Feasibility of An Emergency Department Fall Screening Tool and Intervention Bundle Checklist on Nursing Fall Prevention Documentation: A Quality Improvement Project.

Background: The World Health Organization (2018) and The Joint Commission (2015) define falling as a sudden, unplanned involuntarily advancement toward the ground, that may or may not result in injury. Fall rates are directly related to a facility’s mortality and morbidity rates, delayed patient care, additional diagnostic testing, and increased length-of-stay. Evaluating the practices of a local emergency department (ED), it was noted that ED nurses are not documenting their acknowledgment of a patient’s risk for falls, and also failed to chart interventions aimed at preventing falls. Failing to implement these practices into regular patient care can lead to negative patient outcomes. Environment: A rural 18 bed ED in North-Central Kentucky that averages 80-110 patients daily. Purpose: The purpose of this quality improvement (QI) project was to evaluate the implementation of an ED-specific fall risk screening tool (KINDER-1) and Preventative Intervention Bundle Checklist (PIBC) during a two-month (eight-week) span. The intervention goal was to increase the rate of nurse documentation of fall risk and prevention interventions compared to documentation without the use of an ED-specific fall risk screening tool and fall PIBC. Intervention: Nurses received education regarding the KINDER-1 Tool and the PIBC and were taught a new screening protocol for all patients entering the ED. Following the fall risk assessment, nurses documented corresponding preventative interventions for high-risk individuals. Method: Randomized retrospective chart audits pre- and post-intervention compared differences in nursing documentation rates. Preintervention freestyle nursing notes, the “patient teach” icon, and utilization of an inpatient screening tool were evaluated. Postintervention audits evaluated compliance to the KINDER-1 and PIBC. Quantitative descriptive statistics demonstrated that the interventions were clinically and statistically significant in bringing about a positive clinical change