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Montefiore Medical Center (MMC) is a large, diverse academic medical system in New York City. Their implementation of Fall TIPS began with a pilot, using the laminated paper poster. The average fall-with-injury rate per thousand patient days decreased from 0.47 to 0.31 from the pre-implementation to post implementation period.1 Seeing a reduction in their fall-with-injury rates, MMC decided to expand their implementation through their hospital system concurrent with their adoption of the EPIC Electronic Health Record system.
Post-implementation, MMC has continued to see significant declines of both their fall rates and their fall-with-injury rates. The average fall-with-injury rate per thousand patient days decreased from 0.47 to 0.31 from the pre-implementation to post implementation period.1
MMC reports that three key factors contributed to their successful rollout:
MMC’s audit data shows consistently high compliance with the Fall TIPS program, in the 80-90% range, and we know that Fall TIPS audit compliance of at least 80% results in a clinically significant reduction in falls.2
New York-Presbyterian, one of the nation’s most comprehensive academic health care delivery systems implemented the Fall TIPS electronic poster, which they’re using with their EPIC EHR system. They print out patient education sheets along with the printed poster that hangs in patient rooms.
Post-implementation, New York-Presbyterian has consistently observed high Fall TIPS compliance of at least 80%, and our research shows that Fall TIPS audit compliance of at least 80% results in a clinically significant reduction in falls.3
They have found that the key elements of their success and the program’s sustainability are:
Now, all falls are evaluated in the context of Fall TIPS, and every fall is discussed at the leadership level.
With this demonstrated success, New York-Presbyterian is looking to use the Fall TIPS process as a framework for additional new programs, helping staff to see the connections between these programs in improving patient safety and health outcomes, rather than perceiving them as separate, disconnected processes.
St. Joseph’s Health is a world-class hospital and healthcare network supported by leading and renowned physicians, nurses and care teams. The organization is committed to providing exceptional quality care for patients and communities, with a special concern for those who are poor, vulnerable and underserved.
St. Joseph’s University Medical Center (SJUMC) in Paterson, NJ, and St. Joseph’s Wayne Medical Center (SJWMC) in Wayne, NJ, house approximately 850 inpatient beds. The nursing staff currently uses the Johns Hopkins Falls Risk Assessment tool and uses the falls TIPS tool, developed by Dr. Dykes, as a stand-alone instrument to engage patients in falls prevention. The Nursing Department will be standardizing our Falls risk assessment tool by moving to the Morse Falls Risk Assessment tool with our upcoming computerized EHR platform. At SJUMC, the TIPS tool is used on 15 adult inpatient units, including neurological and psychiatric units. At SJWMC, the tool is used on four hospital units and within an acute rehabilitation unit.
This patient engagement tool for falls prevention was piloted on three nursing units for at least six months (acute rehabilitation unit, Neurological unit and cardiac telemetry unit) in 2016 and 2017 with success, resulting in decreased falls rates on each pilot unit at the six-month mark. Results of the pilot program were brought to the Directors of Nursing Committee meeting, where the Falls Safety Team was asked to implement the tool in additional units. We tightened our internal benchmarks for falls reduction, which also coincided with this initiative.
By May 2018, the tool has rolled out to all adult units (total 20 units) on both campuses. Auditing compliance will ensue for three months during each shift on each unit. Pilot units have seen compliance over 90% by the third month of use. Falls rates on each unit will be observed for six months after first use of the tool to determine impact.
“I think it’s very effective; I like that every patient has their own prescription. So what may be a fall risk for me wouldn’t be a fall risk for the young lady across the hall. So I think it’s very, very useful. And it teaches the patient why it’s important to have this. “
“Where do I rate myself now about my risk of fall? Believe it or not, a 10, because I know I’m not going to fall. They’re not going to let me fall.”
“Really in terms of ambulation, I think that they cover your needs here. There’s always more than one person trying to assist you. Morning and night. There’s always a presence. And even if it’s late at night you can always call, use the call bell. It’s really safe here, it’s very clear. I have never not felt safe.”
“I was very cognizant of fall prevention because they made me aware of it”
“Make sure that you’re more aware right from the beginning, which I have been and I think it’s made a difference with how I navigate around the room and just go at a slightly slower pace than I would have normally.”
“With the skill set you’ve given her, the tools that you guys have given, I would say that she’s a 10 (confident she won’t fall in the hospital).”
“He wouldn’t see [his fall prevention plan] from the bed. I’ve seen it. I know what his fall prevention plan is. It’s very effective.”
“Even the PCAs are really good, they work as a team with the nurses. Because the nurses aren’t always available, obviously with what they have to do, but the PCAs are just as knowledgeable on the fall prevention techniques. So they really work very close together. They’re very great.”
“They’ll come in and they’re very helpful with each other. That’s one thing I’ve noticed. Tremendous teamwork on this floor. So that says a lot to whatever you’re trying to do here, because it’s important.”
1Dykes, P.C., et al., Pilot Testing Fall TIPS (Tailoring Interventions for Patient Safety): a Patient-Centered Fall Prevention Toolkit. Joint Commission Journal on Quality and Patient Safety, 2017. 43(8): p. 403-413.
2Dykes, P.C., et al., Pilot Testing Fall TIPS (Tailoring Interventions for Patient Safety): a Patient-Centered Fall Prevention Toolkit. Joint Commission Journal on Quality and Patient Safety, 2017. 43(8): p. 403-413.
3Dykes, P.C., et al., Pilot Testing Fall TIPS (Tailoring Interventions for Patient Safety): a Patient-Centered Fall Prevention Toolkit. Joint Commission Journal on Quality and Patient Safety, 2017. 43(8): p. 403-413.