JMIR Publications

ABSTRACT

Background:

Patient falls are a major problem in hospitals. The development of a Patient-Centered Fall Prevention Toolkit, Fall TIPS (Tailoring Interventions for Patient Safety), reduced falls by 25% in acute care hospitals by leveraging health information technology to complete the three-step fall prevention process: 1) conduct fall risk assessments 2) develop tailored fall prevention plans with the evidence-based interventions and 3) consistently implement the plan. We learned that Fall TIPS was most effective when patients and family were engaged in all three steps of the fall prevention process. Over the past decade our team developed three Fall TIPS modalities: the original EHR version, a laminated paper version that uses color to provide clinical decision support linking patient-specific risk factors to the interventions, and a bedside display version that automatically populates the bedside monitor with the patient’s fall prevention plan based on clinical documentation in the electronic health record. The relative effectiveness of each Fall TIPS modality for engaging patients and family in the three-step fall prevention process was unknown.

Objective:

The purpose of this study is to examine if the Fall TIPS modality impacts patient engagement in the three-step fall prevention process and thus Fall TIPS efficacy.

Methods:

To assess patient engagement in the three-step fall prevention process, random audits were conducted with the question: “Does the patient/family member know their fall prevention plan?” Audits were also conducted to measure adherence, defined by the presence of the Fall TIPS poster at the bedside. Champions from three hospitals reported data from April-June 2017 on six Neurology and seven Medical units. Peer-to-peer feedback to reiterate the best practice for patient engagement was central to data collection.

Results:

1209 audits were submitted for the patient engagement measure and 1401 for presence of the Fall TIPS poster at the bedside. All units reached 80% adherence for both measures. Some units maintained high levels of patient engagement and adherence with the poster protocol. Others showed improvement over time, reaching clinically significant adherence (>80%) by the final month of data collection.

Conclusions:

Each Fall TIPS modality effectively facilitates patient engagement in the three-step fall prevention process, suggesting all three can be used to integrate evidence-based fall prevention practices into clinical workflow. The three Fall TIPS modalities may prove an effective strategy for spread, allowing diverse institutions to choose the modality the fits with the organizational culture and health information technology infrastructure.