2021 Annual Conference

CNS Improving Outcomes
Quality Initiatives

Significance and Background: At the end of 2018 there was an increase in patient falls in the adult non-ICU spaces of a Midwestern teaching hospital. Review of the falls revealed a trend of bed and bed alarm related factors contributing to these cases. At the same time, the hospital standardized to a bed with smart technology monitoring abilities that could capture and alert staff to changes in pre-set safety parameters. A core team of fall prevention committee members, led by two clinical nurse specialists, created a standard for bed use and monitoring in addition to a rounding plan for compliance, education and assessment of outcomes. Research objectives: The project had 3 identified objectives. (1) Reduce the fall rate over a three month period post intervention implementation; (2) Reduce the number of falls over a three month period post intervention implementation; and (3) Maintain unit compliance to appropriate smart bed monitoring functionality (bed light equals green) at a rate greater than 85%. Methods: The intervention for this work centered on educating and promoting the use of appropriate smart bed monitoring technology for the first two weeks of initiation. After that two week period, groups of two to three members of the core fall prevention team rounded on 15 units looking for compliance with the use of appropriate smart bed monitoring technology from mid-March until the end of April. The beds would illuminate green when the pre-set safety parameters were in place and teams used an electronic data collection tool to track and measure compliance. On the spot education and coaching took place for any fall outs and results were delivered to unit leadership following the rounding. Evaluation Methods: Fall rate and number were assessed for three months prior to the initiation of the weekly focused rounding. Weekly rounding began in March of 2019 and fall rates and numbers were monitored in the non-ICU adult spaces for April, May and June. Compliance to bed safety parameters being set correctly was also measured. This intervention would be considered successful if there was a reduction in overall fall number and rate, and a smart bed monitoring functionality compliance greater than 0.85 or 85%. Outcomes: There was a reduction in fall rate post-intervention implementation by 22.4% from 3.17 to 2.46. There was a reduction in overall number of falls by 21.6% from 111 to 87 in a three month period. Of the 15 non-ICU adult units in which this intervention was initiated, 12 units had a reduction in both fall rate and number. This is indicative of an 80% unit improvement rate. There was an increase in compliance to smart bed monitoring functionality by 61% from 30% to 91%. Implications: Dedicated, focused rounding with education and coaching in addition to standardized use of smart bed monitoring of pre-set bed safety parameters dictated by patient condition significantly reduced falls in the adult non-ICU space. This technology and rounding plan has the potential to be generalized to the ICU space as well. The ICU version of the smart bed monitoring functionality is more complex and would take increased dedicated education for competency from staff. In addition, this rounding plan proved successful and will be mimicked for future initiative roll outs.