Morrissey Lisa K, Ho Phuc, Ilowite Maya, Johnson David A, Nixon Colleen M, Thomas Marissa K, Waitt Julie A, Wierzchowski Amy, Renaud Ashley M
From the Department of Nursing, Hematology/Oncology/Stem Transplant Program, Boston Children's Hospital, Boston, Mass.
Division of Hematology/Oncology, Dana-Farber Boston Children's Cancer and Blood Disorders Program, Department of Pediatrics, Harvard Medical School, Boston, Mass.
Pediatr Qual Saf. 2024 Aug 30;9(5):e755. doi: 10.1097/pq9.0000000000000755. eCollection 2024 Sep-Oct.
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.
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.
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.
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.
住院儿科患者跌倒问题严重影响患者安全。患有癌症和血液疾病的儿童及青少年存在内在风险因素，增加了跌倒受伤的可能性。波士顿儿童医院的血液学/肿瘤学（HO）和干细胞移植（SCT）住院病房开展了一项为期多年的质量改进项目，以减少该群体的住院患者跌倒情况。
一个有针对性的跌倒预防特别工作组在2020年至2023年期间实施了关键举措。这些举措包括加强沟通策略，以提高对跌倒风险最高患者的认识；对每起有伤害的跌倒事件进行正式的明显原因分析；启动一项由物理治疗主导的项目，以减少身体机能下降。结果指标包括跌倒总数、每1000个患者日的可预防跌倒致伤率以及两次可预防跌倒致伤之间的天数。我们的质量改进团队使用统计过程控制图来跟踪随时间的变化。
每1000个患者日的可预防跌倒致伤综合率从2020财年的0.63降至2023年的0.25。在2021 - 2023年期间，SCT和HO病房两次可预防跌倒致伤之间的天数分别最多达到442天和410天，而2020年分别为124天和117天。这两个病房在4年里的跌倒总数减少了51%。
一项多方面的跌倒预防质量改进举措有效减少了儿科HO和SCT住院病房可预防的跌倒致伤情况，从而减少了脆弱患者群体中可避免的伤害。
