Each year, up to one million people fall in hospitals across the United States. In 2017, New Hanover Regional Medical Center had measures in place to reduce patient falls, but reducing patient falls continued to be a challenge.
To help create the best environment possible for our patients, NHRMC held a three-day Lean “Kaizen” event engaging a team of workers involved in every aspect of patient care. The team members were taken off their regular work schedules so they could evaluate the current situation and try to find out how to prevent further falls. The team included members of the NHRMC Orthopedic Hospital, who have recorded more than 200 consecutive days without a patient fall.
The project
The team identified four ways to help reduce falls:
- Standard work: Because more than half of patient falls were related to toileting, the team instituted a re-dedication to hourly rounding with toileting first and improved communication between shifts. Some medications increase the need for toileting or cause dizziness, so staff made a toileting schedule for patients on those medications.
- Walk the patients: If patients are walking 600 supervised steps per day, they gain strength and confidence on their feet. Patients who meet that goal generally leave the hospital two days sooner than others with the same condition
- Fewer sleep interruptions: Vital signs and medication administration were changed to other times when possible
- Identify patients at risk for falling, and ensure everyone involved in patient care has visual cues to be extra careful with the patient. This will include pop-up precautions when certain medications are prescribed
The impact
NHRMC set a goal of reducing the patient fall rate by 10 percent in 2018 and another 10 percent in 2019. The ultimate goal is zero falls. From October 2017 to March 2018, NHRMC piloted the new practices on one floor, and the fall rate dropped from 4.1 to 0.8. The system has since been expanded to the ninth floor with plans to extend to the other floors in the patient tower in the coming months.
“Improving communication between staff members and during shift changes was vital to the success of this project,” said Sandy Andrews, Outcomes Manager in Patient Safety at NHRMC. “We set up toileting schedules and communicated them to patients and family members. As a result, falls related to toileting were greatly reduced.”
The Fall Reduction Kaizen Event at New Hanover Regional Medical Center earned a Bronze Touchstone Award from Atrium Health, which has a services agreement with NHRMC. The Touchstone Award was one of seven earned by NHRMC in 2018.
Team members
- Executive VP Sponsor: MaryEllen Bonczek
- Physician Champion: Dr Amit Datta
- Lean Coach: Eva Pittman
- Value Stream Managers: Johnsie Davis and Janet DeLucca
- Team Leader: Sandy Andrews
- Team Members: Desarie Diletro, Teah O’Neil, Jenna Brown, Cathy Wright, Erin Kepler, Wendy Browning, Tyler Sihelnick, Shannon Eidsness, Stephanie Grundman, D. Charmaine Lewis, Ruth Marescalco, Ava McKitrick, Donna McGee, Rosalyn Thomas, Sharlotte Williams, Brenda McDuffie Sanders, Chawaun Newkirk, Sarah Heath, Heleana Douglas, Beth Hicks, Caitlin Dunn.