The adult intensive care unit (AICU) is a medical and surgical intensive care unit that treats many patient populations, each with their own nuanced need for fall prevention.
The AICU Fall and Safety Committee, spear-headed by Linda McClintock, RN, strives for a continued culture of fall risk awareness that is engrained in all staff including nurses, patient care technicians and unit clerks. The implemented interventions were developed after considering the patient populations and analyzing the data of cases.
The team began its fall prevention program by identifying that despite a house-wide trend of falls related to toileting, the AICU falls were related to slipping from chairs. The team came together and implemented the “Green In-Between” initiative, which was a key factor in bringing its “falls from a chair” to zero.
Although great progress was made, the unit continued to see some injury falls that needed attention. To combat the impulsivity phenomenon that was identified, the team implemented the “24-hour Safety Window.” The goal of this initiative was to use the first 24 hours of admission for both shifts to adequately assess the patient’s physical ability and consistent use of the call light and gage the patient’s impulsivity.
During this time, a bed exit alarm is applied, and three side rails are engaged (two long and one short). Additionally, all high-fall-risk patients, regardless of mental status, have a bed exit alarm engaged at night. The unit clerk sends out a reminder for this alarm at 10 p.m. This approach to fall prevention is reviewed with each new member of the team upon hire and as needed with established staff. The committee does routine checks to verify access to equipment and adherence to best practice and RUSH policy.
Over time, the AICU team has reduced overall fall events. In one year the AICU demonstrated an 86% reduction in falls — zero with injury. The team continued its progress through fiscal year 2023 and reached the milestone of more than 1,500 days without an injury fall. The team continues to seek opportunities for improvement on how to best keep patients safe. They attribute their successes to the work of the fall and safety committee and the culture they have created.