• postpartum patients;
  • falls;
  • Dionne’s Egress Test (DET)

Poster Presentation

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  2. Poster Presentation

Purpose for the Program

Falls are recognized as an important patient safety issue for hospitalized patients of all ages. Obstetric patients, many of whom receive epidural analgesia, can be at high risk of falls. A literature search yielded limited research that addressed falls taken by obstetric patients. The search found Dionne's EGRESS Test, which was developed to address falls taken by bariatric patients, and a postepidural fall risk assessment score to address falls of obstetric patients after receiving epidural analgesia. Neither tool had been validated for use within the obstetric community.

A review of our institutional records showed that 42 postpartum patients fell from 2004 to 2010. Primary reasons for the falls included the following: 57% were due to weak legs, 19% were due to fainting/dizziness, 10% were due to slipping or tripping, and 14% were due to unknown causes. Of the reported falls, 64% were due to patients trying to get to the bathroom, with and without assistance. To date, there has not been a standardized tool used to assess a postpartum patient's ability to ambulate.

Proposed Change

Our institutional fall risk assessment protocol does not adequately assess the postpartum patient. Using Dionne's EGRESS Test, this study will evaluate a postpartum patient's ability to safely ambulate. Dionne's EGRESS Test is a three-step process that evaluates a patient's mobility to go from a sitting position to a standing one, march in place, and step forward and back. Patients must successfully complete all three steps to ambulate independently. Implementation of the Dionne's EGRESS Test began July 5, 2011.

Implementation, Outcomes, and Evaluation

This study will utilize a retrospective design using data collected from all obstetric postpartum patients meeting criteria. All nurses caring for postpartum patients will be educated on how to perform the Dionne's EGRESS Test. If the patient does not successfully pass the Dionne's EGRESS Test, it will be repeated until successfully completed. Results of the Dionne's EGRESS Test will be documented in the patient's electronic chart. The study will take place over a 24-month period. It is hypothesized that postpartum patients that have undergone the Dionne's EGRESS Test will experience a clinically significant reduction in falls.

Implications for Nursing Practice

This study embodies the philosophy and core values of our institution. Positive results would significantly affect the safety of patients and have widespread application. The success of this study aligns with the National Patient Safety goal of reducing falls of patients. It promotes further nursing research, heightens nursing awareness of falls of postpartum patients, and improves the patient experience.