US metrics system slashes hospital falls by more than a third in six months

The ‘Knowledge-Based Nursing Initiative’ combines standard prevention techniques with electronic data assessment.

On admission, a nurse adds data on the patient to the system, which assesses the risk of a fall occurring and prompts the nurse to put in place relevant prevention measures, such as raising bedrails.

If the patient does suffer a fall, this is recorded so nurses can see which prevention techniques are more successful.

The initiative is a partnership between Aurora Health Care, IT company Cerner and the college of nursing at the University of Wisconsin-Milwaukee. As well as falls, the system is being used across other areas including pressure ulcers and infection control. It has been in operation across Aurora’s 14 hospitals for six months.

Professor Norma Lang, an RCN fellow who has led the project at the University of Wisconsin-Milwaukee, presented her findings on the success of the system to the RCN last week.

She said the electronic system was aimed at providing ‘decision-support’ to nurses, as well as collating patient information and outcome data.

‘In falls, for example, it will prompt nurses with assessment factors which will appear on screen, including the best evidence for interventions to use in patients at high risk from falls,’ she said.

Professor Lang said the system allowed hospitals to measure a range of factors including the number of patients that had fallen, the percentage of patients assessed for risk within 24 hours of admission, and the percentage of patients at risk of a fall where a prevention care plan had been put in place.

‘Using the IT we can know what the falls rate is, and how, since using it, falls have reduced,’ she added. 

The system has also helped increase the number of patients identified as potentially at risk, she said. Once the electronic system had been installed the percentage of patients identified as at risk of a fall rose from 50% to nearly 74% over six months.

Anne Casey, RCN adviser on information standards, backed the model as something that the NHS could potentially adapt for its own use. She said: ‘This is one example of the way it might be possible to measure [nursing performance] and we could learn from them.’

Some parts of the health service have already adopted similar approaches. In January Nursing Times revealed how NHS North West had cut falls by a quarter since introducing a falls assessment quality indicator, or metric, as part of a pilot programme last year.

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