Purpose for the Program
When the annual rate of mothers who fell in a level III hospital reached 26 in 2009, a multidisciplinary team convened to identify causative factors that led to the increase. The team focused on physiologic changes during pregnancy that are known to increase risk of falling. Pregnant patients have an increased risk of accidental fall, unanticipated physiologic falls, and anticipated physiologic falls. The goal of the team was to develop a program that would reduce the number of falls and implement strategies to decrease the rate of falls taken by mothers at the hospital by 50%.
The implementation of a program to reduce falls provided an opportunity to comply with the Joint Commission patient safety goal to reduce falls. Lack of awareness that obstetric patients are at an increased risk of falls prompted the implementation of a risk assessment tool and a mobility assessment before ambulation after delivery.
Implementation, Outcomes, and Evaluation
Our current care delivery process was reviewed and several opportunities for improving patient care were identified by using a fishbone diagram. The implementation of a fall-risk assessment on admission, upon transfer to the postpartum unit, and every 24 hours helped to identify those patients at an increased risk of falling. A mobility assessment and Egress test before ambulation was also implementation to identify patients at a greater risk of falling when ambulating for the first time after 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. For 2012 YTD, we have had five documented falls. We have continued to monitor the rates of maternal falls and hope to accomplish a new goal of zero falls 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 monitor compliance provides staff an opportunity to continue making improvements in the care delivery process.