Purpose: The purpose of this quality improvement project was to assess the perceptions of Acuity Adaptable staff nurses’ and care technicians fall prevention practices. The ultimate goal of the project was to understand barriers and suggestions about current fall prevention practices.
Significance: The average cost of an inpatient fall with injury at the facility is $44,000. Falls with injury increase cost and length of hospital stay and may produce serious harm to patients. Preventing inpatient falls is a critical aspect of patient safety. The number of falls on the Acuity Adaptable Units was not significantly reduced in the past year, and further reduction in falls was needed. In 2016, the average raw numbers of falls per month were 10.58, and 2017 year to date average raw number of falls per month is 9.8. One potential solution to identifying ways to further reduce falls was to survey staff for their perceptions about current fall prevention practices. Understanding staff perceptions and involving staff in the quality improvement process may lead to prevention solutions and actionable items to reduce falls.
Methods: An 8-item voluntary survey developed by the authors was administered to Acuity Adaptable Staff to assess their perceptions of fall prevention practices. Survey items addressed barriers, suggestions, concerns, and having the necessary fall prevention tools available.
Findings: Out of 233 eligible nursing staff, 60 registered nurses (RNs) completed the survey. Day shift staff RNs (n=22/37%) and Night Shift staff RNs (n=38/63%) participated with registered nurses representing 98% (n=59), and 12 eligible care techs 2% (n=1). Eighty-five percent were full time (n=51), ten percent part time (n=6), and five percent from the nursing float pool(n=3). Identified barriers to fall prevention were primarily related to patient non-compliance, lack of patient perception that they are a fall risk, confusion/medical condition, and the nursing staff not getting to the patient in time to prevent the fall. Concerns from surveyed staff included that bed alarms or other interventions were not consistently utilized, especially by non-nursing departments, fall risk assessment tool not accurately scored, and lack of staff communication that the patient is a high fall risk. Comments were made that staff felt the “Call Don’t Fall” sign and the chair alarm were effective interventions. Staff suggestions included additional interventions: implementing a gait belt, therapy activities, lap belts, pre-made packets of safety precautions (fall sign, yellow non-slip footwear and armband), shower mats, and additional staff and patient fall prevention education.
Conclusions: By surveying the staff, valuable information was gained about staff perception of fall prevention practices on the Acuity Adaptable Units. Other healthcare organizations could survey staff about their perceptions of effective fall prevention practices.
Implications: Staff should be involved in evaluating the fall prevention interventions and processes. Future plans to decrease falls on this unit includes implementing identified prevention solutions and actionable items to reduce falls based on the staff survey results.