Fall prevention for inpatient oncology using lean and rapid improvement event techniques

Abstract

Objective: The objective of this project was to reduce patient falls and falls with injury on three oncology divisions at a large urban teaching hospital. By standardizing assessment, intervention, and post-fall investigation processes the goal was to decrease patient falls and falls with injury rate by 50% and 30%, respectively.

Background: Preventing patients from being injured due to a fall during their hospitalization has been a concern in healthcare for many years. Organizations around the world such as Institute of Medicine, The Joint Commission, National Institute for Health and Clinical Excellence, National Australian Patient Safety Foundation, and the World Health Organization have been conducting research and publishing guidelines to identify evidence based interventions for fall prevention (Ulrich et al., 2008, Di Pilla, 2010). Falls are the most common cause of non-fatal injury and hospital admission for trauma. Death rates due to falls have risen sharply over the past decade due to aging of the population.

Methods: A Rapid Improvement Event (RIE) technique was selected to implement the fall prevention initiative because it aligned with the hospital's lean transformation initiative. There was coordination with other departmental staff (physical and occupational therapy, pharmacy, physicians, information systems, low bed equipment vendor, and clinical operations) to achieve multidisciplinary input.

Results: A 22% decrease in total fall rate and a 37% decrease in falls with injury rate were achieved in the 16-month post-intervention period. Although a 22% decrease in total falls did not meet the goal of 50% decrease, the total falls with injury decrease of 37% did exceed the goal of 30%.

Conclusions: Falls are a multi-faceted, complex problem that needs constant vigilance and continuous improvement to sustain patient safety. Anticipating physiologic changes in patients' conditions and implementing interventions before the fall is critical to fall prevention. While well-validated screening tools performed thoroughly and accurately can help hospital staff identify patient specific fall risk factors, risk assessment alone does not prevent falls. If the prevention of patient falls is identified as important by leadership and staff at the division level and all are invested in achieving established goals, success can be achieved and sustained.

Keywords: Case study, falls, hospital, human factors, organizational transformation, patients.