Implementing and improving fall prevention measures is an important area of focus for nursing excellence. Director of Medical and Surgical Nursing Services, Marian Asiedu, MSN, RN, CWCN, and her team spent over a year evaluating the existing fall prevention techniques at Johns Hopkins Howard County Medical Center (JHHCMC). Their work helped to identify new safety strategies and improve patient care across the medical center.  

The team began by looking at the National Database of Nursing Quality Indicators for falls and identifying which JHHCMC units fell above the benchmark. “We deemed those to be high fall-risk units,” says Marian. “If we could get those units below or even at the benchmark, the whole organization would be at goal.

Marian and her colleagues implemented a BEST bundle: Bed alarm, Education, Siderails and Toileting schedule, across the high-risk units that indicated fall prevention safety measures for identified patients. Staff were instructed to regularly perform “K Card” audits to ensure those processes were in place. If the patient’s room was in compliance, the “K Card” was marked green. If not, the “K Card” was marked red, and the issue was discussed at huddle. “Noncompliance with protocol and policies is what will lead to a fall,” says Marian, “so we made sure the nurses were discussing what they could do to prevent another noncompliance.”  

The team also used purposeful rounding to address the “four Ps” – pain, position, potty and personal needs. “We started asking patients how often the staff came in and if they were asking about these needs,” says Marian. “Every one to two hours, we want a staff member to check in, so the patient doesn’t attempt to ambulate alone and risk falling. 

“Once a week we also conducted preventable harm rounds when we met with the nurse in the patient's room and asked the nurse to talk us through interventions they have implemented to prevent a fall. If there's anything missing in that moment, we can correct it. This also shows the patient that we're doing everything to keep them safe. If the family member was in the room, we involved them in that conversation too and could provide them with education about fall safety in the hospital and how to prevent a fall at home.”    

A patient partnership agreement was also piloted on two units to help patients and families play an active role in preventing falls. When a high or moderate fall-risk patient is admitted they receive extra education about fall safety. The nurse explains the mobility goals, why they're a high-fall risk, what equipment we're going to use to help them to mobilize and what activities they're going to be engaged in for the day to prevent a fall as well as improve mobility. Then the patient signs an informal agreement to work with the nursing staff. “We don’t want to do things to our patients – we want to do things with them,” says Marian. “This agreement gets them involved and invested in what we’re doing. We have seen a drastic reduction in falls with this pilot.” 

Since each unit is different, fall prevention measures will vary across the hospital. Marian and her team are working on finetuning their methods and rolling out a more widespread program. “It’s about drilling down to see where the loopholes are so we can re-educate, re-invent or re-coach our nurses,” says Marian. “We will do whatever we need to do to meet our goals – even if that means starting over again.”