Baby Steps! At Least We're Not Standing Still! Reducing ... · Agency for Healthcare Research and...
1
Baby Steps! At Least We're Not Standing Still! Reducing Inpatient Falls Raquel Bryan, MPH, MHA, RN-BC, Nursing Quality Coordinator, Cleveland Clinic Florida To have sustained reduction in the number of inpatient falls at our 155-bed community based, not for profit, teaching hospital by implementing fall prevention initiatives. To increase the knowledge of bedside nursing staff and non-nursing staff on fall prevention practices. To utilize the fall prevention tools to reduce the risk of fall. Inpatient falls are one of the most common adverse events and continue to be a significant problem for hospitals. According to the Agency for Healthcare Research and Quality (AHRQ), falls are a leading cause of hospital-acquired injury, and frequently prolong or complicate hospital stays. Approximately 700,000 to 1,000,000 individuals fall in the hospital each year. Inpatient falls are usually associated with elimination-related activities such as walking to or from the bathroom or bedside commode, reaching for toilet tissue, or exiting a soiled bed. Falls can have serious physical and psychological effects. Falls can result in increased length of stay and high rate of discharge into long- term care facilities. Psychologically, the consequences of a fall for patients can result in fear of falling, anxiety, distress, depression, and reduced physical activity. Likewise, falls also have an impact on the family members, caregivers, and health care professionals by making them susceptible to overly protective behavior or emotional reactions to falls, which can affect the patient's independence and rehabilitation. In response to the increase inpatient fall rate in quarter two (Q2) of 2012, which reached a rate of 4.26 falls per 1,000 patient days, Cleveland Clinic Florida (CCF) Hospital implemented multiple initiatives to decrease the fall rates. According to DiBardin, D., Cohen, E., Didwania, A. (2012), “Inpatient falls remain a main focus of patient safety and a measure of quality in this era of healthcare reform and quality improvement. Inpatient fall rates per 1000 patient-days range from 1.4 to 18.2. The absolute percentage of inpatients that fall ranges from 1.3% to 7%. Of inpatient falls, almost all data suggest that roughly one-third result in some type of injury while 3%-8% result in serious injury or death”. Also, in 2012, an article published by The Joint Commission Journal on Quality and Patient Safety states that “Although not all falls are preventable, recent Centers for Medicare & Medicaid Services regulations limit reimbursement for the care of fall-related injuries sustained during hospitalization.” The National Data Base of Nursing Quality Indicators (NDNQI) defined a fall as “an unplanned descent to the floor (or extension of the floor), including assisted falls, with or without injury to the patient, whether resulting from physiological or environmental reasons.” Knowing the importance of patient safety and the National Patient Safety Goals, a multidisciplinary fall committee was formed with the initial meeting held on October 15, 2012. Changing the institutional perception that fall prevention is a responsibility of only nursing staff was imperative to the fall prevention strategies. Therefore, this multidisciplinary team was formed to foster a cultural shift across disciplines. The committee members analyzed 2012 YTD data. From the analysis of the fall data, the fall committee developed several high priority recommendations for fall prevention. A two-phase implementation process was used to educate CCF staff. In phase 1, the multidisciplinary team provided education to nursing and non-nursing personnel, working in the inpatient care areas using the fall minimization policy and the prevention tools used to visually identify patients at high risk for fall. The physician champion educated the medical team on the fall prevention tools used on patients classified as high fall risk. In phase 2, the following initiatives were implemented: 1. Nursing representatives from the fall committee conducted quarterly fall intervention rounds on each unit to ensure compliance using the fall prevention tools 2. Unit based fall champions providing real time education to their peers and patients during fall intervention rounds 3. Patient education by nurses, pharmacist, physical therapy and physician champions was completed daily. 4. Phlebotomy and transport team members ensured bed was in low position and bed alarm turned on before they left the patient's room, and reminded the patients to call for assistance for out of bed activities 5. Implemented Fall awareness banner: an electronic awareness tool in electronic medical record used to identify high fall risk patients 6. Insured continued leadership participation in fall prevention: Unit leader accessed EPIC generated fall risk lists and rounded on patients at risk for fall daily or weekly 7. Addition of a 5th “P” (precautions) to the hourly rounding practice: the nursing staff were required to educate patients/families of their fall risk status and individualized interventions to prevent falls (potty, pain, position, possession and precautions) 8. Physical therapy communicated with nursing staff recommendation regarding patients ability to ambulate safely 9. Pharmacists educated patients on medications that placed them at risk for fall and interventions to prevent falls 10. Implementation of the double sided non-skid socks to prevent accidental falls 11. Implementation of a non-skid chair mat to prevent falls from recliners 12. Post fall assessment huddles to