Systemic change requires visionary leadership. The board of trustees for our facility established a new three-year strategic plan based on our six indicators of success. One such indicator is Quality & Patient Safety, and the board determined that this indicator should include a vision "to eliminate all preventable harm."
Given this direction, we chose to focus on patient falls and began to ask ourselves whether we could eliminate all falls. The prior year baseline for our organization was 3.8 falls per 1,000 patient days. When compared to the National Database of Nursing Quality Indicators, we were within the benchmark for our medical-surgical units.
We still believed there was opportunity for improvement. To ensure organizational involvement, we added the organizational fall rate as part of the leadership merit-based performance management system. This includes all supervisors, directors, and the administrative team. This step was crucial to remove barriers and to demonstrate support for this common goal.
Our strategy was simple: First, we organized a multidisciplinary team to meet monthly and began to look at the data. We found that although our falls had reduced over the past five years, there was still great variability from month to month and from unit to unit. We evaluated our fall reduction policy/program and felt it was relevant and remained current to the evidence-based literature we researched, with one exception: We implemented a national strategy promoted by the Iowa Healthcare Collaborative, which was to place a yellow wristband on all patients identified as a fall risk. We then reeducated our staff on their roles and the importance of the program.
Next, we went back to the data, which we stratified manually into day of week, time of day, level of fall prevention in place at time of fall, staffing adequacy, etc. We found through our data review that 42% of our falls occurred with bathroom activities, and there was a pattern of falls occurring at change of shift.
To address these issues, we educated our nursing staff on the data and modified our hourly rounding program so nursing staff were required to assist fall risk patients to the bathroom hourly. We also adjusted change of shift activities to free up the patient care technicians so they could make bathroom rounds prior to performing their vital signs and other duties. We use shift huddles to reinforce the fall prevention strategies and report successes, as well as issues, with falls that occur.