Practice Tip of the Week | Prevent Falls Sign for Safety: Impacting Medical-Surgical Units

By Leonard Benavidez, DNP, RN-BC

Falls in acute care settings pose a significant threat, particularly for high-risk patients, often resulting in severe injuries, increased healthcare costs, and adverse outcomes. Despite the implementation of various fall prevention strategies, the high fall rates within medical-surgical units remain a serious patient safety issue. This article discusses a practice change project aimed at reducing falls in a 16-bed medical-surgical unit in a South Texas hospital through the implementation of a patient safety agreement.

 Falls are a significant global public health concern, resulting in approximately 684,00 deaths annually and contributing to over 38 million disability-adjusted life years lost each year (WHO, 2021). In the United States, between 700,000 and 1,000,000 hospitalized patients fall each year, making it the most frequently reported adverse event in hospitals (AHRQ, 2021). The economic impact is substantial, with the cost of increased hospital stays and injuries ranging from $19,376 to $32,215 per episode (Dykes et al., 2020). The practicum site for this project had a fall rate of 3.9 falls per 1000 patient days in 2022, surpassing its goal rate of 3.3 falls per 1000 patient days.

Method

The project was conducted in a medical-surgical unit with a diverse patient population, primarily Latino, with a high prevalence of diabetes, obesity, and stroke. Using the Knowledge-to-Action (KTA) model, the intervention involved having patients sign a patient safety agreement upon admission. This agreement aimed to engage patients in fall prevention education, fostering collaboration between patients and healthcare providers.

Pre-intervention data was collected over eight weeks, followed by an eight-week intervention period. Education sessions were held for nurses and unit managers to ensure compliance with the new intervention. Data on fall rates was extracted from the Quality/Risk department’s shared fall folder and analyzed using SPSS software.

Results

During the pre-intervention period, the unit observed two falls out of a sample size of 222, resulting in a fall rate of 2.40 falls per 1,000 patient days. Post-intervention, no falls were reported out of a sample size of 236, resulting in a fall rate of 0.0 falls per 1,000 patient days. The Wilcoxon Rank Sum test indicated a clinically significant reduction in fall rates, through statistical significance was not achieved (Z = -1.461, p = .442).

Discussion

The implementation of the patient safety fall agreement demonstrated a reduction in fall rates, highlighting the importance of patient engagement in fall prevention strategies. This intervention transformed fall prevention measures from passive to active participation, emphasizing the need for continuous education and collaboration among healthcare providers and patients.

The success of this intervention underscores the potential for broader adoption across other inpatient units. By fostering a culture of safety and adherence to best practices, healthcare systems can achieve improved patient outcomes and enhanced quality of care.

Conclusion

The project highlighted the effectiveness of engaging patients in their care through a patient safety fall agreement, resulting in a significant reduction in fall rates. Although the intervention did not achieve statistical significance, the clinical relevance of the findings supports the adoption of similar strategies in other healthcare settings. Ongoing education and support from hospital leadership are crucial for the sustainability of these interventions, ultimately promoting patient safety and reducing the incidence of falls in medical-surgical units.

REFERENCES

Agency for Healthcare Research and Quality. (2021). A toolkit for improving quality of care. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html

Bargmann, S. M., & Brundrett, S. M. (2020). Implementation of a Multicomponent Fall Prevention Program: Contracting with Patients for Fall Safety. Military Medicine, 185(Supplement_2), 28–34. https://doi.org/10.1093/milmed/usz411

Centers for Disease Control and Prevention. (2020). Older adult fall prevention. https://www.cdc.gov/falls/data/fall-deaths.html

Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., ... & Bates, D. W. (2020). Evaluation of a Patient-Centered Fall-Prevention Tool Kit to Reduce Falls and Injuries: A Nonrandomized Controlled Trial. JAMA Network Open, 3(11), e2025889. https://doi.org/10.1001/jamanetworkopen.2020.25889

World Health Organization. (2021). Falls. https://www.who.int/news-room/fact-sheets/detail/falls