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Beyond Socks, Signs, and Alarms

A Reflective Accountability Model for Fall Prevention

Hoke, Linda M. PhD, RN, AGCNS-BC, CCNS, CCRN; Guarracino, Dana BSN, RN

AJN The American Journal of Nursing: January 2016 - Volume 116 - Issue 1 - p 42–47
doi: 10.1097/01.NAJ.0000476167.43671.00
Cultivating Quality

Despite standard fall precautions, including nonskid socks, signs, alarms, and patient instructions, our 48-bed cardiac intermediate care unit (CICU) had a 41% increase in the rate of falls (from 2.2 to 3.1 per 1,000 patient days) and a 65% increase in the rate of falls with injury (from 0.75 to 1.24 per 1,000 patient days) between fiscal years (FY) 2012 and 2013. An evaluation of the falls data conducted by a cohort of four clinical nurses found that the majority of falls occurred when patients were unassisted by nurses, most often during toileting. Supported by the leadership team, the clinical nurses developed an accountability care program that required nurses to use reflective practice to evaluate each fall, including sending an e-mail to all staff members with both the nurse's and the patient's perspective on the fall, as well as the nurse's reflection on what could have been done to prevent the fall. Other program components were a postfall huddle and guidelines for assisting and remaining with fall risk patients for the duration of their toileting. Placing the accountability for falls with the nurse resulted in decreases in the unit's rates of falls and falls with injury of 55% (from 3.1 to 1.39 per 1,000 patient days) and 72% (from 1.24 to 0.35 per 1,000 patient days), respectively, between FY2013 and FY2014. Prompt call bell response (less than 60 seconds) also contributed to the goal of fall prevention.

When the rates of patient falls increased in one cardiac intermediate care unit despite the use of standard fall precautions, a group of clinical nurses designed a nursing practice initiative featuring nurse self-reflection that successfully led to a decrease in falls.

Linda M. Hoke is a unit-based clinical nurse specialist in the cardiac intermediate care unit and Dana Guarracino is a ventricular assist device coordinator at the Hospital of the University of Pennsylvania, Philadelphia. Contact author: Linda M. Hoke, The authors have disclosed no potential conflicts of interest, financial or otherwise.

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