Investigating fall prevention in an inpatient orthopedic and neurology unit: a quality improvement project

Abstract

Background: Patient falls are an issue in hospitals nationwide since the Centers for Medicare and Medicaid Services has stopped reimbursing facilities for them. This has led to an increase in the length and cost of hospital stays, costing hospitals and healthcare systems billions of dollars annually across the United States. Local problem: An Orthopedic and Neurology Unit in North Central Montana has seen a steep increase in in-patient falls over the last two years, which has increased the length of stay, hospital costs, and the number of case reviews. Methods: The Institute for Healthcare Improvement's (IHI) model for quality improvement was used, and the Plan, Do, Study, Act (PDSA) Cycle was determined to be the best tool for implementing and evaluating the project. The project spanned over 33 days and consisted of two PDSA cycles. Interventions: Interventions used included: 1) educating staff about the facility's fall prevention policy, 2) correct use of the Morse Falls scale, 3) installing command hooks in each patient room for easy access to gait belts, 4) a daily checklist for nursing staff to document fall prevention interventions and 5) the use of Posey and bed alarms. Results: Staff compliance with fall prevention interventions was the largest component potentially affecting falls. Lack of staff education and training in the use of the Morse Falls Scale and fall prevention was also a prominent issue, as was resistance to change and cognitive overload. Conclusion: The facility should consider annual fall prevention training as well as annual Morse Fall Scale training.