When a fall occurs—and, yes, they do occur—we conduct an immediate root cause analysis. We evaluate whether the patient was assessed correctly and interventions were implemented, and then determine the cause variable that led to the patient's fall. Each fall is reported at the monthly meeting for further evaluation and education.
Other fall reduction strategies that we continued to utilize are as follows:
- Bed alarms. We purchased more units and increased use of the bed alarms through our call light to the two-way communication device.
- Volunteer sitter program. We are fortunate to live in a university community and have tapped into the university to establish a sitter pool for students to volunteer once provided the competency development.
- Companion program. We have hired staff to work in our float pool to function as companions for patients needing one-to-one care. The companions function as patient care technicians for the one patient assignment, thus freeing up time for nursing staff to care for other patients.
- Daily fall risk assessment and falling star program. We evaluate patients for fall risk at least once per day to see what variables have changed. In addition, if a patient has suffered a fall, we attach a falling star symbol to the outside of the patient room to alert staff to the greater potential of a repeat fall.
- Monthly celebration. We track the unit fall rates daily. The unit that goes the most days without a patient fall within the month receives a celebration.
- Poly-pharmacy review. We are implementing a poly-pharmacy review of all fall risk patients on 10 or more medications to identify opportunities to reduce the impact of medications on the patient's outcome.
The results through the first six months of this fiscal year demonstrate our fall rate as 2.8/1,000. This is a 26% reduction in falls from the previous year baseline rate of 3.8/1,000, and the monthly variation in fall rate has diminished. We have not eliminated falls, nor do I know whether that is possible; however, we are well on our way to reducing the potential of this harm for our patients.
Neal T. Loes, RN, BSN, MS, is chief nursing officer at Mary Greeley Medical Center in Ames, IA.
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