Atrium Health's approach to fall prevention used to be inadequate, and was not properly protecting its hospital patients' safety.

THE PROBLEM

The health system's previous falls prevention technology lacked the discreteness required to obtain specific patient data unit details. While Atrium staff had access to raw numbers, the information was not discerned enough to allow staff to delve into crucial aspects such as the time of day and specific days of the week without resorting to extensive manual efforts.

This limitation hindered staff's ability to conduct a thorough analysis and identify patterns efficiently.

PROPOSAL

"The pressing need for a more refined approach was particularly evident from a nursing perspective, considering that falls are a significant concern in healthcare settings," said Robert Rose, market chief nurse executive for the central division at Atrium Health. "Our hospitals also adhered to magnet indicators, and the new technology we implemented has proved instrumental in developing a robust plan for falls prevention.

"The advanced features of the new falls prevention technology allowed us to overcome the challenges we faced previously," he continued. "With improved monitoring and measurement capabilities, we have been better equipped to understand the dynamics of falls, identify trends and implement targeted interventions. The technology not only has streamlined our processes but also has served as a valuable tool in our commitment to reducing falls and enhancing overall patient safety."

"Embedding evidence and links directly into the workflow ensures important information doesn't go overlooked."

Dawn Ross, DPN, RN-BC, Atrium Health

The focus when looking for the new technology was on evaluating outcomes and understanding whether technology could genuinely improve results rather than being adopted just for the sake of having it. Staff seeing other facilities that had already implemented the technology allowed them to analyze the outcomes of falls in that context.

"This assessment was crucial in determining the impact of the technology on outcomes," Rose said. "It is important to not just adopt technology for the sake of it but to ensure that it genuinely contributes to improving outcomes. The ability to assess and base results on the experiences of other facilities influenced the decision to implement the falls prevention technology. We went through a very thorough evaluation of the technology before deciding to proceed with implementation.

"There were definitely some challenges associated with the implementation, as it was a significant change for the nursing teams and colleagues involved," he continued. "The falls prevention technology introduced a paradigm shift, requiring adaptation from the healthcare professionals who were not accustomed to such innovations."

The proposal for falls prevention technology was grounded in assessing outcomes, learning from existing implementations and ensuring the technology offered specific interventions to reduce falls. The decision to implement was not only based on the desire for technology but on a thorough evaluation of its impact and relevance to improving patient outcomes.

"The implementation process involved navigating through challenges associated with change, particularly for the nursing teams involved," Rose said.

MEETING THE CHALLENGE

Atrium Health faced challenges within falls prevention, prompting a thorough evaluation of available tools and consultations with different vendors. Eventually, the Hester Davis Falls Program was chosen. 

At the time, there was no partnership between Hester Davis and Atrium Health's EHR vendor. To address this, a large multidisciplinary team was assembled, comprising individuals from various departments involved in fall prevention.

Since this initial build, Atrium has transitioned to Epic for its EHR and there is a partnership in place, making the build much easier for staff.

"The initial step involved assigning an IT analyst and a clinical informatics specialist," said Dawn Ross, DPN, RN-BC, vice president and chief clinical informatics officer at Atrium Health. "Subsequently, individuals from nursing, falls team, administration, nutrition, transport, therapies, facilities, pharmacy, supply chain and respiratory were included in the collaborative effort.

"Due to the absence of a pre-existing partnership, an elaborate build was undertaken, followed by testing and workflow analysis," she continued. "The team assessed how the technology supported different workflows and strategically used the multidisciplinary team to ensure comprehensive coverage."

Notably, the Hester Davis program went beyond identifying fall risks – it offered interventions tied to those risks. The organization invested in chair alarms, bed alarms and mats to enhance patient safety. During implementation, the team identified the importance of proximity and accessibility to these tools.

"The data-driven approach enabled by the technology allows for a deeper understanding of when and how falls occur, leading to valuable insights and informed interventions."

Robert Rose, Atrium Health

Initially stored in central supply and later in a unit supply room, the tools eventually found their place directly in patient rooms, ensuring they are readily available to nurses for timely intervention.

"A unique aspect of the falls management program was the accompanying analytics and program features," Ross explained. "The organization implemented a falls huddle form, electronically submitting information directly from the EHR. The link to the fall debrief was embedded in the Epic workflow, streamlining the process for healthcare professionals.

"The integration of these tools, interventions and analytics has collectively contributed to achieving positive outcomes in falls prevention within the organization," she added.

RESULTS

The technology platform has shown significant success in reducing fall rates and preventing falls with injuries since its implementation in April 2022. The fall rates, which initially averaged around 3.5, have decreased to as low as 2.22 and currently sit at about 3.1.

"This demonstrates a positive trend and highlights the effectiveness of the technology in minimizing falls," Rose reported. "Moreover, there has been a noticeable decrease in falls with injuries, emphasizing the main goal of the initiative. The implemented technology has contributed to avoiding falls with injuries, which is crucial in healthcare settings.

"The data-driven approach enabled by the technology allows for a deeper understanding of when and how falls occur, leading to valuable insights and informed interventions," he continued. "Additionally, the financial impact is substantial, with an estimated cost avoidance of about $500,000 based on literature-related falls."

The overall positive impact on patient safety, nursing care and cost savings underscores the successful outcomes achieved through the implementation of this technology, he added.

ADVICE FOR OTHERS

"One key lesson we learned is the importance of incorporating foam mats," Ross advised. "These mats proved to be imperative in preventing injuries related to falls. It might seem like a simple addition, but their impact on patient safety is significant.

"Collaboration with EHR vendors is another crucial aspect," she continued. "Integrating the fall prevention technology with the EHR system enhances its effectiveness. The EHR vendor can play a complementary role, supplementing the technology and ensuring that relevant information is seamlessly connected. This integration not only streamlines the workflow for healthcare providers but also reinforces the completion of necessary interventions."

Moreover, it's vital to group information within the EHR to avoid nurses having to navigate through multiple platforms, she added.

"Embedding evidence and links directly into the workflow ensures important information doesn't go overlooked," she said. "We took the extra step of including fall prevention documentation in our required shift documentation, emphasizing the importance of reassessment in preventing falls.

"An intuitive but valuable lesson we learned is to have computers at the bedside," she concluded. "This not only facilitates real-time documentation but also engages patients in the process. Being able to explain to patients what is being documented and why creates a sense of involvement, turning them into active participants in the fall prevention team."

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