assess the root causes of each fall to identify trends and missed prevention opportunities Fostering a culture of safety and continuous quality improvement requires teamwork. CCF caregivers working cohesively as a multidisciplinary team has led to a decrease in the number of inpa- tient falls over a 2 year span of time. At the end of 2012 the CCF fall rate was 3.93 falls per 1000 patient days. In 2013 our fall rate decrease to 3.07 falls per 1000 patient days which is a 22 percent decrease in the fall rate, and in 2014 our fall rate went down by 17 percent to rate of 2.54 falls per 1000 patient days. Implementing these fall prevention measures at our hospital has led to a decrease number of inpatient falls throughout the years. Finally, having a multi- faceted approach to fall prevention and formu- lating a wide range plan for fall prevention can promote patient safety and increase both patients and caregiver satisfaction. Objectives Background Review Of Literature Methodology Outcomes/Measures/Results Changing the institutional perception that fall prevention is the responsibility of only nursing staff to shifting the responsibility of fall prevention to all staff has led to the success and sustainability of the fall prevent initiatives. Since the implementation of the fall committee, CCF has experienced a steady decrease in the fall rate. Teamwork of all our caregivers, the use of an effective assessment tool to identify patients at risk for fall, and the use of an assortment of fall prevention tools, has increased patient safety with a decrease in the number of falls over the past 2 years. We can say with confidence at least we are not standing still. Implications For Nursing Practice Reference Cleveland Clinic Nursing Institute. Fall minimization and post fall care, adult. Nursing protocol. Enterprise Policy # F 100. 3/01/2012? REVISED Weinberg, J., Proske, D., Szerszen,, A., Lefkovic, K., Cline, C., El-Sayegh, S., . . . Weiserbs, K. (2011). An Inpatient Fall Prevention Initiative in a Tertiary Care Hospital. The Joint Commission Journal on Quality and Patient Safety, 37(7), 12011-12011. DiBardin, D., Cohen, E., Didwania, A. (2012). Meta-analysis: Multidisciplinary Fall Prevention Strategies in the Acute. Journal of Hospital Medicine, 7(6), 1-1. National Database of Nursing Quality Indicators. Guidelines for Data Collection on the American Nurses Association's National Quality Forum Endorsed Measures: Nursing Care Hours per Patient Day, Skill Mix, Falls, Falls with Injury. National Center for Nursing Quality; March 2012. World Health Organization. Violence and Injury Prevention: Falls.2012. Accessed at www.who.intlviolence_injury_preventionlother_injurylfallslen on 25 July 2012. Special thanks to the multidisciplinary fall committee and the CCF staff 3.05 3.29 3.93 3.07 2.54 # Falls/1000 patient days 2010 2011 2012 2013 2014 Inpatient Falls nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
Transcript of Baby Steps! At Least We're Not Standing Still! Reducing ... · Agency for Healthcare Research and...
Baby Steps! At Least We're Not Standing Still! Reducing Inpatient Falls
Raquel Bryan, MPH, MHA, RN-BC, Nursing Quality Coordinator, Cleveland Clinic Florida
To have sustained reduction in the number of inpatient falls at our 155-bed community based, not for profit, teaching hospital by implementing fall prevention initiatives.
To increase the knowledge of bedside nursing staff and non-nursing staff on fall prevention practices.
To utilize the fall prevention tools to reduce the risk of fall.
Inpatient falls are one of the most common adverse events and continue to be a significant problem for hospitals. According to the Agency for Healthcare Research and Quality (AHRQ), falls are a leading cause of hospital-acquired injury, and frequently prolong or complicate hospital stays. Approximately 700,000 to 1,000,000 individuals fall in the hospital each year. Inpatient falls are usually associated with elimination-related activities such as walking to or from the bathroom or bedside commode, reaching for toilet tissue, or exiting a soiled bed.
Falls can have serious physical and psychological effects. Falls can result in increased length of stay and high rate of discharge into long-term care facilities.
Psychologically, the consequences of a fall for patients can result in fear of falling, anxiety, distress, depression, and reduced physical activity. Likewise, falls also have an impact on the family members, caregivers, and health care professionals by making them susceptible to overly protective behavior or emotional reactions to falls, which can affect the patient's independence and rehabilitation. In response to the increase inpatient fall rate in quarter two (Q2) of 2012, which reached a rate of 4.26 falls per 1,000 patient days, Cleveland Clinic Florida (CCF) Hospital implemented multiple initiatives to decrease the fall rates.
According to DiBardin, D., Cohen, E., Didwania, A. (2012), “Inpatient falls remain a main focus of patient safety and a measure of quality in this era of healthcare reform and quality improvement. Inpatient fall rates per 1000 patient-days range from 1.4 to 18.2. The absolute percentage of inpatients that fall ranges from 1.3% to 7%. Of inpatient falls, almost all data suggest that roughly one-third result in some type of injury while 3%-8% result in serious injury or
death”. Also, in 2012, an article published by The Joint Commission Journal on Quality and Patient Safety states that “Although not all falls are preventable, recent Centers for Medicare & Medicaid Services regulations limit reimbursement for the care of fall-related injuries sustained during hospitalization.”
