Chesapeake Regional Healthcare’s Success in Preventing Falls in Hospitals

The hospital can be a dangerous place for a patient, due in part to the unfamiliar environment. This can increase the patient’s risk for falling while hospitalized. Approximately 25% of hospital falls result in injuries, including fractures and death (Heng, et al., 2020). With the Preventing Falls in Hospitals Toolkit provided by AHRQ, Chesapeake Regional Healthcare (CRH) improved its preexisting Fall Prevention Program. In 2022, inpatient fall prevention was CRH’s top operational strategic goal. In October 2022, a new Nursing Quality Specialist joined the Quality department at CRH and explored ways to reduce patient falls and subsequent injuries.

Implementation of AHRQ’s Patient Safety Tools

Starting in November 2022, the Nursing Quality Specialist began assessing the Fall Prevention Policies and Practices. By using AHRQ Tool 2D: Assessing Current Fall Prevention Policies and Practices, she assessed the current status of fall prevention activities in the hospital. A Fall Prevention Committee was already in place with support from Leadership, Rehab, Pharmacy, Quality, Risk Management, and CRH’s Stryker representative. The incident reporting system captured fall event documentation and was reviewed daily by Risk Management, the Nursing Quality Specialist, and the Nurse Manager of the unit where the fall occurred. Monthly fall prevention compliance audits were conducted on six inpatient units to ensure that the necessary fall precautions were in place. The audits revealed inconsistent practices with use of fall risk signage, activation of bed alarms in the appropriate zone, use of fall risk armbands or gripper socks, and maintaining beds in the lowest, locked position.

The Nursing Quality Specialist advocated for immediate process improvements to ensure the safety of the hospital’s patients. In early December 2022, the Nursing Quality Specialist created an initiative entitled “Fall Free Friday.” The goal of this initiative was to decrease patient falls and falls with injury. This rounding initiative initially focused on two medical telemetry units which had experienced an increase in falls and falls with injury. AHRQ’s Tool 3B: Scheduled Rounding Protocol was helpful in the development of the rounding audit forms. The audits forms for “Fall Free Friday” included bed in low and locked position, bed alarm activated in appropriate zone, non-skid gripper socks in place, fall risk armband applied, and fall risk signage visible. AHRQ’s Tool 3L: Patient and Family Education was utilized to share the importance of fall precautions to the patient and family during rounding. Patients and families were educated regarding the reason for the different interventions. In addition, the Nursing Quality Specialist ensured patients’ ability to use the call bell and their understanding of the importance of not getting up unassisted. AHRQ’s Tool 3H: Morse Fall Scale assisted the Nursing Quality Specialist when selecting the patients for audits. Patients with Morse Scores ≥ 45 were prioritized for rounding as these patients were at highest risk for falls. For 6 months, “Fall Free Friday” audits were completed by the Nursing Quality Specialist every Friday. The times of rounding varied in order to capture data from different shifts. In March 2023, “Fall Free Friday” rounding expanded to include the stepdown unit, and in August 2023, “Fall Free Friday” rounding expanded to include another medical surgical unit. As of November 16, 2023, “Fall Free Rounding” has audited 899 patients, with averages of 80 patients each month.

The Nursing Quality Specialist created awards to celebrate successes in fall prevention noted during “Fall Free” rounds. Staff recipients are awarded gift baskets and are spotlighted as “Fall Prevention Champions.” Their pictures are shared throughout the organization in our safety huddles. “Fall Free Friday” has shown continuous improvement in fall precaution compliance and continues to bring awareness to the staff about patient fall prevention.

AHRQ’s Tool 4B: Staff Roles and Tool 4C: Assessing Staff Education and Training were utilized when collaborating with other members of the healthcare team for patient fall prevention. Training was provided to the Environmental Service staff by the Stryker representative regarding how to zero a bed during a discharge clean. Discharge cleaning protocol was revised to include this step in the discharge checklist. This process change ensured that the weight-activated bed alarm would function properly upon a patient’s admission. The Nursing Quality Specialist instructed Safety Coaches in April 2023 how interdisciplinary departments can ensure the patient is safe and that fall precautions are in place. Additionally, she collaborated with the IT department to provide education at the April 2023 Patient Fall Prevention Committee meeting regarding proper documentation of fall risk scores, reviewing the fall risk score, and the new predictive analytic score.

Using AHRQ’s Tool 5B: Assessing Fall Prevention Care Practices, the Nursing Quality Specialist currently conducts audits five times per month on an average of 103 patients monthly. Since rebuilding the Fall Prevention Program and the initiation of “Fall Free Friday,” staff are more engaged in fall prevention measures. The organization’s fall rates are monitored monthly, and information is disseminated throughout the organization. Unit-level information is shared during shift change huddles. Root cause analyses are completed for each fall resulting in significant injury.

Reducing Patient Falls

AHRQ’s Preventing Falls in Hospitals toolkit was instrumental in guiding the Nursing Quality Specialist. “Fall Free Friday” has proven to be successful for both the medical-telemetry and the stepdown units. These audits resulted in a 31% decrease in acute care falls from 4th quarter 2022 to 1st quarter 2023.

As illustrated in the graphs below, CRH demonstrated sustained success by not exceeding the threshold for 7 months. This is an amazing accomplishment and proves the engagement of staff regarding patient fall prevention. Due to the increase in falls during September 2023, CRH is further investigating fall prevention opportunities. In October 2023, at our Fall Safety Fair using the Tool4B: Staff Roles, information was provided to all staff on Fall Prevention. CRH stressed that fall prevention is everyone’s responsibility within the organization, not just the staff at bedside. Patient fall prevention is always on the forefront of our minds. CRH is so proud of the progress we have made and will continue to focus on preventing patient falls within our hospital.