title: An inpatient fall prevention initiative in a tertiary care hospital.
abstract: BACKGROUND
  In response to increasing inpatient fall rates, which reached 3.9 falls per 1000 inpatient-days in the last quarter of 2005, Staten Island University Hospital, a 714-bed, tertiary care hospital (Staten Island, New York), implemented a fall prevention initiative (FPI). The initiative was intended to decrease inpatient falls and associated injury by institutionalizing staff safety awareness; accountability, and critical thinking; eradicating historically acceptable system failures; and mandating a critical evaluation of safety precautions and application of fall prevention protocol.
  
  
  METHODS
  The intervention included two phases (1) a review phase, in which existing fall prevention efforts were evaluated, and (2) the FPI implementation phase, in which systems were implemented to ensure fall risk assessments, fall incident investigations, identifying and confronting problem issues, planning and adherence to corrective action, and accountability for missed preventive opportunities. For all 1,098,471 inpatient-days of persons aged 18 years and older, with an admission lasting at least one day, between April 2006 and March 2010, data were collected for inpatient falls and fall-associated injuries per 1000 inpatient-days.
  
  
  RESULTS
  Four-year inpatient fall rates decreased by 63.9% (p < .0001); the greatest reduction (72.3%) occurred between the first quarter (Q1) 2005 and Q4 2009. Minor and moderate fall-related injuries significantly decreased by 54.4% and 64.0%, respectively. Two falls with major injury occurred during the study.
  
  
  CONCLUSIONS
  The FPI was associated with a significant reduction in fall and fall-related injury rates. The results suggest that increasing commitment to continuous quality improvement through enhanced safety awareness and accountability contributed to the initiative's success and led to a change of normative behavior and a culture of safety.
authors.affiliation: Department of Rehabilitation Medicine, Staten Island University Hospital, Staten Island, New York, USA. jweinberg@siuh.edu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Weinberg
authors.forename: Donna
authors.initials: D
authors.lastname: Proske
authors.forename: Anita
authors.initials: A
authors.lastname: Szerszen
authors.forename: Karen
authors.initials: K
authors.lastname: Lefkovic
authors.forename: Carol
authors.initials: C
authors.lastname: Cline
authors.forename: Suzanne
authors.initials: S
authors.lastname: El-Sayegh
authors.forename: Mark
authors.initials: M
authors.lastname: Jarrett
authors.forename: Kera F
authors.initials: KF
authors.lastname: Weiserbs
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D006746:Hospital Bed Capacity, 500 and over; D006785:Hospitals, University; D006801:Humans; D015279:Organizational Culture; D016730:Program Development; D017751:Safety Management / Q000458:organization & administration*