Reducing Falls Related to Toileting

Practice Problem: The practice problem for the medical-surgical unit is a high rate of falls associated with toileting activities, despite universal fall precautions for all patients. The current fall rate is an average rate of 4 falls per 1,000 patient days. PICOT: The PICOT question that guided this project was: Among adult patients in the inpatient medical-surgical unit (P), what is the effect of adding a toileting care plan (I) to the current practice of universal fall precautions (C) to reduce the severity and incidence of falls (O) within an 8-week period (T)? Evidence: Nine high-quality articles supported a toileting care plan encompassing patient-centered fall interventions could decrease falls and falls with injuries. Interventions: Staff education on risk for patient falls, individualized risk assessments for falls, individualized toileting care plan, and effective handoff communication to all bedside staff about risks for falls. Outcome: The desired reduction in the rate of falls was not achieved during the intervention period; however, the project highlighted organizational challenges related to coordination of change, staffing, and unit participation. Further increased knowledge and utilization of the Morse fall risk assessment tool, resource allotment for fall reduction programming, and reprioritization for organization review of skills related to toileting plans was achieved. Conclusion: Clinical significance was achieved with this EBP project, even without the overall goal achievement of a reduction in fall rates on the pilot unit. The project highlighted the need for organizational readiness for change, effective strategy for concurrent priorities, and agility for unanticipated confounders, such as significant staffing concerns.