Safety Auditing as a Nursing Accountability Measure for Hospital Fall Prevention

Preventing falls is important to patient safety.  Despite 15 years of focused, evidence-based efforts our hospital was not consistently reducing falls to desired benchmarks.  Decreasing falls through a sustainable culture change where healthcare providers are held accountable for intervention compliance was instituted.  Institution of a baseline then quarterly Safety Audits by Fall Unit Peer Leaders in every hospital area.  The Safety Audit Form is a visual representation of evidence and hospital policy based intervention requirements based on a patient’s Fall Risk Assessment Score.  The Safety Audits were performed from the Form and afforded direct remediation and correction of staff shortcomings in fall prevention by the unit peer leader immediately, increasing knowledge and awareness of all staff.  At timed intervals Unit Fall Peer Leaders (UFPL) audit their units and turn in the Safety Audit Form to one of the hospital’s Fall Committee Co-Chairs for Audit Evaluation.  Audit Evaluations were compiled and returned to the UFPL and manager that day for sharing with unit staff and development of action plans to correct issues and knowledge deficits in real time.  Audit results were shared at Fall Committee meetings, Risk and Quality Committee meetings, and Shared Leadership meetings to address compliance and accountability by all hospital staff.  There were 8 fall prevention interventions that were routinely audited.  From baseline to most recent audit (July 2014) each area showed a percent increase in compliance.  In Critical Care areas there was an 81% increase in compliance with correct documentation, 48% increase in compliance with bed in lowest position, and 171% increase in bed/chair alarm compliance.  In Floor Areas there was a 50% increase in compliance with correct documentation, 20% increase in compliance with having non-skid footwear available, and 33% increase in bed/chair alarm compliance.  Within the first three months of Safety Audit institution falls decreased from 3.41 to 3.05 falls/1000 patient days.  The overall annual benchmark goal of 3.17 falls/1000 patient days was achieved.  Fall rates continued to decrease; at the 11-month mark post culture change the average was 2.76 falls/1000 patient days.  Fall prevention is important for patient safety and satisfaction.  Our hospital needed a sustainable culture change to ensure patient safety and reduce patient fall rates.  Safety Audits as part of a culture change and as an accountability measure has proven a marked increase in intervention compliance and decrease of hospital fall rates.