nursing interventions based on these findings. Phase III aims to complete prospective data collection and analysis to evaluate the OFRAS assessment tool.

Implementing an obstetric population falls prevention guideline decreased the number of inpatient falls. Developing the OFRAS with a scoring tool to determine the patient’s fall risk with interventions reflecting these scores provides a systematic approach for nurses. This is an evidence-based approach to care focusing safety efforts on a typically young, healthy patient population.

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