"Catch a Falling Star": The Development of the Obstetric Falls Risk Assessment System to Improve Patient Safety

Purpose for the program: Because pregnancy is not an illness, an obstetric patient can be overlooked when assessing falls risk among hospitalized patients.  A review of current practices among perinatal units for falls risk assessment revealed that existing fall risk tools are used.  These tools were created for geriatric and/or medical surgical patients.  Currently, there is no research on obstetric fall risk assessment tools.  The purpose of the Obstetric Falls Risk Assessment System (OFRAS) is to improve safety among inpatient pregnant women using an assessment tool and scoring system to determine fall risk. 

Proposed change: Implement a systematic risk assessment tool specific to the obstetric population to prevent obstetric falls and increase staff awareness.

Implementation, outcomes and evaluation: The development and implementation of the OFRAS occurred in three phases.  In Phase I, an obstetric falls prevention guideline was developed and implemented.  It was based upon obstetric fall risk factors identified by a panel of expert perinatal nurses and validated through literature review.  Following implementation falls decreased from 6 to 1 in an 8 month period. The guideline focused on nurses’ assessment of the patient’s readiness to ambulate, since 37% of inpatient falls occur during ambulation for toileting needs.  The guideline relied on nursing clinical judgment to determine fall risk, which prior research suggests has comparable accuracy to using a fall risk tool. However, the judgment of less experienced nurses may be less accurate. Therefore, Phase II was development and evaluation of the OFRAS for systematic assessment of ante, intra and post-partum patients using a scoring system to quantify fall risk.   Obstetric fall risk factors were stratified across 6 categories to create a fall risk scoring system.  Seven obstetric patient falls and 14 near misses were analyzed retrospectively using the OFRAS. This preliminary analysis revealed additional risk factors which were then incorporated into the OFRAS.  Phase III began by implementing the OFRAS into the EMR. Research using the OFRAS to analyze readiness to ambulate among 100 epiduralized obstetric patients post anesthesia and evaluate reliability, validity, and sensitivity is planned. Expansion to a multi-site trial is being explored.

Implications for nursing practice:   Implementing a falls prevention guideline tailored for the obstetric population decreased the number of inpatient falls.  Developing an obstetric falls risk assessment tool using a scoring system to determine the patient’s risk for a fall provides a structured systematic approach for RNs to use. It is an evidence-based approach to care focusing safety efforts on a typically young, healthy patient population.

Keywords: falls, falls tool