Falls in the Emergency Department

Abstract

Background Patient falls in hospitals have been a long-standing issue for many inpatient units as well as emergency departments (ED). Studies have been conducted to find a reasonable solution to this issue. A literature review was conducted and found that bundled interventions that include multiple interventions, such as a falls wristband; supportive, non-skid footwear; patient education; and hourly rounding can be helpful to reduce falls numbers in the hospital setting. Overall, the literature supports a multi-pronged approach to reducing falls. Local Problem A local suburban hospital ED had experienced an increase in falls and requested a nurse practitioner student to assist them by implementing a falls prevention bundle for high falls risk patients. The student utilized information from the literature review and formulated a plan to implement a falls prevention bundle in the ED, including educating patients on their individual falls risk, providing the high falls risk patients with falls wristbands, non-skid footwear and auditing the use of hourly rounding. Interventions Over the course of two weeks, the project leader educated registered nurses and patient care technicians on the project, and how and where to locate the bundle items on the unit. After these two weeks, the bundle was officially implemented by the staff members and the project leader began auditing 5 randomly chosen high fall risk patients per week, to evaluate the usage of the bundle. After 14 weeks of implementation, monthly falls rates were evaluated, and electronic chart audits were completed by the project leader. Results In September, the project leader educated 51 nurses and patient care technicians out of 174 staff members, or 29.31% of the total ED staff. The unit had three falls noted on the incident report for the month of October. In October’s audits, 60% of high fall risk patients had received their non-skid socks upon entry to the ED. Seventy-six percent of nurses self-reported use of hourly rounding as well. In the month of November, there were zero falls, a great accomplishment. However, per the audit results, some of the bundle usage numbers had decreased. Of note, the project leader did not record any patients with the falls education handout in audits during the entire project. In the first week of December, data on patients who had fallen from 8/22/18-11/26/18 was collected. This data shows that zero of these patients had hourly rounding documented on them within the electronic chart. Conclusions Overall, it appeared that the falls numbers decreasing over the implementation period was not due to individual aspects of the intervention bundle, but perhaps due to the auditing process. The project leader’s presence on the unit every week, reminder emails sent to staff, and a poster with falls information were all incorporated once audits revealed that aspects of the bundle were not being consistently utilized. Perhaps re-education provided during the audits coupled with the presence of the project leader on the unit helped to increase falls awareness in order to decrease the falls rate for the unit.