Fall Innovations: A Multimodal Initiative to Decrease Falls in the Blood and Marrow Transplant Setting

Fall Innovations: A Multimodal Initiative to Decrease Falls in the Blood and Marrow Transplant Setting

Topic Significance & Study Purpose/Background/Rationale

A Stem Cell Transplant unit presents unique challenges for fall initiatives.  Relatively healthy patients admitted to a private room, and effectively isolated behind closed doors, are challenged with progressive weakness and fatigue following their preparative regimen.  As they become a greater risk for fall, patients also develop pancytopenia, increasing their risk of injury.  The purpose of this study was to develop an inter-professional, multimodal protocol to address rising fall rates on the Stem Cell Transplant unit.  Literature review revealed the utilization of multiple strategies concurrently resulted in greater improvement in fall rates.  

Methods, Intervention, & Analysis

• The culture of “patients fall” perception was challenged.
• A unit specific fall risk patient teaching tool was developed.
• A Staff Safety Pledge was signed by all staff members.
• Daily rounding on patients by Charge Nurse and Manager to validate bed alarm usage.
• Unit-based fall huddles and Service-line based outlier meetings to review circumstances surrounding falls.
• Medications review to determine those that most greatly increase risk of falls.  Patients not assessed as high fall risk were placed on bed alarms for two hours after receiving these meds.
• All staff members received education on Crucial Conversations and how to address patients’ refusal of bed alarm usage. 
• Continued refusal of the bed alarm was escalated to nursing leadership.
• Collaboration with Physical Therapy- the use of a communication board to report activity and required assistance by staff.

Findings & Interpretation

• 2012 total falls were 19, fall rate 3.02/ 1000 patient days.
• 2013 total falls were 27, fall rate 4.45/ 1000 patient days.
• 2014 falls through 3^rd quarter is 10, fall rate 2.08/ 1000 patient days.

Discussion & Implications

Consistent implementation of any strategy is the best way to ensure sustained results.  Nurse leader rounding to validate use of the bed alarm and consistent messaging to staff and patients is necessary to keep protocols high priority.

• References to be listed on poster presentation