2019 Research Forum

Carina Wong RN, Denise Sedano RN, Nikki Cervera RN, Taylor Dransart RN, and Jericka Venus RN Postpartum Fall Prevention Post-Epidural in Maternal Child Labor and Delivery/Neonatal ICU Nurse Residency Evidence Based Practice Project

Postpartum falls is an important quality improvement because there is currently no universal tool used to identify the risk of falls specifically for postpartum patients in our Maternal Child units. Falls of any kind should not occur on any unit because falls lead to prolonged hospitalizations and increases the risks of the patient developing a complication. Postpartum patients typically believe they can ambulate after giving birth, but are not aware of their true strengths to ambulate due to anesthesia, change in fluid balance, and loss of sensation in their lower extremities. Postpartum patients are typically not previously educated on their risk of falls before their delivery and to ask for help when getting up out of bed. Postpartum patients would benefit from education on their fall risk during their pregnancy as well as postpartum. Future research should be indicated in the postpartum falls area and a universal/standardized assessment tool should be identified with intentions to prevent all postpartum falls. Introduction Objectives Reduce the risk of postpartum falls at Kern Medical with the use of the Modified Bromage Scale. Utilize the Up, Safer, Sooner program and equipment implemented at Kern Medical in January 2018. Educate all nurses working in mother baby units on the importance of applying the Bromage Scale into their routine assessments. Thoroughly provide patient education on falls and calling for help when getting out of bed to ante/intra/postpartum patients on mother baby units.

Methods

Conclusions After reviewing multiple articles regarding postpartum falls, all articles identified a fall risk that was applied to assess postpartum patients and identified a significant decrease in the fall rates. Late implementation of the Bromage scale and lack of education to Maternal Child staff caused little change in the Maternal Child Units. Maternal Child units continue to utilize the Up, Safer, Sooner program. More monitoring and follow ups on fall occurrences in other baby units should be warranted with the application of the Bromage scale. Recommendations include: Adoption of Bromage scale to all Maternal Child units. Proper education to Maternal Child staff on documentation and use of the Bromage scale. Placing laminated Bromage scale and time chart in patient rooms. Complete audits on charts for patients who received Bromage scaling. Potentially build the Bromage scale into Maternal Child’s future charting. system. References Brewin, D., & Naninni, A. (2014). Womenʼs Perspectives on Falls and Fall Prevention During Pregnancy. MCN, The American Journal of Maternal/Child Nursing,39 (5), 300-305. doi:10.1097/nmc.0000000000000064 Gaffey, A. D. (2015). Fall prevention in our healthiest patients: Assessing risk and preventing injury for moms and babies. Journal of Healthcare Risk Management, 34(3), 37-40. doi:10.1002/jhrm.21163 Heafner, L., Suda, D., Casalenuovo, N., Leach, L. S., Erickson, V., & Gawlinski, A. (2013). Development of a Tool to Assess Risk for Falls in Women in Hospital Obstetric Units. Nursing for Womens Health, 17(2), 98-107. doi:10.1111/1751-486x.12018 Lockwood, S. (2013). Postpartum Safety: A Patient-Centered Approach to Fall Prevention. The American Journal of Maternal/Child Nursing,38 (1), 15-18. doi:DOI:10.1097/NMC.0b013e31826bae4b Warren, S. (2012). Fall Risk Screen for the Postepidural, Postpartum Patient. Journal of Obstetric, Gynecologic & Neonatal Nursing,41 . doi:10.1111/j.1552-6909.2012.01362_11.x Acknowledgements Monette Hoburn BSN RNC, c-EFM| Perinatal Clinical Educator Vivian Cervantes RNC-OB| Quality Coordinator Marinda DuToit RNC | Clinical Director - Maternal Child Services Kyisha Clay-Roby BSN, RNC-MNN| Clinical Supervisor Perinatal Services Eva Flanagan BSN, RNC| Clinical Supervisor NICU/Pediatrics

In this evidence based practice project we identified a postpartum fall tool, Bromage scale, which was applied in postpartum patients who received an epidural and delivered their baby vaginally. The patients are reassessed every hour after delivery to identify their postpartum fall risk. The original use of the Bromage scale was to assess the adequacy of epidural anesthesia for abdominal surgery. The Bromage scale helps assess motor block and determines motors function, prevent pressure areas, ensures safe ambulation, and detects onset of complications of an epidural. Per Kern Medical’s Policy PCS-PC-990, “Nurses will assess the patient's level of motor block using the Modified Bromage Scale every hour or more frequently if needed.” Along with the use of Bromage scale during assessment in combination the Sara Steady implemented with the Up, Safer, Soon program will help reduce the risk of postpartum patients who received epidurals from falling.

Figure 2: Kern Medical is identified with FCN # 243 in the 75 th percentile (upper quartile) inclusive of all occurrences of falls in Maternal Child units.

Figure 1: Data not available for April 2018-December 2018.

The Bromage scale is a fall risk tool Mother Baby units have specifically applied to their assessments in November of 2016. In the first quarter of 2018, there have been three recorded falls in Labor and Delivery and 66% of the falls were in patients who received an epidural placement. All falls including epidural placement have occurred at the bedside in the first quarter of 2018. 66% of falls in all quarters of 2017 occurred in patients who received an epidural. There was no significant identifier for the months that falls did not occur. Staff education was provided to Labor and Delivery staff on fall rates and using the Bromage scale in April 2018. The implementation of Up, Safer, Sooner Program and the Bromage scale is still in its beginning stages on the Maternal Child units and currently cannot provide enough data to identify a trend or significant decrease in falls in the first quarter of 2018. Results

Modified Bromage Scale Tool

Diane Nicholls NNP, RN Kelly Ballard NNP, RN Pamela Gavin BSN, RN Amie Sevier RN | Quality Resource Michael Friesen NP| Quality Resource Center

Figure 3: In the first quarter of 2018, all falls in Labor and Delivery occurred at the bedside and all falls in Postpartum occurred in the bathroom.

Figure 4: Data not available for April-December 2018. 2017 includes data from all quarters.

135