title: A 10-year journey in sustaining fall reduction in an academic medical center in Singapore.
abstract: BACKGROUND
  The incidence rate of falls at 1.3 falls/1000 patient-days at a tertiary hospital in 2004 was found to be high when benchmarked against other hospitals' fall rates in Singapore. This marked the starting point of a journey of reducing fall incidence by successfully combining evidence-based healthcare measures with quality-improvement strategies.
  
  
  OBJECTIVE
  The aim of this project was to implement fall-reduction strategies in the inpatient care areas in an acute care tertiary hospital.
  
  
  METHODS
  Two action research studies commissioned for ascertaining an appropriate fall-risk assessment and effectiveness of targeted individualized interventions formed the foundation of fall-reduction strategies. Evidence-based healthcare measures were combined with quality-improvement strategies that addressed fall risks to prevent falls and mitigate injuries. The process of managing fall-related incidents was standardized as the fall rate continues to be a key nursing performance indicator.
  
  
  RESULTS
  The overall fall trend decreased from 1.09/1000 patient-days in 2008 to 0.82/1000 patient-days in 2012. The decreasing trends were sustained in 2013 and 2014 at 0.91/100 and 0.85/1000, respectively. The fall injury rate reduced from 0.31/1000 patient-days in 2008 and was maintained at a rate of 0.20-0.24 during 2009-2012.
  
  
  CONCLUSIONS
  The implementation of fall-reduction strategies reduced the fall incidence rate in this acute care setting. However, more work is required to ensure the changes made to the fall assessment, interventions, and processes are sustained and incorporated in patient care.
authors.affiliation: 1Nursing Department 2Medical Affairs (Clinical Governance), National University Hospital, Singapore.
authors.forename: Siti Zubaidah
authors.initials: SZ
authors.lastname: Mordiffi
authors.forename: Sow Chun
authors.initials: SC
authors.lastname: Ng
authors.forename: N K Emily
authors.initials: NK
authors.lastname: Ang
authors.forename: Siu Yin
authors.initials: SY
authors.lastname: Lee
authors.forename: Margaret
authors.initials: M
authors.lastname: Lee
authors.forename: Siew Tin
authors.initials: ST
authors.lastname: Teng
authors.forename: Wai Kin
authors.initials: WK
authors.lastname: Yip
authors.forename: Swee Chye
authors.initials: SC
authors.lastname: Quek
authors.forename: Diana R
authors.initials: DR
authors.lastname: Santos
mesh_terms: D000046:Academic Medical Centers; D000056:Accident Prevention; D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D019985:Benchmarking; D055317:Evidence-Based Practice; D006801:Humans; D015994:Incidence; D009730:Nursing Assessment; D058996:Quality Improvement; D018570:Risk Assessment; D017751:Safety Management / Q000458:organization & administration*; D012846:Singapore / Q000453:epidemiology