Lean strategies help North Carolina hospital reduce patient falls by 22 percent

Although the patient fall rate at New Hanover Regional Medical Center three years ago was considered acceptable under national standards, hospital leaders knew they could do better. So they embarked on a lean strategy initiative to prevent patient falls.

Jack Barto, president and CEO of the Wilmington, North Carolina facility, said in a blog post that the organization formed a patient safety services fall team to examine the underlying causes of why patients fall and what caregivers can do to prevent them. The team learned that many falls were due to medicated or disoriented patients with physical impairments tripping in unfamiliar surroundings or unable to reach the bathroom--the source of 54 percent of the falls.

The team then took what Barto describes as simple steps that cost little and required almost no investment in technology:

  • Nurses now check on patients every hour to anticipate their needs, such as visits to the bathroom, and strategically administer medication so patients are more likely to sleep through the night without the need to use the bathroom.

  • The hospital identifies high-risk patients by having them wear yellow socks and placing signs in patient rooms that identify fall risks and how caregivers should respond.

  • Nurses have walkers placed in every room of patients at risk for falls.

  • High-risk patients sign a "fall prevention partnership" agreement with nursing staff.

  • If a fall occurs, nurses conduct a "fall huddle" with the team to discuss the incident and how to prevent it in the future.

As a result of these measures, Barto said the hospital's patient fall rate decreased 22 percent to 2.5 per 1,000 patient days. He estimated that the prevention initiative saved the system more than $500,000 based on national industry figures that calculate a typical fall will cost a healthcare system $8,000 to $13,000.

"This is but one example of how healthcare providers, by standardizing best processes and consistently following them, can change the delivery of care, one improvement at a time," he said.

Patient falls are a frequent problem at hospitals. The Joint Commission reports there are about 11,000 fatal falls in hospitals every year, and injuries cost hospitals more than $14,000 in additional expenses.

"Patient falls are a serious problem that have received a great deal of attention, yet defy easy solutions," said Erin DuPree, M.D., vice president and chief medical officer at the Joint Commission Center for Transforming Healthcare, FierceHealthcare previously reported.

Every year, approximately 1 in 3 adults over the age of 65 will fall and nearly 30 percent suffer moderate to severe injuries, according to the Patient-Centered Outcomes Resource Institute (PCORI). This week the institute announced a partnership with the National Institute on Aging of the National Institutes of Health to embark on a five-year, $30 million national study of a patient-centered approach to prevented fall-related injuries in older adults.

"We cannot eliminate falls altogether, but we know that many fall-related injuries are preventable through good, evidence-based interventions," said PCORI Executive Director Joe Selby, M.D., M.P.H. "What's lacking is evidence on the optimal combination of interventions to meet patients' individual needs and circumstances and how best to deliver tailored plans. Older adults and their caregivers and healthcare providers are essential partners in the effort to answer these questions."

The trial will test the effectiveness of using nurses or nurse practitioners who are trained as "falls care managers" to develop and deliver evidence-based prevention plans tailored to the specific risks of each individual and to monitor patients' outcomes in consultation with their primary care providers.

To learn more:
- read the blog post
- here's the announcement

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