Falls in BMT Patients

Topic Significance & Study Purpose/Background/Rationale 

The University of Minnesota Health's Adult Blood and Marrow unit is continually addressing the important issue of inpatient falls. The Adult BMT patients are a very vulnerable high risk population.  Nursing interventions serve to decrease costs, prevent lengthening of hospitalization, prevent added injuries and stress to patient and caregivers.  In December 2013 the Adult BMT unit moved from a 24  to a remodeled 30 bed unit. Listed are some evidence-based factors that categorize BMT patients as high risk:

Increased age, fatigue, medication related side effects, co morbidities, decreased strength, decreased tone, altered mental status, nutritional status, anemia, oxygen tubing, IV lines and monitoring lines.

Methods, Intervention, & Analysis 

· Nursing involvement with renovation allowed identification of environmental concerns that increased patients risk.

· Installation of Night motion sensor detected lighting.

· New beds that include innovative features for locking desired bed settings and alerting staff to changes in those settings.

· 3 bed alarm sensitivity settings.

· Changes to EPIC charting including highlighted Falls Risk documentation which prompts for interventions.

· Nursing high level shift to shift report that discusses patient risk.

· Weekly electronic medication record interdisciplinary rounds address high risk medications.

· Patient yellow falls wristbands (stocked in bedside supply cart).

· Distinguishable falls precautions door magnets to alert anyone entering room.

· Dedicated patient whiteboard, that color codes activity/falls level.

· Non-skid socks for patient use (stocked in bedside supply cart).

· Post fall huddle form, which prompts immediate analysis. 

· Teach back on call light use.

Findings & Interpretation 

In 2012 overall fall rate was 4.72.  In 2013 overall fall rate was 3.31. Current fall rate 2014 is 2.41 falls per 1000 patient days. Results show decrease in the annual fall rate. 

Discussion & Implications 

-Continued goal toward decreasing rate to zero.

-Ongoing fall risk assessment from interdisciplinary team.

-Teaching to staff, patients, and caregivers about risks and prevention.

-Continued evaluation, investigation and adoption of best practices.