Saturday, July 16, 2005
This presentation is part of : Evidence-Based Nursing to Meet Acute Care Challenges
An Evidence-Based Practice Approach to Reduce Patient Falls
Barbara Rickabaugh, RN, MS, Center for Nursing Research, University of California Davis Medical Center, Sacramento, CA, USA, Gail Easter, RN, MS, Patient Care Services, The University of California Davis Medical Center, Sacramento, CA, USA, Linda Moore, RN, BSN, MPA, Nursing Administration, U C Davis Medical Center, Sacramento, CA, USA, and Anita Garvey, RN, ND, Patient Care Services - Neuroscience Unit, U. C. Davis Medical Center, Sacramento, CA, USA.
Learning Objective #1: Identify at least two interventions to reduce patient falls in an acute care setting
Learning Objective #2: Describe the evidence-based practice process used by a multidisciplinary committee to reduce patient falls

Purpose: This presentation describes an approach to reduce patient falls in a large university hospital. A comprehensive evidence-based plan was developed to reduce patient falls. The implementation of one simple strategy caused a 37% reduction in patient falls. Further decline in the patient fall rate is anticipated as the plan unfolds.

Method: · The 2003 data indicated an average of 2.7 falls/1000 patient days (range: 0-8.4 for individual patient care areas). Sixty-seven percent (67%) of falls occurred to and from bed or bathroom. The Evidence-based Practice Committee (EBPC) felt improvement was indicated. · A literature review was conducted on patient falls and nurse staffing, fall risk factors, fall assessment instruments and interventions in an acute care setting. · Based on the evidence from the literature review, the committee decided on the following interventions: 1) place the bed in low position with three rails up and the bottom rail down on the exiting side of the bed, 2) place a poster in view reminding the patient and family to call for assistance, 3) incorporate a Risk Factor Assessment every 24 hours and after change in status via the electronic medical record system (EMR), 4) generate an automatic request via EMR for pharmacy medication review on select high risk patients. · Prior to the beginning of the three rails up, one down campaign, an educational program using the train-the-trainer concept was provided for assistant nurse managers, clinical resource nurses and unit safety officers.

Evaluation: · The monthly patient fall rate declined to an average of 1.7/1000 patient days (37% reduction) after the implementation of this evidence-based approach.

Conclusion: Some of the EBPC recommendations have been successfully implemented into clinical practice. The results have been encouraging and patient safety has improved.