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Reducing Falls in Hospitalized Children and Adolescents with Cancer and Blood Disorders: A Quality Improvement
Lisa K Morrissey1, Phuc Ho1, Maya Ilowite2
1From the Department of Nursing, Hematology/Oncology/Stem Transplant Program, Boston Children's Hospital, Boston, Mass.
Insights
Hospitalized children with cancer and blood disorders are at high risk for falls. A quality improvement initiative significantly reduced preventable falls with injury in these vulnerable pediatric patients.
Area of Science:
- Pediatric Patient Safety
- Quality Improvement in Healthcare
- Oncology and Hematology Nursing
Background:
- Hospitalized pediatric patients, particularly those with cancer and blood disorders, face significant risks from falls.
- Inherent risk factors in these pediatric populations increase the likelihood of fall-related injuries.
- The Hematology/Oncology (HO) and Stem Cell Transplant (SCT) inpatient units initiated a multiyear quality improvement effort to decrease inpatient falls.
Purpose of the Study:
- To implement and evaluate a quality improvement initiative aimed at reducing inpatient falls.
- To decrease the incidence of preventable falls with injury in pediatric Hematology/Oncology and Stem Cell Transplant units.
- To enhance patient safety for vulnerable pediatric populations undergoing cancer and blood disorder treatments.
Main Methods:
- A dedicated Falls Reduction Task Force implemented targeted initiatives from 2020 to 2023.
- Key strategies included enhanced communication for high-risk patients, formal apparent cause analysis for falls with injury, and a physical therapy program for deconditioning.
- Outcome measures included total falls, rate of preventable falls with injury per 1000 patient days, and days between preventable falls with injury, tracked using statistical process control charts.
Main Results:
- The rate of preventable falls with injury per 1000 patient days decreased from 0.63 in FY 2020 to 0.25 in 2023.
- The SCT and HO units achieved extended periods between preventable falls with injury (442 and 410 days, respectively) in 2021-2023, a significant increase from 2020.
- A 51% reduction in total falls was observed across both units over the 4-year initiative.
Conclusions:
- A multifaceted quality improvement initiative successfully reduced preventable falls with injury in pediatric Hematology/Oncology and Stem Cell Transplant units.
- The intervention effectively mitigated avoidable harm in a vulnerable pediatric patient population.
- Sustained efforts in fall prevention are crucial for improving patient safety in specialized pediatric inpatient settings.
Background:
Falls in hospitalized pediatric patients represent a serious patient safety concern. Children and adolescents with cancer and blood disorders have inherent risk factors that increase the likelihood of injury from falls. The Hematology/Oncology (HO) and Stem Cell Transplant (SCT) inpatient units at Boston Children's Hospital embarked on a multiyear quality improvement journey to reduce inpatient falls in this population.
Methods:
A targeted Falls Reduction Task Force implemented key initiatives between 2020 and 2023. These include enhancing communication strategies to heighten awareness of the highest fall-risk patients, conducting a formal apparent cause analysis on every fall with injury, and initiating a physical therapy-led program to reduce deconditioning. Outcome measures were total falls, rate of preventable falls with injury per 1000 patient days, and days between preventable falls with injury. Our quality improvement team used statistical process control charts to track changes over time.
Results:
The combined rate of preventable falls with injury per 1000 patient days decreased from 0.63 in fiscal year (FY) 2020 to 0.25 in 2023. The SCT and HO units achieved a maximum of 442 days and 410 days, respectively, between preventable falls with injury in 2021-2023, compared with 124 and 117 days in 2020. The two units observed a 51% reduction in total falls over 4 years.
Conclusions:
A multifaceted fall reduction quality initiative effectively reduced preventable falls with injury on pediatric HO and SCT inpatient units, thereby reducing avoidable harm in a vulnerable patient population.
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