The A1 medical/surgical unit at Mercy Health-Anderson Hospital in Cincinnati reduced its fall rate from 10 falls per 1,000 patient days to two falls per 1,000 patient days over three years through a quality improvement program called Transforming Care at the Bedside. TCAB, a national initiative by the Robert Wood Johnson Foundation and Institute for Healthcare Improvement, focuses on improving care on medical and surgical units.
"The med/surg unit is kind of the unsung hero," says Terri Martin, RN, BSN, MBA, clinical director of Anderson Hospital and leader of the hospital's TCAB program. "It's the backbone of the hospital in many ways, but there's not always a lot of focus on [its] operations." Anderson Hospital's overall goals of participating in the TCAB program were to "transform leadership, retain and engage med/surg nurses, improve quality of care on med/surg units, make care more streamlined and efficient and improve the patient experience with a real focus on everything being patient centered," Ms. Martin says.
One of the areas the hospital targeted was patient falls. The first step the medical/surgical unit team took to prevent patient falls was measure the unit's compliance with best practices for fall prevention. The team then identified areas of weakness to focus on.
Anderson Hospital learned how other hospitals prevented falls at meetings with other TCAB participant hospitals through webinars, phone conferences and face-to-face meetings. For example, one hospital in TCAB used red socks to quickly identify patients who are at high risk for falls. The Anderson Hospital TCAB unit adopted that strategy; now, physicians and staff know that any patient with red socks is at high risk of falling. Ms. Martin shares several other strategies that have successfully reduced fall rates at the hospital:
1. Make it easy to identify high-risk patients. In addition to giving red socks to patients who are at high risk for falling, the hospital puts an armband on high-risk patients and uses a visual cue outside the patients' doors alerting providers of the fall risk. By making it easy to identify high-risk patients, clinicians and staff can quickly initiate the correct protocols to reduce the risk of falling.
2. Provide safety companions. Anderson Hospital increased the number of safety companions for people who are disoriented and unable to follow direction. Safety companions provide continuous observation and aid to patients to prevent falls.
3. Keep the patient busy. Hospital staff gave patients different activities to do so they would be occupied and less likely to get out of bed. Staff also educate and partner with families in fall prevention.
4. Set bed alarms. Anderson Hospital changed the way they use bed alarms for patients at high risk for falls. The bed alarm's default time interval is 10 seconds between the time a patient leaves the bed and the time the alarm sounds. Clinicians and staff established a protocol to check that the bed alarm interval is always at one or two seconds. "Otherwise, the patient could be halfway down the hall before it rings," Ms. Martin says.
5. Do safety rounds. One of the most effective strategies Anderson Hospital used to prevent falls was conducting twice-daily safety rounds on all high-risk patients in addition to the hourly rounds. During the safety rounding, a nurse would check that all precautions to prevent falls were in place, including the red socks, armband, fall sign and bed alarm.
Beginning in September 2011, Anderson Hospital went 353 days without a fall with harm due to the strategies created through the TCAB project.
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