Implementation of the Fall Round Checklist in Hospitalized Adult Patients

Abstract

Background: One million inpatient falls occurs in U.S hospitals annually, with medical units incurring the highest fall rates. In fiscal year 2018, 325 falls occurred in patients at high risk for falls at a local academic hospital. One hundred and forty-eight or 46% were found to have gaps in fall prevention practices at the time of fall. As costs associated with falls are no longer reimbursed by the Centers for Medicare and Medicaid, the organization’s goal was to improve fall prevention practices in low performing units. Clinical audits on falls have been found to directly measure fall prevention practices by assessing nursing compliance. Methods: This Doctorate of Nursing Practice project was implemented over a 14 week period. Data was collected while conducting an electronic health record audit and direct bedside observations using the “Fall Round Checklist” by the project leader and resource nurse participants. Percentages were used to evaluate nursing compliance with each item on the checklist from data entered into Excel. Results: Eleven medical-surgical units were audited. Two hundred and fifty- five patients were identified as high risk for falls. Consistent fall prevention interventions were observed in fall risk assessment documentation (87%). Environmental measures (call bell in sight and within reach, bed in low position, table and personal items within reach, clutter free room) averaged 96% compliance. Lack of consistency was noted with documentation of fall interventions (41%), turning the bed alarm on (46%), yellow armbands (50%), or supervision with toileting (41%). Conclusion: Successful implementation of the “Fall Round Checklist” identified gaps in practice that will assist the organization in improving fall prevention practices in low performing units through corrective actions of care processes, thus ensuring safe and quality care.