Clinician-led project to reduce in-hospital falls

Erin Finn Director Clinical Governance

Stephen Caddick Team Leader Quality Sandy Lewis Senior Consumer Liaison Officer West Moreton Hospital and Health Service, Ipswich, Queensland

Background

Inpatient falls are the most common adverse event reported in hospitals.

Problem/Aim

Benchmarking data from the Health Roundtable have shown Ipswich Hospital as an outlier among peer hospitals for both its rate of all inhospital falls and its rate of falls with serious harm (fracture or intracranial injury). The aim of this improvement project was to reduce the rate of all falls, and the rate of falls with serious harm, at Ipswich Hospital.

Design

A working group of multidisciplinary frontline clinicians from a variety of wards in the hospital was formed to explore the factors it believed contributed to falls at Ipswich Hospital. The Pareto principle was applied to prioritise the factors that the clinicians considered most important. At its next meeting, the working group brainstormed potential interventions for each key contributing factor. The potential interventions were then prioritised for testing by using a cost/ effort matrix, focusing on low-cost/ low-effort for initial trials. The two chosen interventions for trial were:

• improved interdisciplinary communication using a patient flow manager (PFM) application • improved compliance with timely nursing falls risk assessment and management planning. These interventions were tested in PDSA cycles, each in separate wards.

Results

The interdisciplinary communication intervention on Ward 7C involved physiotherapists directly entering patient mobility information in the PFM (from which nursing handovers are created). There was some role confusion in the first week, but this reduced with changed communication strategies in Week 2. In Week 3, the process was working smoothly, and by Week 4, staff were keen to roll out the new process further. Initial results were positive, with falls reduced from nine (13.6 per 1,000 occupied bed days) in the month preceding the intervention to five (6.8 per 1,000 occupied bed days) in the intervention period, a reduction of 6.8 per 1,000 occupied bed days (with one of those occurring on the first day). Excluding the first day of the trial, only one fall occurred on a weekday during the intervention period, with the remaining three falls occurring on a weekend when physiotherapists were not present to update the PFM. This apparent effect warrants furtherexploration. The reliable risk assessment intervention on Ward 7A initially involved reminders to staff of the need for timely risk assessment, followed by a daily review of each patient chart by either a quality coordinator or the ward’s clinical development facilitator (CDF). In the second week, noncompliance data were displayed in the ward on a safety cross. Initial results were again positive, with compliance rapidly increasing and sustained over the trial period. There were no falls in the ward during the intervention period.

Conclusion

While the authors are cautious about drawing conclusions at this early stage, the early data that are available suggest that both interventions appear promising to reduce falls at Ipswich Hospital. Further time is required to determine the sustainability of the interventions, as well as their longterm effect on falls rates.

Next steps

During April, Ward 7C tested the combined effects of the two initial interventions, which resulted in a further reduction in the number of patient falls to four (5.8 per 1,000 occupied bed days, a reduction of 1 per 1,000 occupied bed days). The next step will be to implement the two interventions across all medical wards.

Acknowledgements

The project team would like to acknowledge the members of the working group: Carol McLennan, Scott Jen, Kim Brown, Vicky Bates, Scott Brown, Megan Bool, Denise Woodford, Sharon Kwiatkowski, Leah Ireland, Shelley Smith, Sam Woodhouse and Craig Hulme.