Another Tool on Your Assessment Belt - Using the Orthostatic Algorithm© to Reduce Patient Falls

Topic Significance & Study Purpose/Background/Rationale Falls are a serious risk for patients undergoing blood and marrow transplant (BMT) or treatment with cellular immunotherapy (CI) and may result in injury or death. Identifying patients at risk for fall can be challenging. The fall rate on our inpatient BMT-CI unit was 3.70% per 1000 patient days and the fall with injury rate was 0.97% per 1000 patient days with 32.14% attributed to orthostatic hypotension in fiscal year (FY) 2016. A detailed chart analysis was conducted on all patients that fell to identify patient trends. An algorithm was developed based on the similar patient fall circumstances identified in the chart analysis, which were transplant day -1 to +3, fever > 101.0, orthostatic positive vital signs, and complaints of lightheadedness or dizziness. The purpose of this research study was to determine if an orthostatic vital sign algorithm used in the BMT-CI population has decreased inpatient falls. Methods, Intervention, & Analysis A pre-test post-test program evaluation was conducted for one year pre and one year post implementation of the BMT-CI Orthostatic Vital Sign Algorithm on newly admitted BMT-CI inpatients. Detailed information for 321 admitted patients was included in the post implementation data. Nursing adherence with the algorithm was also monitored and methods to increase compliance such as daily huddle reminders, chart audits, and reminder cards employed. Findings & Interpretation Overall falls post-implementation decreased to 3.44% with zero falls and fall-related injuries due to orthostatic hypotension. Adherence rate of nurses to the algorithm increased from 60% to 93% indicating successful adoption of the algorithm. Discussion & Implications The algorithm provides nursing with an additional tool that can be utilized for the assessment of the unique BMT-CI patient. The algorithm has been adopted as standard of practice and is used for early identification of patients at high risk for falls. Preventive treatment interventions can be performed leading to the prevention of patient falls that may have otherwise occurred.