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MPSC 2010 Annual Conference Solution Submission Reducing Falls: Hotspots Analysis, Mandatory Technology, and the Socratic Method Organization Name: Sinai Hospital of Baltimore Contact Person: E-Mail: Cory Silkman, MAR, BSN, RN-BC [email protected] Type: Title: Phone: Acute Care Hospital Manager, Patient Care Services 410.601.6012 IDENTIFICATION: Patients on a 23-bed neuro-rehabilitation unit experienced falls per 1000 patient days at nearly three times the nursing literature benchmark. The organization previously implemented a variety of fall reduction interventions gleaned from the literature and those contained within a reputable, published fall risk assessment and prevention tool, however, the falls rate for the unit remained elevated. Baseline falls data showed a quarterly falls rate per 1000 patient days as high as 24.23. PROCESS: Leadership conducted an in-depth analysis of falls data for the prior 12 months. The analysis examined the relationship between actual falls and fall risk categories, repeat falls, time of day, location, activity, and injuries. Leadership conducted a literature review to determine standards of practice and best practices related to fall prevention. The unit’s Multi-disciplinary Committee -- consisting of medicine, nursing, and therapy service - reviewed the fall data analysis and approved the proposed fall reduction interventions. The unit’s nursing Outcomes and Practice Committee -- consisting of frontline nursing staff -provided feedback on fall mechanisms and proposed fall reduction interventions. The Advanced Practice Nurse reviewed the falls analysis data and proposed fall reduction interventions. Leadership examined the utilization of fall-reduction technologies available on the unit. SOLUTION: Mandatory Use of Safety Technologies MPSC 2010 Annual Conference Solution Submission • Staff utilized midsection-triggered bed alarms on all patients except those with a “room independent” activity order. Torso-activated alarms were used on high fall-risk patients with impulsivity • Toilet alarms used for all patients identified as a high fall risk • Wheelchair alarms used for all patients identified as a moderate or high fall risk Hotspots analysis • Management created a color-coded guide to the unit’s physical layout to identify locations in which falls were more likely to occur relative to other locations on the unit. This intervention helped to determine the probability that a patient in a given location would experience a fall, thereby indicating focus areas for rounds review • The hotspots indicated the relationship between proximity to the nursing station and fall occurrences Socratic Method Rounds • Management conducted a daily review of fall risk assessments, nurse-selected fall prevention interventions, and the actual patient care environment for all high fall risk patients and those in hotspots • Nurses provided rationales on the spot for any discrepancies between prior and current fall risk assessments, risk-reduction interventions left undocumented, and lack of technology utilization in the patient care environment • Afforded time to educate nurse on “erring on the side of safety versus that of patient convenience” OUTCOMES: See attached graph of the fall rate per 1000/days. MPSC 2010 Annual Conference Solution Submission MPSC 2010 Annual Conference Solution Submission