Tailoring Interventions in Reducing Rate of Falls in a Psychiatric Inpatient Hospital

Problem statement: Patients on psychiatric units experience 13 to 25 falls per 1,000 patient days compared to four falls per 1,000 days in a medical-surgical area, according to the National Database of Nursing Quality Indicators (Abraham, 2016).

Summary of evidence: Tailoring Interventions for Patient Safety (TIPS), an evidence-based inpatient falls prevention program, reduced falls by 25% in a randomized controlled study in four urban US hospitals (Dykes et al., 2010). Based on this evidence, the TIPS program was adopted to reduce the rate of falls and improve quality in four inpatient units at a psychiatric hospital in New York.

Description of practice or protocol: After buy-in from leadership and nursing staff, all 103 nursing staff members were educated on the TIPS program with in-person and online training on the Morse assessment tool (Morse, 1985) and on documentation in the electronic medical record (EMR). TIPS reminder posters were placed throughout the hospital.

Validation of evidence: The outcomes were the total number of falls and total number of falls with injury per 1000 patient days.

Relevance of PMH nursing: Although there is no statistical significance of falls and falls rate in using fall TIPS, the data is trending towards significance. The findings showed a decrease in the falls rate using the fall TIPS program compared to pre-implementation in September 2019 from 4.73 to post-implementation in February 2020 1.46; falls with injury fell in September 2019 from 1.18 to 0.58 in February 2020. The overall falls incidents decreased by 14% from 149 in 2018 to 128 in 2019.

Future implications: Using EMR data to identify multi-factorial risk factors for inpatient psychiatric unit falls, the TIPS program supported consistent assessment and tailored interventions, while involving patient and family members with multidisciplinary staff in the plan of care.  

Learning Outcome: After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.