Reducing Fall Rates in Medical Surgical Unit Using 4AT Delirium Screening Tool

Abstract

Problem: Hospital falls are linked to multiple factors with delirium being one of them. For a teaching hospital, the safety concern data revealed that the total number of falls in 2022 was 459 and the targeted medical surgical unit alone made up 15% (69 falls) of the total fall. Purpose: This quality improvement (QI) initiative aimed to promote safety interventions and decrease fall rate using the 4AT (Arousal, Attention, Abbreviated Mental Test-4, Acute change) delirium screening tool on admission and each shift for patients 65 years and older. The synthesis of literature highly suggests screening elderly patients with the 4AT tool to identify delirious or at risk for delirium and assists with preventive measures including fall. Method: The 4AT delirium screening tool was integrated inti the electronic health record to implement evidence-based structure and workflow changes. Complete 4AT questionnaires to generate automated numbers that determined patients at risk of developing delirium (i.e., score ≥ 3). A workshop, online modules, and PowerPoint were used for education, while the project leader (PL), educator, champions, and nurse manager reinforced education and compliance. Furthermore, implementation included a secure data collection plan and strategies to achieve the project goal. Nurses were required to complete the 4AT tool. Compliance was measured through a weekly audit process done by the PL, then feedback was exchanged regularly on outcomes and improvement needed for the project. Results: The use of 4AT tool resulted in early identification of delirious or at risk for delirium patients prompting the initiation of fall precautions. The compliance rate was 99% and 100% of the delirious patients had a fall precaution order placed. There was a decrease in fall rate (4.5 % compared to last year 15 %) since implementation of this initiative. Conclusions: This QI project highly supports the screening of all elderly patients to identify delirium early and initiating fall precautions for score ≥ 3 to decrease the fall rate in med-surg unit.