Understanding the Sustainability of Quality Improvement in an Academic Medical Center: A Case of the Falls Prevention Toolkit

Abstract

Most nurses providing care at the bedside have a story about a patient who experienced a fall that either sped up their disease process or prolonged their hospitalization. Due to the potential severity of harm from falls, health systems and payers have placed an intentional focus on reducing the incidence of falls. Numerous studies have explored interventions to decrease the incidents of falls, for example, tailoring interventions to the specific unit's environment (Jacobs, 2016), increasing staff training (Montejano-Lozyoa, 2020), and talking with patients about their fears to bridge the fall risk perception gap that often occurs between patients and staff (Kityoshi-Teo, 2020). While there is an abundance of research on individual interventions, there is a deficiency in knowledge about intervention sustainability. The purpose of this project is to conduct a quality improvement assessment to understand the impact and sustainability of the Vidant Health Falls toolkit implementation on reducing falls. Understanding the impact of this toolkit, we can adjust it to provide better outcomes for both our patients and our hospital payers. In 2021, Vidant Health implemented a fall reduction tool kit in its effort to address the incidence of falls across their academic medical center. Focus groups with key staff members were conducted after units had been using the toolkit for at least 6 months. ”Key staff members” will be used throughout this paper to describe individuals whose units utilize the toolkit and have had personal experience with its usage. Interviews with these key staff members revealed that there were two overarching barriers to successful implementation: lack of time to execute the toolkit, and lack of understanding why the toolkit is important. These findings reinforce that health systems implementing falls reduction toolkits should include education during new hire education that explains the rationale behind the toolkit in order to create a foundation for a falls prevention culture.