Purpose for the Program
An increase in nurse injuries related to falls of postpartum patients resulted in an increase in worker's compensation and overtime expenditures. Young healthy women with full cognitive capabilities are not viewed as a high-risk population; however, this postpartum patient population becomes high risk for falls because of two prominent factors: motor nerve block postepidural and orthostatic hypotension related to blood loss.
A comprehensive search of online databases revealed only one article to guide a standardized approach to fall assessment in the post-epidural obstetric patient. It had not been tested for reliability or validity. A trial was conducted using the assessment tool.
Implementation, Outcomes, and Evaluation
The rate of falls in the labor and delivery unit decreased from 11 to 0 in fiscal year 2010 because the problem areas were identified. Patients still fainted in the bathroom, though by definition this was not classified as a fall. Nurses transferred the patient from the toilet via wheelchair back to bed, yet the risk of injury to the patient and the nurse remained. Though the tool was not ideal, we did find that it had an impact on the rate of falls, rate of nurse injury, and worker's compensation dollars.
Implications for Nursing Practice
Problems identified with the tool were corrected, and it was changed to accommodate all obstetric patients after delivery. The tool was transformed into the Cooksey-Post Obstetric Delivery Fall Risk Assessment and presented to the Baylor Healthcare Perinatal Educator Group to meet the needs of all Baylor perinatal facilities. It was then presented to the Baylor Healthcare Perinatal Counsel. Permission was given to test the Cooksey-Post Obstetric Delivery Fall Risk Assessment in electronic recovery charting. Implementation of the trial started June 2011.