Implementation of a Multicomponent Fall Prevention Program: Contracting With Patients for Fall Safety

INTRODUCTION Falls during hospitalizations can increase the length and cost of a hospital stay. Review of patient safety reports on a 26-bed medical-surgical telemetry unit revealed that the number of falls went from 6 in 2015 to 12 in 2016. The reports identified a knowledge gap in the patient population and nursing staff related to high fall risk interventions. A literature review suggests that patient-staff safety agreements, in combination with proper implementation of Clinical Practice Guidelines, can successfully increase education and adherence to fall prevention measures and reduce the number of inpatient falls. MATERIALS AND METHODS The objective of this evidence-based practice project was to determine if the implementation of a patient fall safety agreement in combination with an existing evidence-based fall prevention bundle reduces the number of falls. Based on the literature review, the unit developed a multicomponent fall prevention program that emphasizes staff and patient education. The program consists of (1) assessment of the patient’s fall risk using the Johns Hopkins Fall Assessment Tool, (2) daily patient education on factors contributing to the patient’s fall risk during the shift assessment, (3) an educational handout on fall risk factors maintained at the bedside, (4) ensuring compliance with implementation of previously existing fall prevention measures, and (5) a patient fall safety agreement. RESULTS During the first 4 months, the fall rate decreased by 55% and staff compliance with interventions for high fall risk patients increased to 89%. To achieve added compliance, the unit implemented an incentive program, which resulted in the increased adherence to the fall risk interventions. The unit experienced 87 and 88 consecutive fall-free days, which was the longest consecutive days since May 2015. This project has reached sustainment and the unit continues to see a low fall rate, well below the national average for medical-surgical units. CONCLUSION One of the largest obstacles to this project was staff and leadership turnover. However, the project found that patient fall safety agreements facilitate a dialogue among staff and patients as well as encourage patients to take ownership of their own care. They improve the safety of patients and create a collaborative environment for nurses to conduct safe, quality patient care.