Individualizing Fall Prevention with Fall Prevention Clinical Decision Tool
Topic of Interest
Quality Initiatives
Abstract
Title: Fall Prevention Clinical Decision Tool on an Adult, Medical-Surgical Unit
Significance and Background: Patient falls within a hospital setting are a prevalent safety problem. The Centers for Medicare and Medicaid Services have identified patient falls during hospitalization should never occur and are considered a hospital-acquired condition. Patient falls within a 31-bed, adult, medical-surgical, nursing unit have been increasing significantly within the past three years. This nursing unit experienced a 71% increase in patient falls within the first quarter of fiscal year 2018 and 2019 of patients hospitalized for medical and post-operative care following orthopaedic, general, colorectal, or podiatric surgeries; costing the hospital an additional $365,456.00 and a superfluous 163.8 hospital days per year.
Evaluation Methods: The Fall Prevention Clinical Decision Tool was developed as a guide for nursing staff in an acute care setting to identify patients at an increased risk of falling during their hospitalization. The content is based on the hospital’s current Fall Prevention Program strategies evidenced to reduce in-patient falls. The project data will include the AHRQ Ministry of Health Fall Prevention Knowledge test as the pre- and post-test, adherence rate of nursing staff to the Fall Prevention Program intervention, and the unit-based fall rate pre- and post-intervention.
Outcomes: Following Roger’s Theory of Diffusion framework, nightshift nursing staff adherence to the existing hospital Fall Prevention Program significantly increased. A total of 1,206 Fall Prevention Clinical Decision Tools have been collected during the 8-week implementation period. The tool was analyzed for nursing staff adherence to the existing Fall Prevention Program and unit-based patient falls rate. The unit-based fall rate decreased from 2.25 to 1.11 patient falls per 1,000 patient days.
Implications: Implementing a Fall Prevention Clinical Decision Tool is effective in heightening awareness of patient fall interventions within a medical-surgical nursing unit. The Fall Prevention Clinical Decision Tool guides nursing staff to correlate patients’ Morse Fall Scale score with the patients’ fall risk. The tool provides recommendations of which Fall Prevention Program interventions are appropriate to implement for patients that are identified as being at a low, moderate, or high risk of falling based on the patients’ Morse Fall Scale score. The Fall Prevention Clinical Decision Tool can be adapted to any Fall Prevention Program interventions and any clinical nursing practice culture.
Keywords: fall prevention, falls-acute care, fall prevention in hospitals, fall prevention checklist