Inpatient Falls: Defining the Problem and Identifying Possible Solutions. Part II: Application of Quality Improvement Principles to Hospital Falls.

In this 2 part series, analysis of the risk stratification tools that are available and definition of the scope of the problem and potential solutions through a review of the literature is presented. A systematic review was used to identify articles for risk stratification and interventions. Three risk stratification systems are discussed, STRATIFY, Morse Fall Scale, and the Hendrich Fall Risk Model (HFRM). Of these scoring systems, the HFRM is the easiest to use and score. Predominantly, multifactorial interventions are used to prevent patient falls. Education and rehabilitation are common themes in studies with statistically significant results. The second article presents a guide to implementing a quality improvement project around hospital falls. A 10-step approach to Plan-Do-Study-Act (PDSA) cycles is described. Specific examples of problems and analysis are easily applicable to any institution. Furthermore, the sustainability of interventions and targeting new areas for improvement are discussed. Although specific to falls in the hospitalized patient, the goal is to present a stepwise approach that is broadly applicable to other areas requiring quality improvement.