Professional Practice
Innovative Patient-Focused Tool Helps Lower Fall Rates
After settling into their nurse residency program last year, it didn't take long for Carolyn Lee, RN, BSN, and the other residents assigned to 6NE Oncology to see that their patients were vulnerable to falls. "Many of our patients are older, they're weak from their medication, they were getting wrapped up in their poles, they were stumbling as they headed to the bathroom," Lee said. "When you see a problem that is affecting your patients and their families, as a nurse you just want to make a difference and turn things around. We were all seeing the same thing. And we all wanted to find a solution."
So when it came time for the nurse residents to design and implement their evidence-based clinical project, it seemed logical to focus on fall prevention. But the nurses knew they needed a new approach. "Everybody recognizes falls are a problem, but there hasn't been a great way for achieving improvement," says Lee, who served as the project's team leader. "We decided to put a little different spin on it and focus on education. But we realized it's not enough to just educate the patients; we have to educate their families and friends, too."
With the support of Patient Care Manager Corrin Steinhauer, RN, MS, OCN, Sally Black, RN, MSN, MBA, OCN, clinical director of oncology and the Clinical Research Center and Clinical Nurse Specialist Jan Beschorner, RN, MS, AOCN, the team developed an educational pamphlet to be distributed to all adult patients admitted to 6NE. The pamphlet contains information about falls among oncology patients and includes an eight-question self assessment that helps identify a patient's fall risk. This new Oncology Fall Prevention Screening Tool (OFPST) was developed based upon a literature review and clinical expertise.
If the OFPST answers and the nurse-conducted Morse Fall Risk Assessment identify a patient as a fall risk, nursing staff implement a series of interventions. The safety precautions, which are taken from the Morse Fall Risk assessment, include:
- Alerting all patient care staff of the fall risk
- Providing fall-prevention education to the patient and family
- Ensuring a clear path to the bathroom
- Adjusting bed to lowest position
- Providing non-slip footwear
- Ensuring call light, telephone and personal items are within easy reach
- Identifying high-risk medications
- Applying fall-prevention bracelet
- Instituting hourly rounds by RN and PCT to assess patient's needs
The project was implemented in February 2010, and results from the three-month pilot showed a significant decrease in fall rates, bringing the unit below the National Database of Nursing Quality Indicators (NDNQI) median of 3.9 falls per 1,000 patient days.
The program was so successful, it has already been adopted as a pilot by two other oncology units at the Medical Center and is being considered for hospital-wide implementation. And the nurse residency team couldn't be more proud and excited, Lee said. "The fact that we were able to radar in on this problem, address it and come out with such positive results was really wonderful. Now, we're hoping to make a difference with our organization and even worldwide."
