Problem
Inpatient falls represent a significant challenge to the nursing practice because they result in additional trauma, such as fractures, lacerations, or internal bleeding, all of which put further pressure on the healthcare system. In their article, Wilson et al. (2022) wanted to address the problem by testing a zero-harm approach to fall prevention, aiming to reduce falls with injuries by 25% within one year. Within the approach, the researchers combined several strategies of fall prevention, ranging from education to a transparent root-cause analysis process after falls.
Problem Significance
Patients who are admitted to the hospital have an increased risk of falling, which leads to decreased mobility and functioning, as well as restricted participation in daily activities. After patients fall, the nursing personnel has to dedicate more time to caring for them, which puts a strain on their practice, especially in understaffed healthcare facilities (Wilson et al., 2022). Financial costs to patients, their families, and the healthcare system overall increase as a result of falls, with the annual cost of serious hospital fall injuries estimated at $50 billion (Wilson et al., 2022). Therefore, the problem of falls requires addressing as soon and as effectively as possible.
Findings of the Intervention
The researchers implemented a multidisciplinary and multifaceted intervention for quality improvement targeting fall prevention. The strategies that were combined included education encompassing the entire organization, the adoption of the Morse Fall Risk Assessment Tool, and the displaying of unit-specific fall rates in real-time. Moreover, after a fall had occurred, the intervention called for the implementation of an open and honest root-cause analysis process targeted at identifying why the fall took place and what could have been done to prevent it.
Since the implementation of the intervention, it was found that the incidence of patient falls resulting in injuries steadily decreased over time. As the year passed, the rate continued declining, with an average rate of 1.02 falls per 1,000 patient stays being recorded (Wilson et al., 2022). After the intervention, there were significantly fewer falls among individuals who were older than 80 years, while in patients aged between 60 and 79, the proportion was higher (Wilson et al., 2022). Besides lowering the rate of falls, the intervention caused clinical staff to become more aware about fall prevention, which was connected to the displaying of ward-specific fall rates in real-time. When such information is visible, it prompts discussions regarding various cases of falls and strategies that could have prevented them.
Recommendations for Nursing Practice
The innovative zero-harm approach to fall prevention has the potential to be implemented across different settings because it is flexible and does not require any unique technologies or highly specialized knowledge. The nursing practice can significantly benefit from combining root-cause analysis with the Morse Fall Risk Assessment tool, education, and the recording and displaying fall rates in real-time. Thus, the proposed intervention makes falls not a matter of generalized discussions but rather a tangible issue that must be addressed. Such an approach could embed the culture of prevention, assessment, and analysis into the nursing practice, which will improve patient outcomes in the long run.
PICOT Question
In an inpatient population (P), how can a multifaceted and multidisciplinary fall prevention intervention (I), compared to generic educational interventions (C), reduce the occurrence of falls at hospitals (O) within a one-year period (T)?
Reference
Wilson, M-A., Teper, M. H., Sinno, M., Kohlberger, K., Nuseir, D., Chan, A., … Taher, A. (2022). Designing and implementing a zero harm falls prevention program: A quality improvement study. Journal of Nursing Care Quality, 37(3), 199-205. Web.