Many patients at Eskenazi Health (formerly Wishard Health Services), in Indianapolis, experience immobility and disorientation, two significant drivers of falls. Eskenazi staff logged an average of 64 falls per quarter in 2010 and, in response, carried out a multifaceted and interdisciplinary falls prevention strategy that reduced falls by 40 percent from a 2010 baseline to the second quarter of 2013.
To achieve the reduction, Eskenazi, a level I trauma center where 70 percent of patients are either uninsured or on Medicaid, implemented hourly “Care Rounds” addressing patient needs and promoting safety and satisfaction. All staff, not just nursing, took part. For example, volunteers, environmental services, and nutritionists assisted bedside staff in hourly rounding by ensuring that patients could reach their nurse call light, phone, and bedside table. Nurses and other clinical staff addressed pain, positioning, and toileting needs of patients. Meanwhile, pharmacists investigated potential correlations between medications, disorientation, and falls. In addition, Eskenazi provided in-services on bed alarms to Med/Surg and Telemetry. Transportation staff also were invited. Mobile camera carts were used to supplement monitoring of high-risk patients.
A key to the strategy’s success was an implementation tactic where Eskenazi tested and evaluated an intervention on one unit and adapted it before spreading it to others. For example, in April 2012, a pilot of scripts for staff to use while rounding and a documentation tool led to a 50 percent reduction in falls in 60 days for one unit. These “Care Round” tools then were adopted in all Med/Surg and Telemetry units starting in June 2012.
Patient and staff feedback also is an important component of evaluating and adapting interventions. For instance, Eskenazi surveyed patients and staff about the effectiveness of a “Call Don’t Fall” sign, a poster in English and Spanish that was placed in patients’ rooms and bathrooms to increase awareness of falls.
Eskenazi looked to sustain its success by further encouraging family members to monitor and report patient mobility needs.