Falls in hospitalized patients of all ages are recognized as an important patient safety issue. Obstetrical (OB) patients, many of whom receive epidural analgesia, can be at high risk for falls. A literature search yielded limited research that addressed falls in obstetrical patients. The search found Dionne's EGRESS test (Dionne, 2004), which was developed to address falls in bariatric patients, and a postepidural fall risk assessment score (PEFRAS) to address OB falls after epidurals (Frank, et al 2009). Neither tool had been validated for use within the obstetric community.

A review of our institutional records showed 42 postpartum patient falls from 2004 to 2010. Primary reasons included: 57% were due to weak legs, 19% were due to fainting/dizziness, 10% were due to slipping or tripping, and 14% unknown causes. Of the reported falls, 64% were due to patients trying to get to the bathroom, both with and without assistance. To date, there has not been a standardized tool used to assess the patients' ability to ambulate post-delivery.

Proposed change:

Our institutional fall risk assessment protocol does not adequately assess the postpartum patient.  This study will evaluate the postpartum patients’ ability to safely ambulate using Dionne’s EGRESS test (DET). The DET is a 3 step process evaluating a patient's mobility to go from sit to stand, march in place and stepping forward and back. Patients must successfully complete all three steps to ambulate independently. Implementation of the DET began July 5^th 2011.

Implementation, outcomes and evaluation:

This study will utilize a retrospective design using data collected from all obstetrical postpartum patients meeting criteria. All nurses caring for postpartum patients will be educated on how to perform the Dionne's Egress Test. If the patient does not successfully pass the DET, it will be repeated until successfully completed. Results of the DET will be documented in the patient’s electronic chart. The study will take place over a 24-month period. It is hypothesized that postpartum patients that have undergone the DET will experience a clinically significant reduction in falls.

Implications for nursing practice:

This study embodies the philosophy and core values of our institution.  Positive results would significantly impact the safety of patients and have widespread application.  The success of this study aligns with the National Patient Safety goal of reducing patient falls. It promotes further nursing research, heightens nursing awareness of postpartum patient’s falls and improves the patient experience. 

Keywords: Postpartum patients, falls, Dionne's Egress Test (DET)