Hospitals in pursuit of excellence

Combining Nursing Assessment, Electronic Medical Record Technology and Risk Stratified Interventions to Develop an Effective Falls Prevention Program

The project was to develop an infrastructure for a falls prevention program based on nursing fall risk assessment augmented by key information from the electronic medical record to support clinical practice standards and effective prevention strategies to decrease falls and fall-related injuries. The goal across all four hospitals was to attain and sustain fall rates and fall with injury rates below the National Database of Nursing Quality Indicators mean for like magnet units.

It was essential that staff believed that falls are preventable occurrences rather than inevitable events resulting from a patients’ actions. A multidisciplinary approach, focusing on appropriately using the Schmid scale to identify patients at fall risk and building supplemental alerts within the EMR, was utilized. This methodology allowed patients to be risk stratified into two groups; high fall risk and high fall risk with high risk of injury, necessitating varying levels of intervention.

Within six months of the education, activation of the EMR tool and implementation of risk group specific interventions, the corporate (four hospitals) fall rate dropped by 37 percent and the injury from fall rate decreased by 52 percent.

This case study is part of the Illinois Hospital Association's annual quality awards. Each year, IHA recognizes and celebrates the achievements of Illinois hospitals in continually improving and transforming health care in the state. These hospitals are improving health by striving to achieve the Triple Aim--improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.

Award recipients achieve measurable and meaningful progress in providing care that is:

• Safe
• Timely
• Effective
• Efficient
• Equitable
• Patient-centered

(The Institute of Medicine's six aims for improvement.)