We Must, We Must, We Must Reduce Our Maternal Fall Rate: Strategies Implemented
Title: We Must, We Must, We Must Reduce Our Maternal Fall Rate: Strategies Implemented
- Identify risk factors that predispose obstetrical patients at an increased risk for falling.
- Design a fall reduction program to help reduce maternal falls and injuries.
- Examine strategies implemented to decrease maternal falls.
When the maternal fall rate in a Level III hospital reached 26 annually in 2009, a multidisciplinary team convened to identify causative factors leading to the increase. The team focused on physiologic changes during pregnancy that are known to increase one's risk for falling. Pregnant patients have an increased risk for accidental fall, unanticipated physilogic falls and anticipated physiologic falls. The goal of the team was to develope a falls reduction program and implement strategies to decrease the maternal fall rate by 50%
Proposed change:
The implementation of a falls reduction program provided an opportunity to comply with the Joint Commission patient safety goal to reduce falls. Lack of awareness that obstetrical patients are at an increased risk prompted the implementation of a falls risk assessment tool and a mobility assessment prior to ambulation after delivery.
Implementation, outcomes and evaluation:
Our current care delivery process was reviewed and several opportunites for improving patient care were identified using a fishbone diagram. The implementation of a falls risk assessment on admission, upon transfer to the postpartum and every 24 hours helped to identify those patients at an increased risk for falling. A mobility assessment and Egress test prior to ambulation was also implementation to identify patients at a greater risk of falling when ambulating for the first time following delivery. When the mobility assessment identified patients not ready to ambulate, alternative nursing interventions were instituted. Staff education included learning the morse fall scale, performing the mobility assessment and Egress Test, use of gait belts, documentation of care and injury prevention.
The interventions were implemented in 2010. In 2011, the annual number of maternal falls dropped from 26 to 18. Currently for 2012 YTD, we have had 5 documented falls. We continue to monitor maternal fall rates and hope to accomplish a new goal of zero fall over the next 6 months.
Implications for nursing practice:
The implementation of such a practice change is a slow process. Continued monitoring and re-education help to reinforce the need for change to improve patient outcomes. Making sure that equipment needed by staff is readily available greatly improves compliance of a practice change. Engaging staff to montior compliance provides staff an opprtunity to continue making improvements in the care delivery process.
Keywords: hospital falls, accidental falls, fall prevention practices, fall reduction strategies, hourly rounds