Using the HIGH 5 Fall Bundle to Reduce Patient Falls in the Medical-Surgical Unit

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Background: Nurses are responsible for identifying patients at risk of falling and developing a plan of care to reduce risk in the hospital setting. As a result, nurse-driven safety interventions using an interdisciplinary approach can positively influence fall rate indicators. An assessment of unit nursing practice validated barriers to fall prevention and increased fall rates. A thorough examination revealed: 1). an inconsistency in the fall risk assessment documentation upon admission to the medical-surgical unit, and 2). a lack of fall prevention education. This increased the potential for patient harm and decreased staff compliance. Purpose: The purpose was to implement a comprehensive fall prevention program with goals of 1). reduction in patient fall rate, and 2). improvement in nursing compliance through the use of a fall prevention program and nurses' documentation of fall risk assessments each time a patient is admitted to the medical-surgical unit. Methods: The methodology included the development of 1). an interdisciplinary team, and 2). the contents of a "HIGH 5 fall bundle" included key performance indicators and visual cues for each nurse caring for fall-risk patients. 3). a standardized fall prevention process including education for all RNs, and 4). The pre-and post-implementation analyses included monthly fall rates and compliance with fall prevention. Results: The fall rate showed an overall improvement in fall reduction for two consecutive months. The project objective was to increase the number of fall risk assessments completed upon admission to the medical-surgical unit. The project concluded with a positive variance of a 3.5% increase which is statistically significant and exceeds the goal of greater than 90% of patients with a documented fall risk assessment upon admission. The impact of the QI project exceeded the goals. The organization plans to disseminate the training to the entire hospital and make it mandatory for all RNs to participate. Conclusion: Patient fall prevention is critical to decreasing the risk of injury, hospitalization costs, length of stay, disability, and death. To improve fall prevention strategies, reduce the risk of injury, and improve nursing compliance in the medical-surgical unit, a collaborative team approach utilizing a standardized process and improved access to standardized education was required.
Submitted in partial fulfillment of the requirements for the degree Doctor of Nursing Practice
Nursing, Health Care Management