Reducing Falls in an Acute Medical-Surgical

Patient falls are one of the most costly things that all hospitals deal with and try to control. On B5 medical-surgical unit at Thomas Jefferson’s Methodist division, the number of falls per 1000 patient days became a huge problem in October 2017. Prior to October, the unit had enjoyed a steady reduction in their fall rate, down to a rate of 0 falls/1000 days over a 4 month period. In response to the high fall rate, the B5 unit council decided to implement an evidence-based intervention to attempt to reduce the number of falls on their unit.

In October 2017, the fall rate was 6.12, then in November it climbed to 9.32; at this time the B5 Unit Council felt they should roll out an evidence-based intervention to try and help reduce falls. The Unit Council decided to create Seasonal Magnets themed to the 4 seasons that would be an additional feature outside the room of those patients deemed to be “high risk for “falls”. The Unit Council hoped this would help to overcome the lack of attention staff paid to the current Red “Falls Risk” Magnets that were currently being used. This intervention was explained to the staff via education by the Unit Council members and the CNS, and weekly newsletter notification and then instituted to begin on November 1^st. This intervention took a while to show any signs of helping the fall issue, but then the fall rate fell to 1.61 in January 2018. Great! Unfortunately, come February the unit began to experience an increase in patient falls including having more than 1 patient fall more than 1 time. This prompted the Unit Council to revisit the patient falls situation and look for further interventions. After surveying the nursing staff and having multiple discussions with staff, as well as reviewing literature, the Unit Council decided to design and create an educational pamphlet to be given to patients on the falls prevention interventions already in use on the floor as well as educational information on what can cause falls and how to avoid falling as a patient. This was finalized and voted on by the B5 staff and then education was again implemented for all staff via Unit council members and the CNS. Finally, this intervention was put into action on May 1^st, when the handouts started to be given to every admission coming into B5.

This is a focused, performance improvement project to address an ongoing problem with patient falls in the B5 medical-surgical unit at Methodist Hospital. Though there is no data at this time to show the success of these interventions, it appears preliminarily, that these interventions may be making a difference. The current plan is to look at the falls data for May, June and July in August to evaluate whether these interventions were successful in lowering the fall rate. Then the work will focus on maintenance of these interventions to maintain the decreased fall rate to below the NDNQI 25^th percentile, and hopefully, eventually to a rate of 0.

All nursing staff, including nursing assistants, clinical charge nurses, administrative charge nurses, and the Clinical Nurse Specialist of the B5 unit, were involved in successfully implementing these interventions on the unit. Patients were very receptive to the patient handout and the staff were then encouraged to teach them about the tips and points made in the patient handout. At the conclusion of the 90 day trial period, an evaluation will be given to staff to elicit any recommendations or critics. Unit council on B5 will then review all information and re-evaluate these interventions and determine the course of action for the future of B5.