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August 2012 Issue

Fall Prevention Pilot Cuts Patient Falls in Half

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Unit 7900 staff members were recognized with a pizza party in celebration of their success during a pilot program to reduce patient falls. Photo by Scott Ragan

By Patty Johnson, BJC TODAY

Falls among inpatients are a common problem in hospitals everywhere, with complex patient characteristics, circumstances and activities contributing to the falls.

To better protect patients and reduce fall injury rates, BJC HealthCare’s Falls with Injury Preventable Harm Team started a pilot program on three oncology units at Barnes-Jewish Hospital in August 2011. (A fourth unit, at Alton Memorial Hospital, began the pilot shortly thereafter.)

Since the program began, falls on the units have decreased 23 to 41 percent, and falls with injury have decreased 6 to 65 percent.

Identification, Education and Implementation of Interventions

Prior to the implementation of the pilot, the team completed an extensive review of fall prevention data nationwide and within BJC, benchmarked BJC hospitals’ data against best practices elsewhere and zeroed in on three units with high rates of falls – units 7900, 6900 and 3200.

“Oncology has a unique set of patients,” says Eileen Costantinou, chair of the BJH fall team and a member of the BJC Falls with Injury Preventable Harm Team. “Many of these patients were strong and healthy before they came into the hospital. But their treatment can make them sick and weak, and they might not understand their limitations.

“It’s difficult because they’ve lost their sense of empowerment, yet they’re not ready to ask for help,” Costantinou says. “That’s why it’s so important to involve the patients in keeping them safe.”

The three oncology units became the focus of a one-day event that brought together the units’ frontline staff and managers, as well as performance improvement and subject matter experts from across BJC.

The Falls with Injury Preventable Harm Team had discovered that three key areas related to patient falls lacked standardization across the organization:

  • Gait assessment, or assessment of the patient’s ability to walk
  • Mental status assessment, such as whether the patient showed confusion or disorientation
  • Follow-up investigation documentation, including the steps taken immediately after a fall

The goal of the one-day event was to create minimum standards for each of those areas. The teams selected a gait assessment tool and a mental status assessment tool and identified a post-fall investigation form and process. In addition, one team created an algorithm – a step-by-step list of instructions – to help staff select the proper interventions for each patient based on the patient’s fall risk assessment.

“The previous fall risk assessment in the electronic medical record wasn’t intuitive and wasn’t leading staff to select the proper interventions,” says Pat Matt, BJC Center for Clinical Excellence quality patient care specialist and clinical lead for the Falls with Injury and Pressure Ulcer Preventable Harm Team. (The Falls with Injury and Pressure Ulcer Preventable Harm teams combined to form one team in 2011.)

“The nurses were completing the fall risk assessment – they just weren’t choosing all of the correct interventions all of the time,” Matt adds. “The new process defines exactly what interventions need to be taken based on the patient’s fall risk assessment.”
For example, Matt says, if a patient has some difficulty walking, an intervention might include a walker being provided at the patient’s bedside for use during the patient’s hospital stay.

The final piece of the puzzle, the post-fall investigation tool, was standardized to provide a better understanding of factors contributing to falls and to identify areas of improvement.

After all of this “pre-work” was completed, each of the three oncology units at Barnes-Jewish Hospital determined how the interventions would be implemented on the units, staff members were trained, and the pilot program went live in August.

Pilot Makes a Difference

Since the pilot program began, the fall rate has decreased significantly on all of the units.

On 7900, for example, the fall rate dropped by 44 percent last year. Cathie Limbaugh, clinical nurse specialist, says the focus on assessment and proper interventions has been helpful – but education for patients and families, as well as staff engagement and understanding, are equally important.

“Fall prevention is everyone’s job and a team effort,” Limbaugh says. “Awareness is such a key component, including the fact that a patient’s status is frequently subject to change and that this changes the risk for fall.

“We learned a lot and we’re still learning,” Limbaugh says.

Adds Costantinou, “The staff did an awesome job. The culture really has changed. And this wouldn’t have been successful without the clinical nurse specialists and their guidance, knowledge and expertise with staff and patients. They were absolutely instrumental in the success of this program.”

“The level of engagement on the floors has been phenomenal,” adds Matt. “The staff truly own it. It’s ongoing and will continue to be ongoing. It’s about improving all along and engaging with all of the units.”

The standardized fall risk assessment, BJC interventions and post-fall investigation tool were rolled out in Horizon Clinicals in December and in Compass in March. Eventually, these and other documents will be available for all units to access on a SharePoint site.