The National Data Base of Nursing Quality Indicators (NDNQI) defined a fall as “an unplanned descent to the floor (or extension of the floor), including assisted falls, with or without injury to the patient, whether resulting from physiological or environmental reasons.” Knowing the importance of patient safety and the National Patient Safety Goals, a multidisciplinary fall committee was formed with the initial meeting held on October 15, 2012. Changing the institutional perception that fall prevention is a responsibility of only nursing staff was imperative to the fall prevention strategies. Therefore, this multidisciplinary team was formed to foster a cultural shift across disciplines. The committee members analyzed 2012 YTD data. From the analysis of the fall data, the fall committee developed several high priority recommendations for fall prevention. A two-phase implementation process was used to educate CCF staff. In phase 1, the multidisciplinary team provided education to nursing and non-nursing personnel, working in the inpatient care areas using the fall minimization policy and the prevention tools used to visually identify patients at high risk for fall. The physician champion educated the medical team on the fall prevention tools used on patients classified as high fall risk. In phase 2, the following initiatives were implemented:
1. Nursing representatives from the fall committee conducted quarterly fall intervention rounds on each unit to ensure compliance using the fall prevention tools
2. Unit based fall champions providing real time education to their peers and patients during fall intervention rounds
3. Patient education by nurses, pharmacist, physical therapy and physician champions was completed daily.
4. Phlebotomy and transport team members ensured bed was in low position and bed alarm turned on before they left the patient's room, and reminded the patients to call for assistance for out of bed activities
5. Implemented Fall awareness banner: an electronic awareness tool in electronic medical record used to identify high fall risk patients
6. Insured continued leadership participation in fall prevention: Unit leader accessed EPIC generated fall risk lists and rounded on patients at risk for fall daily or weekly
7. Addition of a 5th “P” (precautions) to the hourly rounding practice: the nursing staff were required to educate patients/families of their fall risk status and individualized interventions to prevent falls (potty, pain, position, possession and precautions)
8. Physical therapy communicated with nursing staff recommendation regarding patients ability to ambulate safely
9. Pharmacists educated patients on medications that placed them at risk for fall and interventions to prevent falls
10. Implementation of the double sided non-skid socks to prevent accidental falls
11. Implementation of a non-skid chair mat to prevent falls from recliners
12. Post fall assessment huddles to assess the root causes of each fall to identify trends and missed prevention opportunities
Fostering a culture of safety and continuous quality improvement requires teamwork. CCF caregivers working cohesively as a multidisciplinary team has led to a decrease in the number of inpa-tient falls over a 2 year span of time. At the end of 2012 the CCF fall rate was 3.93 falls per 1000 patient days. In 2013 our fall rate decrease to 3.07 falls per 1000 patient days which is a 22 percent decrease in the fall rate, and in 2014 our fall rate went down by 17 percent to rate of 2.54 falls per 1000 patient days. Implementing these fall prevention measures at our hospital has led to a decrease number of inpatient falls throughout the years. Finally, having a multi-faceted approach to fall prevention and formu-lating a wide range plan for fall prevention can promote patient safety and increase both patients and caregiver satisfaction.
Objectives
Background
Review Of Literature
Methodology
Outcomes/Measures/Results
Changing the institutional perception that fall prevention is the responsibility of only nursing staff to shifting the responsibility of fall prevention to all staff has led to the success and sustainability of the fall prevent initiatives. Since the implementation of the fall committee, CCF has experienced a steady decrease in the fall rate. Teamwork of all our caregivers, the use of an effective assessment tool to identify patients at risk for fall, and the use of an assortment of fall prevention tools, has increased patient safety with a decrease in the number of falls over the past 2 years. We can say with confidence at least we are not standing still.
Implications For Nursing Practice
Reference
Cleveland Clinic Nursing Institute. Fall minimization and post fall care, adult. Nursing protocol. Enterprise Policy # F 100. 3/01/2012? REVISED
Weinberg, J., Proske, D., Szerszen,, A., Lefkovic, K., Cline, C., El-Sayegh, S., . . . Weiserbs, K. (2011). An Inpatient Fall Prevention Initiative in a Tertiary Care Hospital. The Joint Commission Journal on Quality and Patient Safety, 37(7), 12011-12011.
DiBardin, D., Cohen, E., Didwania, A. (2012). Meta-analysis: Multidisciplinary Fall Prevention Strategies in the Acute. Journal of Hospital Medicine, 7(6), 1-1.
National Database of Nursing Quality Indicators. Guidelines for Data Collection on the American Nurses Association's National Quality Forum Endorsed Measures: Nursing Care Hours per Patient Day, Skill Mix, Falls, Falls with Injury. National Center for Nursing Quality; March 2012.
World Health Organization. Violence and Injury Prevention: Falls.2012. Accessed at www.who.intlviolence_injury_preventionlother_injurylfallslen on 25 July 2012.
Special thanks to the multidisciplinary fall committee and the CCF staff
3.053.29
3.93
3.07
2.54
# Fa
lls/1
000
patie
nt d
ays
2010 2011 2012 2013 2014
Inpatient Falls
nicheprogram.org • 2016 Annual NICHE Conference • Care Across the Continuum
