Falls represent a major public health problem. In the hospital setting, falls are the top adverse event. Injuries from falls are never events that are associated with morbidity and mortality, and which impact reimbursement. Nationally, 3% to 21% of inpatients fall at least once during their hospitalization. Injury prevalence ranges from 30% to 51%. Of these patients who are injured, 6%-44% experience similar types of injury (fracture, subdural hematoma, excessive bleeding) that may lead to death. Many interventions to prevent falls and fall-related injuries have been tested, but require multidisciplinary support for program adoption and reliable implementation.
By November 1, 2013, a 4th floor medical unit of a hospital was to decrease occurrences of patient falls from an average of 3.25 falls per month to 1.5 falls per month by appropriate use of bed alarms, gait belts, and patient and family fall prevention education. A fall was defined as ‘an unplanned descent to the floor with or without injury’.
- Used alarms appropriately and consistently.
- Reviewed bed alarm usage and opportunities.
- Performed audits during rounds to make sure bed alarm cords were secured to the bed.
- Implemented use of bed alarms on all patients.
- Purchased additional chair alarms and increased usage.
- Engaged transporters to ensure bed plugs were plugged in when returning a patient to the room.
- Implemented the “6th P” (bed alarm plug check) during hourly rounds.
- Used gait belts appropriately and consistently.
- Placed gait belt hooks in every patient room.
- Physical Therapy provided staff education regarding technique, benefit, and impacted use of gait belts.
- Placed signage above each hook stating “Gait Belt” to remind patients, staff and families to use the gait belt.
- Changed signage to “Everyone wears one” to be more patient and family centered.
- Included gait belts in admission packet.
- Educated patient and families regarding fall prevention.
- Revised fall prevention guidelines that are given to patients and families. Printed guidelines on yellow paper to align with yellow high-risk fall arm band.
- Placed the fall guidelines at the patient’s bedside, rather than in the admission folder to increase visibility and accessibility.
- Attached the guidelines to the yellow fall risk arm band to facilitate distribution.
The hospital’s 4th floor fall reduction team surpassed the AIM statement’s goal.
- Baseline rate: 0 falls per month
- Cumulative rate (post-interventions): 1.36 falls per month
- Improvement work has resulted in a 66.0% decrease in falls.
Projections done using the baseline period indicate there would have been 35.75 falls since the time the team was chartered, rather than the 15 that occurred.
- Projected (35.75) – Actual (15) = 25.75
- Financial Implications using frequency and severity of occurrences during the baseline:
- Number of Patients who had one fall x $3,500 =
- Number of Patients who had more than 2 falls x $16,500 =
- Number of Patients who had a fall with a serious injury x $27,000 =
This process was standardized throughout the hospital to facilitate ease of access and consistent use, and gait belt hooks were installed in all patients’ rooms throughout the facility. The hospital implemented “caught cha” cards to recognize and reward staff. Fall reduction was achieved through a multidisciplinary approach leveraging the appropriate use of bed alarms, gait belts, and patient and family fall prevention education.