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Hourly rounding, huddles help prevent patient falls

Quality Improvement Monitor, November 30, 2007

Editor's note: This is the second part in a series looking at how to prevent some of the conditions CMS will no longer pay for beginning in October 2008.To reduce patient falls, hospitals should build a care plan that addresses every patient's specific needs and frailties. And should someone tumble despite those precautions, clinicians should form a postfall huddle to ask what happened, why it happened, and what can be done to prevent it from occurring again.

"Those ideas, in my mind, are powerful," says Gail Nielsen, BSHCA, a fellow for the Institute for Healthcare Improvement (IHI) and clinical performance improvement education administrator for Iowa Health System. "However, this hourly rounding, the evidence is clear that we need to get this done. What we're finding is that the work that goes away from getting into the patient's room every hour is worth it. The call light usage diminishes, the falls diminish, and the pressure ulcers diminish. It really does relieve work."

Nielsen should know. She's not only on the faculty of the IHI, she's the point person for her organization's participation in Transforming Care at the Bedside, an initiative of the IHI and the Robert Wood Johnson Foundation (RWJF).

Perhaps most importantly, her health system has seen an enviable reduction in the number of patient falls through its work with IHI and RWJF.

From June 2005 to July 2006 -- before the organization took part in the initiative -- three hospitals in the health system had 1.1 patient injuries per 10,000 patient days; the IHI's target is 1.0 per 10,000 patient days. The three hospitals in Iowa Health System participating in the project were able to reduce that figure to 0.8, a 27% decrease, from July 2006 to June 2007.

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