An increase in nurse injuries related to postpartum patient falls, resulted in an increase in Safe Choice dollar and overtime dollar expenditures.  Young healthy women with full cognitive capabilities are not viewed as a high risk population; however, this patient population becomes high risk for falls due to two prominent factors, motor nerve block post epidural and orthostatic hypotension related to blood loss.  

Proposed change:

A comprehensive search of on-line databases revealed only one article to guide a standardized approach to fall assessment in the post epidural obstetrical patient. It had not been tested for reliability or validity.  A trial was conducted using the assessment tool. 

Implementation, outcomes and evaluation:

The Labor and Delivery fall rate decreased from eleven to zero in fiscal year 2010. Problem areas were identified. Patients fainting in the bathroom remained, although by definition these were not classified as falls.  Nurses transferred the patient from the toilet via wheelchair back to bed. The risk of injury to the patient and the nurse remained. While the tool was not ideal, we did find that it had an impact on our fall rate, nurse injury, and worker's compensation dollars.

Implications for nursing practice:

Problems identified with the tool were adapted.  It was changed to accommodate all post obstetrical delivered patients.  The tool was transformed into the Cooksey-Post Obstetrical Delivery Fall Risk Assessment.   Cooksey-PODFRA was presented to the Baylor Healthcare Perinatal Educator Group to meet the needs of all Baylor Perinatal facilities.  It was then presented to the Baylor Healthcare Perinatal Counsel. Permission was given to trial the Cooksey-PODFRA in the Electronic Recovery charting.  Implementation of the trial started June 2011.

Keywords: Ambulation Readiness Post Obstetrical Delivered Patient