Falling Down is for Babies!Reducing Falls in Hospitalized Pts.

MCCG snapshot

• 637 beds • Level 1 Trauma Center• Serves 29 counties (> 750 k residents)• 5000 employees; 1500 nurses• Regional economic impact > $1 Billion• Magnet designated 2005, 2009

MCCG Case for Action• 2009 under-perform NDNQI benchmark 68% of the

quarters in MS and CC units• Actions taken 2008-2009 not making a sustained

difference….– On line risk assessment– Fall CQIR– High risk interventions– 3Ps– Bed alarms high risk units

Cost of falls at MCCG:• Injury intervention, discomfort, pain • Scans, films, other diagnostics• ↑ length of stay• psychological effects• lawsuits• Decrease trust/ pt satisfaction• ↓reimbursement- CMS “never”

event- IQR

MCCG vs. NDNQI falls 1Q09-4Q09

2010: Ramping Up• Who falls? When? How? Why?• Re-energize Fall Committee• Strict interpretation of “fall”• Fall reduction as strategic goal• Current EBP• Fall research project• Fall NSICs and prevention bundle

Continuing the work 2010• Monitoring and feedback• Inter-disciplinary mandatory education• Recognition and accountability

• Additional technology• ↓ fall incidence 12% and injury incidence 18%– out-perform NDNQI 52%– 65% prevention strategies – We can do better……………

Bring on 2011• Continue to review and incorporate best

practices• Technology: bed alarms on all, pilots,

minimal lift• Integrate processes• 100% daily review of falls with feedback• Patient/ family partnership: contract,

brochure:

Patient/ Family Partnership

More 2011 improvements

• Strategic goal again• Engagement• Falls = errors: 100% review• Avoiding injury while assisting falls• Modify Morse scale: under-scoring high risk

pts. * UNDER-perform 49% 2009 ↑ 81% in 2010

Clinical Documentation of the Morse Screening pre-revision:

Protocol Reference Link

Modified Morse Scale 2011

Basic fall prevention ALL patients:

• Bathroom light• Education about falls

• Shift assessment• De-clutter, belongings• Bed low and locked• “Call Before You Fall”

EBP High fall risk prevention strategies

• >50 modified Morse scale or nursing judgment• Yellow for “caution”- signage, armband, non

skid slippers• Pt/ family partnership- education each shift,

brochure, contract, “teach back”• Bed and chair alarm, familiar voice• All disciplines accountable

More high risk prevention• Strategic side-rails• Bedside change of shift report• Use of minimal lift equipment and BSC• Purposeful/ accompanied toileting• Clinical Observer• Safety Net Bed in special circumstances• Patient Mobility algorithm

Where we’re at todayLeading/ process indicators:• Risk assessment accuracy• Prevention strategies• Staffing Effectiveness

Lagging/ outcome indicators:• Fall incidence, comparison to benchmark• # fall injuries, comparison

Process/ Outcome Summary

•↓ fall incidence 20%•↓ falls with injury rate by

43.4%•↑ by >100% identification

of high fall risk patients

More high risk preventionFall % use of preventative strategies where applicable. Baseline to current 3Q10-4Q11

Process Measures risk assessment

Staffing Effectiveness Indicator: falls vs. turnover

Fall incidence 2009-2011

% out-perform NDNQI benchmark

# falls with injury 2009-2011

Injury falls compare to benchmark

Pushing to ZERO preventable falls in 2012

• Chair alarms and familiar voice on PAR• Looking at more supplies: yellow blankets, self

releasing belt, diversion apron• Focus on mobility• Monthly tracking of actual vs. goal• Unit specific drill down and action plan• Mid course RCA, process flows, identify

projects per GHA HEN HAC

Lessons Learned and Key Enablers #1

• Engage frontline to management to Board

• EBP and research should drive practice• Make fall reduction an organizational

priority• Don’t forget the other disciplines• Capitalize on the power of peers• Don’t assume knowledge = application

Lessons Learned and Key Enablers #2

• Falls are errors to be eliminated• Monitoring outcomes is good, adding

process measures is better• E.H.R. allows knowledge based

assessment/intervention• Survey to ascertain perception and

belief, i.e. restraints DON’T prevent falls

Lessons Learned and Key Enablers #3

• Incorporate education and communication into everything

• Partner with patients and families but factor impulsiveness

• It’s just basic nursing care, so integrate HAPU/ minimal lift and falls with mobility and safety

• Try and try again- it may work this time!

Contact Information

Meryl Montgomery, Nursing QI CoordinatorMontgomery.meryl@mccg.org

478 633 1917

“Keep the drum beat going… promote the joy of sharing!” (GHA HEN)