Abstract
Background: Every year in the United States, hundreds of thousands of patients fall in hospitals with 30 to 50 percent resulting in injury. In Texas, the fall rate in adult patients is 33.9 percent, and in one teaching hospital in South Texas, patient fall rates have been above the national benchmark for two years (2017-2019), despite increased use of sitters for patient safety and multiple fall prevention strategies. The annual direct care cost of all fall events in the United States for individuals more than 65 years old is about $34 billion. Practice problem: The objectives of the fall initiative program were increasing adherence to documentation of data from the Morse Fall Assessment and tailored interventions in the electronic health record. The goal of the project was to promote patient safety by decreasing the fall rate per 1000 patient days to below the national benchmark of 3.44/1000 patient days. Intervention: The project was piloted in two telemetry units over 12 weeks using the Iowa Model of Evidence-based Practice. Telemetry staff received one-on-one education from the educator in the unit using a tailored intervention poster. The Nurse Champion observed 58 rooms and conducted chart documentation to ensure universal fall precautions were carried out during every shift. Incidence of falls was tracked daily, and post fall huddles were conducted after any incidents. Outcome: The average monthly fall rate after implementation was 2.47/1000 patient days, which was below the national benchmark. Conclusion: The fall assessment documentation in two telemetry units at DHR Health can be adapted or implemented hospital-wide. The results showed a statistically significant correlation between the Morse fall score assessment on EHR and monthly fall events (p=0. 0078). Champions were able to identify interventions and areas that needed to be improved such as education, patient engagement and stakeholder buy-in.
Highlights
There is considerable evidence for effective fall prevention, and healthcare stakeholders are implementing quality improvement projects and evidence-based practices to protect patients from harm (Ayton et al, 2017; Dykes et al, 2017; Laulirn & Shorr, 2019)
There were only seven articles synthesized to develop evidence-based practice recommendations for building a fall prevention checklist intervention, other three articles were removed because the authors reviewed, assessed, and evaluated the efficacy of the EBP journals
The DNP project leader found that the Morse Fall Assessment showed clinically and statistically significant results in decreasing the fall rate over 12 weeks with an average of 2.47 /1000 patient days, which is below national benchmark
Summary
There is considerable evidence for effective fall prevention, and healthcare stakeholders are implementing quality improvement projects and evidence-based practices to protect patients from harm (Ayton et al, 2017; Dykes et al, 2017; Laulirn & Shorr, 2019). Recommended successful strategies include the use of a standardized fall assessment, fall checklist, rounding tool, and tailored interventions (Dykes et al, 2017; The Joint Commission, 2015; Spano et al, 2018; Titler et al, 2015) The focus of this project was to implement an effective and proven fall prevention intervention that could become a best practice. Many hospitals are still using fall prevention programs despite the limited evidence from the literature to support their efficacy (Laws & Crawford, 2013) This project utilized the Iowa Model of Evidence Based-Practice to promote patient safety and prevent harm. The Iowa Model's conceptual framework underlined pliancy in acknowledging the importance of high-level research, but recognized that this kind of evidence will not be always available (Buckwalter et al, 2017) In this evidence-based practice project, stakeholders needed to adapt to the best available data from the available practice recommendations (Buckwalter et al, 2017). Based on the literature review and synthesis (see Appendices B and C), the Iowa Model was an excellent model to translate evidence into practice
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