Title : Implementing a zero harm fall prevention through multifactorial strategies in acute care surgery unit
Abstract:
Hospital falls with injuries have a negative impact on the patients and the healthcare system (Wilson M. et al., 2022). In 2023, the acute care general surgery unit had 11 total falls, and three out of eleven had injuries, which means a fall rate of 0.33 per 1000 patient days. Since January 2024, this unit has had ten falls, and the number of falls with injuries has increased to five (0.97 per 1000 patient days). The NDNQI benchmark for in-patient surgical units for falls with injuries is 0.48 per 1000 patient days. These numbers mean that the unit is not meeting the target rate for this year. Approximately 20% of falls with injuries in older adults could lead to fatal complications that warrant hospital admission (Ojo, E. O., & Thiamwong, L. (2022). Reviews of the recent falls on the unit determined that several fallouts of the fall prevention bundle, such as not setting the bed alarm on, within arm’s length not implemented by the staff, no floor mats in each room on the unit, and inaccurate Hester Davis Scoring by the staff. These interventions are some of the best practices for preventing falls. The hospital has a comprehensive fall prevention program, including the fall risk assessment Hester Davis Scale (HDS). However, falls with injuries in the acute care surgery unit have significantly increased. Implementing a multifactorial strategy that includes education and awareness of unit fall rates can reduce the number of falls with injury (Wilson, M. et al., 2022). In Morris, M. et al. 2022 systematic review, clinician education significantly reduces hospital falls (P=0.03). This quality improvement project aimed to achieve a 25% reduction in falls and falls with injuries in the acute care general surgery unit through staff re-education on fall risk assessment, fall champions audits to ensure adherence to fall prevention interventions, and increased staff awareness regarding the fall incidents on the unit. The plan, do, check act (PDCA) framework was used for this project. The team reviewed the monthly fall events, contributing factors, and fall prevention fallouts. This data from the quality dashboard was shared in the shift huddles, weekly quality meetings and monthly staff meetings. All the nurses were re-educated on a fall risk assessment, the fall champions conducted ten audits per month, the monthly unit falls were communicated to the staff and posted to the unit board. The team compared and analyzed the data trends pre- and post-intervention. After three months of various fall prevention strategies, the number of falls was significantly reduced to 11% and zero fall related injuries were able to achieve post-interventions.
