Shore Health System Gets High Marks for Keeping Patients Safe

Patient falls is one measure of the quality of care provided by hospitals around the county. On the University of Maryland Medical System (UMMS) quality report card, the inpatient units at Dorchester General Hospital and The Memorial Hospital at Easton, both members of Shore Health System, have been receiving high marks in the area of patient falls.

The UMMS report card measures data against the National Database of Nursing Quality Indicators (NDNQI®), which compares hospitals of similar size. Shore Health System’s consistently impressive ratings are reflective of a number of initiatives put into place to reduce patient falls during a hospital stay.

Achieving quality improvement in inpatient falls scores began as a nursing initiative in 2007. Nursing leadership helped to establish the multidisciplinary Falls Task Force, which has developed a system-wide approach to improving inpatient fall rates. According to Diane Walbridge, MSN, RN, director of clinical/financial nursing resources for Shore Health System, “We have significantly reduced patient falls at both hospitals since January of 2009 and are currently below the national benchmark in this area.”

Walbridge credits the success to a multi-faceted approach, including reviewing and revising fall risk tools, implementing “fall huddles” among Shore Health System staff, using patient sitters, and educating patients and their families on fall risks. Walbridge notes, however, the use of new fall monitors in both hospitals may be the element most responsible for the recent improvement.

“We needed more tools to help us know when patients were getting out of bed,” Walbridge explains. “During a Falls Fair in October of 2008, nurses got to evaluate and test a number of different fall monitors. They selected a new monitor that interfaces with our patient call system. The new monitor alerts staff immediately when a patient is getting out of bed and identifies the patient’s room number. This allows staff to quickly respond to the patient and prevent a fall from occurring. ”

The Requard Center for Acute Rehabilitation at Memorial Hospital is also receiving satisfactory ratings in the area of inpatients falls on the UMMS report card. The staff implemented its own performance improvement measures when they began caring for patients whose conditions were more medically complex.

According to Bill Roth, senior director of Shore Rehabilitation Services, “Patients are more likely to fall in acute rehabilitation than in acute care because we are working with patients who have greater physical and cognitive impairments, and also encouraging their mobility and independence. Because of this, our unit required extra study and focus in order to achieve the benchmarks in our industry.”

The Requard Center is accredited by the Commission for Accredited Rehabilitation Facilities, which calls for the ongoing measurement and improvement of performance in all areas of operation, including clinical services and safety. Debbie Medford, RN, BC, outcomes coordinator for the Requard Center, comments, “As we began to analyze fall data on our unit, we realized that the hospital-wide policy on falls needed to be adapted to the needs of our unit.”

Medford continues, “Our data showed that patients are more at risk for falling within the first 48 hours of their week-long stay, when they are weakest, and again at the end of their stay, when they are beginning to test their independence. To address this data, we decided to treat our patients as ‘high risk’ for falls upon their arrival. This means using bed-chair alarms during the duration of their stay and not leaving the patient alone in the bathroom or shower.”

Medford also credits the implementation of an interdisciplinary care planning meeting that takes place when a patient arrives on the unit as a key way to involve all necessary staff members in the patient’s plan of care. This meeting includes the physical, occupational and speech therapists, nursing staff members, case management, the physician and family members, all of whom become partners in the rehabilitation process.

Roth concludes, “As an accredited acute rehabilitation unit, we are expected to achieve these benchmarks and assure that health and safety is always our top priority. Our staff has done an outstanding job, and they understand that our goal remains no falls. They have really made a difference in this area and continue to make a difference every day.”