Data Drives a Decrease in Falls

Lutheran Hospital, a community hospital in the Cleveland Clinic healthcare system, decreased falls by 12 percent in 2013. That was a significant achievement considering that six of the hospital’s 10 in-patient units are behavioral health units with high falls risk patients. Kathy Holley, MSN, BSN, RN, director of nursing for behavioral health, attributes the decrease to an organized effort by nurse managers on the hospital’s clinical falls committee to reduce falls.

Four categories of falls

In 2012, nurse managers and directors participated in a series of webinars hosted by the Institute for Healthcare Improvement. The webinars presented information from the Robert Woods Johnson Foundation Prevention of Hospital Falls program that places falls in four categories: intentional, anticipated physiological, unanticipated physiological and accidental. After the webinar, Lutheran Hospital adopted these categories

“Reviewing our falls and placing them into one of these four categories helped our nursing staff and managers understand why falls were occurring,” says Denise Minor, DNP, RN, CNS, NEA-BC, chief nursing officer at Lutheran Hospital. “Before using these categories we had a plan that supported our policy on falls assessment and intervention, but this additional data helped us be more specific with our interventions and therefore decrease falls.”

Tracking falls by category

From May through August 2013, each unit tracked falls by category. The data was compiled in a spreadsheet, which listed other important information such as what time of day the falls happened and whether they occurred after the patient received medication. Nurse managers then used that data to create an action plan with staff for reducing falls.

“The biggest ‘a-ha’ moment was for the behavioral health units,” says Holley. “Their take on falls had been that patients intentionally put themselves on the floor, and we found that was not the case. The majority of falls for our psychiatry patients are related to medications they receive.” Those units have subsequently focused on nurse education and patient observation.

“No-nurses” nurses station

The hospital’s medical/surgical unit made two changes. First, the nurse manager implemented a “no-nurse nurses station,” says Holley. “Our nurses are out by the rooms with their workstations on wheels, doing all of their documentation on the floor.” Second, the unit created a high falls risk zone so all patients who need careful monitoring are in the same area.

Nurses are educated on falls prevention through daily huddles and staff meetings. In addition, occupational and physical therapists educated nurses on how to use gait belts.

Lutheran Hospital’s falls committee met in March to review each unit’s falls data for this year and their plans for 2014. “Our goal is for no patient to fall, but we have to be realistic,” says Holley. “Using data and our staff’s expertise to drive our falls plans has afforded us a much clearer picture.” And that clearer picture has led to a reduction in falls.