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System-based program decreased rate of falls on hospital orthopedic unit
Researchers used a business concept to reduce falls that result in injury by 60% in an acute inpatient setting.
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Use of a systems-based fall prevention system aimed at high-risk situations — rather than high-risk patients — may significantly reduce in-hospital falls and falls that result in injuries among orthopedic patients, according to researchers of a study presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting.
“I would like to ask you to consider that in a dynamic acute inpatient setting, attempting to identify and target high-risk patients may be ineffective,” Grant R. Lohse, MD, of the University of Washington, said during his presentation. “But, perhaps that using a system-based approach of trying to identify and target high-risk situations may be more effective.”
Continuous quality improvement
Lohse noted that traditional study designs for fall prevention focus on high-risk patients and have not effectively stamped out falls.
“I would argue that fall prevention in an acute setting has been difficult,” he said. “Rather than repeat this traditional study design, we have borrowed a concept from business called, continuous quality improvement.”
This concept entails the analysis of the environment and system surrounding a problem to optimize interventions, Lohse said. In their analysis of the setting, patient factors and staffing factors associated with in-hospital falls, Lohse and colleagues found toileting to be the most common high-risk activity. They designed the following system-based nursing interventions for this activity:
- “Wake ‘em, take ‘em,” patients who were awakened by staff in the course of their duties (e.g., vital signs or administration of medications) were offered assistance to the restroom;
- “Assist in and assist out,” patients who required assistance to the commode or restroom were attended and then given assistance back to chair or bed;
- “Timed toileting,” patients were offered assistance to the restroom three times every 8-hour nursing shift; and
- “Shoulder safety,” an intervention in which nurses assisted patients who had undergone shoulder surgery in and out of bed during the first 24 hours postoperatively due to findings that most patients have fallen during this time.
Mitigating risk
The researchers tested the interventions in a prospective study of more than 6,000 patients admitted to the orthopedic ward at the University of Washington between 2007 and 2010, and compared the results with the number of pre-intervention falls sustained. They measured falls per 1,000 patient days. Using the interventions, they recorded a 60% reduction in falls with injury and 40% reduction in total falls.
“Our study, as well as others, has identified toileting as a particularly high-risk activity,” Lohse said, “These simple interventions can help mitigate that risk.” – by Renee Blisard Buddle
Reference:
- Lohse GR, Leopold SS, Cizik AM, Lee MJ, et al. Systems-based safety intervention: Reducing falls with injury and total falls on an orthopaedic ward. Paper #381. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
For more information:
- Grant R. Lohse, MD, can be reached at the University of Washington, 1959 N. E. Pacific St., Box 356500, Seattle, WA 98195; 206-744-4930; email: lohse@uw.edu.
- Disclosure: Lohse has no relevant financial disclosures.
Perspective
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Douglas W. Jackson, MD
The authors are to be commended for instituting a successful fall-prevention program in their institution. Fewer falls and reducing secondary injuries are something we should all strive to achieve in our orthopedic services. The idea of having a zero (“never events” designated by the Centers for Medicare & Medicaid Services) vs. a much reduced fall environment for orthopedic patients recovering from injury and surgery is difficult to achieve, and the authors make this point. A certain number of falls among higher-risk patients will occur in any treatment program. However, developing an accountable system for all physicians, nurses, aides and therapists (the team) where data is reviewed and there is individual accountability, can be expected to improve the quality of care regardless of the area of focus (i.e., falls, hospital stay, pressure sores, the need for blood transfusions, etc.).
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