EXECUTIVE SUMMARY
A hospital is reporting a 75% reduction in falls through the use of a performance improvement team. The team uses a “bundle” of strategies to reduce falls.
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Increasing the awareness of hospital staff members was a key component.
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The plan also addressed common fall risks, such as patients trying to go to the toilet on their own.
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Hospital leaders must be willing to invest in fall reduction.
A hospital in Atlanta has reduced falls by 75% with interventions that were implemented by a performance improvement team. Raising awareness among staff members about the risk of falls was a major component of the effort.
Like all hospitals, Grady Memorial Hospital continually addressed falls as a patient safety and liability risk, and in 2011 the fall rates seemed under control, explains Rosiland Harris, DNP, APRN, RNC, ACNS, BC, director of professional nursing education, practice, and research for the Grady Health System. Then the number of falls with injuries doubled between 2011 and 2012.
That increase was a red flag that something was seriously wrong, Harris says. She determined that fall prevention efforts had relaxed and Grady was not using many of the best practices. Grady’s fall rate was still under the average when compared with national benchmarks, but the rate continued to rise.
Harris and Patient Safety Officer Donise Musheno, RN, MS, CPHQ, worked to secure support from senior leadership and established a multidisciplinary fall team at the hospital with members from risk management, quality, nursing, education, medical staff, and physical therapy. One of the first actions the team took was to ensure that Grady complied to the letter with the universal falls precautions. That effort meant using signage, color-coded socks and arm bands, bed alarms, nurse telephone connections directly to the bed alarms, and a strong focus on hourly rounding to assess the patient’s need to use the bathroom.
“Research has demonstrated over and over again that one of the main reasons people fall is trying to get out of the bed to go to the bathroom,” Harris says. “We also made a strong effort to assess patients thoroughly for their fall risk and then to take the necessary precautions.”
Some of the protocols required substantial purchases for signage, socks, armbands and new telephone systems for nurses, Harris says. Senior leadership support was crucial in making sure those expenditures were approved, she says. Even simple items such as the socks must be kept in constant supply so that no patient is left at risk because the supply ran out.
In addition, Grady ensured that each patient room had a bedside commode. The paper signage previously used was changed for more durable, but more expensive, permanent signage that could be modified for the patient. Grady also mounted a white board in each room so that the nurse making rounds could check off that he or she asked if the patient needed assistance.
Much of the efforts were not innovative but rather the Grady team focused on ensuring strict compliance with the protocols that are known to reduce falls. That focus required staff education and also working with patients to encourage them to communicate their needs, Harris says.
“It took a host of different measures and interventions, and a very intense focus on them,” Harris says. “The hardest thing was to stay focused and not let up. We wanted it to become second nature, and it did because we remained below the national benchmark for nine consecutive quarters, about 27 months.”
As a result of the education, the tools provided, and the enhanced awareness, the recorded rate of falls decreased by more than 75% during the first quarter of 2014. The number of patient falls with injury per 1,000 patient days was 15% in 2011 and 28% in 2012. At the end of 2013, the rate was 0.5%. Grady has since had a steady rate of 0.7%.
Musheno notes that reduction in falls was well worth the investment in time and money, from a patient safety and a financial perspective. A fall with injury typically increases costs to the hospital by 60%, and the Centers for Medicare and Medicaid Services (CMS) limits reimbursement for fall-related injuries.
“From a human factor, taking care our patients and keeping them safe, reducing falls has to be a top priority,” Musheno says. “From the standpoint of the resources that are devoted to caring for patients after a fall and the limited reimbursement from CMS, a fall reduction program like this is a huge opportunity for the organization.”
