By Greg Freeman
Executive Summary
A hospital system in Florida was able to reduce patient falls by 80% through improved education and continuous predictive modeling. The reduction occurred over one year.
- The hospitals conducted boot camps to review fall prevention strategies.
- Staff were encouraged to create their own fall prevention plans.
- Quarterly report cards helped keep staff motivated.
AdventHealth in Tampa Bay, FL, successfully reduced patient falls by 80% through predictive modeling, enhanced education, and a strong culture of continuous improvement and zero harm. The risk manager says other hospitals can learn from the experience and implement strategies to seek the same results.
The hospital system was facing the same challenge with fall reduction that is familiar to all risk managers, says Peggy Maguire, director of risk management with AdventHealth Dade City Hospital and AdventHealth Zephyrhills Hospital. Between the two campuses, in 2022, AdventHealth was averaging a patient fall every 1.17 patient days, which Maguire acknowledges was “pretty terrible” but not so unusual for many hospitals.
When the program rolled out in January 2023, the hospitals’ patient fall rate was 4.04 falls per 1,000 patient days. By the end of 2023, that figure was down to 0.5, Maguire says. A data analysis revealed patterns in patient falls. Most of the patient falls occurred on inpatient units, with the riskiest time being at least 24 hours after admission but no more than 48 hours. Fall risk factors were assessed for individual patients, also.
“We also noticed that Tuesdays and Fridays had higher fall rates for some inexplicable reason, but they did. Over half the time, these falls were linked to the patients using the bathroom,” she says.
AdventHealth turned that information into predictive modeling and asked each inpatient unit to begin reporting in their daily safety huddle their top three patients who were at the highest risk for falls that day, based on the predictive modeling subsets.
“I’d also call nurse managers randomly and say, ‘It’s Friday, so you’re going to have a patient fall today. Who’s it going to be?’” Maguire says. “They had to really think through that. It got them thinking proactively instead of reactively, and that was a huge shift in in the mindset.”
That daily reporting of the top three fall risk patients on each unit reduced falls 10% in the first three months, she says. But Maguire and her colleagues thought there was more to be achieved, and that is when they landed on the idea of a fall-reduction boot camp.
In a past role, Maguire worked for an outpatient kidney dialysis company and visited its dialysis centers regularly. If she was a staff member practicing less than perfect infection control practices, she would pull them off the floor quickly run them through an intense education that she called boot camp. She would send them back out to the floor and watch them.
She decided to apply the same concept to fall reduction at the hospitals, creating an intense, high-focus education program.
“It was a three-hour session for nurse managers for each unit only. We would have an education component followed immediately by a group activity and a report out amongst the entirety of the attendees,” she says. “Then we would go in right into the next education component and repeat the same pattern. We had a lot of education to do on fall risk assessments.”
The boot camp team found that staff had a poor understanding of the Hester Davis Fall Risk Scale and were not scoring patients correctly. There also was a lot of opportunity with messaging from nursing and staffing to patients.
“We also talked about early mobilization, because when the patient gets in the hospital, where do you almost always see them? Laying in bed. You do that for 24 or 48 hours, and deconditioning starts to set in,” Maguire says. “So, they’re not as strong and they’re more vulnerable. There’s an opportunity for early mobilization.”
Make Your Own Plan
At the end of this boot camp, the boot camp team gave the nurse managers an assignment to create a comprehensive takeaway plan based on everything they had learned for the previous three hours and ideas they heard from others. The comprehensive takeaway plan had to include educating the staff.
“One of the things that is key to success is to allow each manager to put their own individual stamp on what their takeaway plan was. I could have handed them a takeaway plan, but then it would be my plan and not their plan,” she says. “When they put their own individual stamp on it, the creativity went through the roof. We had one nurse manager redesign her start and stop times for shifts so they were staggered, because change of shift was also a vulnerable time.”
Another nurse manager purchased pedometers for everybody who worked on the floor to encourage more early mobility. They would have a contest each week to measure how many steps for early mobility each staff member achieved.
“We rolled out the staff education on their comprehensive takeaway plan in small bites to make sure they had comprehension, to make sure that they stuck to it, and then the nurse managers would audit to make sure that the plan was being followed,” Maguire says. “I think those were some very key important parts to having a successful rollout.”
The boot camp was a hot topic in the hospitals when they began in January 2023, but Maguire was concerned that the next big thing would eventually come along, and staff would once again become complacent about falls. To counter that, the hospitals developed a weekly series of two-minute educational videos in March. Then in April they rolled out and created a patient falls champion rule for each unit. AdventHealth also developed a leadership rounding guide and a quarterly report card at the end of six months to show progress.
Direct Care Staff Involved
Patient falls were trending downward the first half of the year after the first boot camp, but then AdventHealth hosted a second boot camp that included the direct care staff.
“That was when our rate just plummeted, because now the direct care staff went into the boot camp, too. It never really went back up other than one occasion, and for that, we implemented a three-day deep dive into the process, and it went back down,” Maguire says. “We modified the boot camp into including physical therapy, and we had stations along the way for education, for gait belt, and patient transfers.”
Then, the boot camp was expanded to include ancillary staff and the results improved even more.
“All of us are part of the patient falls prevention team, not just nurses,” Maguire says. “The entirety of 2024 has been even better than the entirety of 2023. And 2023 was really amazing, especially that latter half, where we saw the lowest numbers we’ve really ever seen on campus.”
Source
- Peggy Maguire, Director of Risk Management, AdventHealth Dade City Hospital and AdventHealth Zephyrhills Hospital, Tampa Bay, FL. Email: [email protected].
Greg Freeman has worked with Relias Media and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Relias Media products. In addition to his work with Relias Media, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.
AdventHealth in Tampa Bay, FL, successfully reduced patient falls by 80% through predictive modeling, enhanced education, and a strong culture of continuous improvement and zero harm. The risk manager says other hospitals can learn from the experience and implement strategies to seek the same results.
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