REDUCING IN

HOSPITAL
FALLS

Marielle Briones, Makeda DeComas,

Ramsey Valdes, Rachel Warner Figure 1
INTRODUCTION
Problem: Hospital Falls

Goal: To improve workflow

and hospital costs by
decreasing in patient falls

Rationale: Patient falls are

the most commonly
reported adverse event (Hill
Figure 2
et al., 2015).
 PLAN:MEASURE
● Goal: To prevent falls in high-risk
populations in a cost-effective manor
○ A non-injury fall costs an average $1586
(Spetz, Brown & Aydin; 2015)

● Fall interventions can be expensive

and time-consuming
○ It is important to individualize interventions
to the risk level of the patient (Spetz, Brown Figure 3
& Aydin; 2015).
○ The Morse Fall Scale is one proven method
to predict fall risk that is relatively quick and
easy (Urbanetto, 2017).

Figure 4
PLAN: ANALYZE ● Interventions to Prevent Falls
○ Low cost standard interventions shown to reduce falls 55-
72% (Hoke & Guarracino, 2016).
■ Non-skid socks, signs, alarms and patient instructions
■ Responding to call alarms within 60 seconds
■ Placing “high-risk” patients closer to the nurses station
■ Doing hourly rounding on “high-risk” patients
■ Educating nurses on their role and accountability for
preventing falls
○ Interdisciplinary Fall Teams are shown to significantly reduce
falls (Goldsack, et al., 2015).
■ Engage in peer education to ensure staff is maintaining
■ Run Root Cause Analyses on falls to determine
Figure 5
patterns and weaknesses
● Challenges to implementing interventions
○ Up-front costs of education to nurses
○ Additional workload for nurses
○ Resistance from nurses to change in fall protocol
DO: IMPROVE
● Improvement Goal: Implement interdisciplinary
staff and patient education program on fall
prevention and reduce redundant interventions
● Who: Nurses and staff providing direct patient
care
○ Unit leaders
● Implementation: education on program guidelines Figure 6

provided at staff meetings before implementation

and monthly thereafter to maintain awareness
DO: IMPROVE
● Collaborative goal setting between provider and
patient (Goldsack et al., 2015) (Hills et al., 2015)
● Patient Goals:
○ Participate in creation of safety goals
○ Participate in determination of mobility level/use
of aids
○ Understand importance of safety interventions
○ Use call bell for assistance
● Staff Goals:
○ Facilitate creation of safety goals
○ Facilitate determination of mobility level/mobility
aids necessity
○ Provide education on safety interventions and Figure 7
ensure patient understanding
○ Respond to call bells in a timely manner
○ Document safety goals and completion of
education
STUDY
● Six month pilot program
○ Documentation Sampling
○ Staff Surveys
○ Patient Surveys
○ Incident Reporting

● Necessary adjustments to
Figure 8
environment, high risk areas,
patient satisfaction and staff
satisfaction
ACT: CONTROL
● Steps to carry on program:
Figure 9
○ Implementation of staff and patient education to the
entire hospital/facility
○ Follow-up with unit leaders
○ Quarterly evaluations and staff surveys
○ Regular unit checks on equipment/supplies that aid in
fall prevention
○ Proper staffing for each unit to sustain tolerable
workload
● Next Cycle: Develop structured protocol for
specialized units
○ NICU, units for AMS patients, etc.
○ Allowing interdisciplinary input
○ Program aim towards family education
Figure 10
REFERENCES
Goldsack, J., Bergey, M., Mascioli, S. & Cunningham, J. (2015). Hourly rounding and patient falls: what factors
boost success? Nursing. 45(2), 25-30. doi:10.1097/01.NURSE.0000459798.79840.95

Hill, A. M., McPhail, S. M., Waldron, N., Etherton-Beer, C., Ingram, K., Flicker, L.,...Haines, T. P. (2015). Fall rates
in hospital rehabilitation units after individualized patient and staff education programmes: a pragmatic, stepped-
wedge, cluster-randomised controlled trial. The Lancet, 385(9987), 2556-2557. doi: https://doi.org/10.1016/S0140-
6736(14)61945-0

Hoke, M. & Guarracino, D. (2016). Beyond socks, signs, and alarms: A reflective accountability model for fall
prevention. American Journal of Nursing, 116(1), 42-47. doi:10.1097/01.NAJ.0000476167.43671.00

Spetz, J., Brown, D. & Aydin, C. (2015). The economics of preventing hospital falls. Journal of Nursing
Administration, 45(1), 50-57. doi:10.1097/NNA.0000000000000154

Urbanetto, J., Pasa, T., Bittencout, H., Franz, F., Rosa, V. & Magnago, T. (2017). Analysis of risk prediction
capability and validity of Morse Fall Scale. Revista Gaucha de Enfermagem, 37(4), 1-6. doi:10.1590/1983-
1447.2016.04.62200