Title : Multimodal approach to achieve zero fall rate in musculoskeletal and sports medicine service line in a tertiary care hospital setting
Background: Globally average fall rate is 3-5 falls per 1000 patients. 23-42% of inpatient falls lead to injury, of which 2% result in fracture. As most elderly patients are admitted to Musculoskeletal Service Line due to traumatic hip fracture, they are even at higher risk for another fall that can lead to poor prognosis and even mortality. From the year 2014 till 2018, 34 incidences of fall has been reported. In the year of 2019, 995 patients were admitted among these 5 cases of fall were reported in musculoskeletal and sports medicine service line. Objective: The aim of this quality project was to reduce the fall rate among orthopedic surgery patients.
Methods: The project was conducted utilizing PDSA framework. Fall etiology was identified to delineate modifiable factors. To reduce the risk of fall, detailed patient initial assessment, proper scoring of Morse scale and environmental safety plays a vital role. For proper screening of patients, in-service sessions were conducted to reinforce the proper and correct filling of Morse score. In order to improve the environmental safety we collaborated with the maintenance department of the hospital. We worked on environmental safety aspects that included proper lightening, cautious boards for slippery floors, bed maintenance in terms of proper locking systems, proper fixed side rails, use of safety belt for patient ambulation, use of emergency and nursing call bell, and availability of foot stools in washrooms. Commode chairs were also altered including changing of wheels, modification in locking systems, increasing cushion thickness and hand rest for patient comfort. To monitor sustainability, electronic and manual complain log has been maintained to monitor bed maintenance work. Furthermore we have an ongoing teaching session as part of staff educational activity in which fall measures has been taught to staff and guidance has been provided to follow fall precautions religiously in order to maintain compliances towards IPSG 6 which helps in reducing fall rates.
Results: After continuous efforts and by using multifactorial approach for fall prevention that includes proper risk score screening and modifying the factors that cause fall, the rate of fall has been reduced. In 2019, 5 cases of fall has been reported among 995 admissions of patient in orthopedic specialty. However in 2020 and 2021, there was 0 cases were reported in all the QTRs in musculoskeletal and sports medicine service line. Conclusion: Fall prevention requires active ongoing engagement in addition to interdisciplinary approach. Environmental modification and accurate use of screening tool helped to reduce the rate of fall in patients admitted to musculoskeletal and sports medicine service line.