Introduction: Fall prevention measures are a hallmark of high-quality hospital care worldwide. Many of the same risk factors for falls in an acute hospital setting contribute to falls in a behavioral health unit. However, some risk factors are unique to the inpatient psychiatric setting. Factors include the expectation for increased mobilization on an inpatient psychiatric unit, extrapyramidal side effects of medications, orthostatic hypotension as a side effect of medication, inability to use devices such as walkers and canes on psychiatric units because of safety concerns. The current quality improvement study (QI) was designed to investigate the effectiveness of the DMAIC (Define, Measure, Analyze, Improve, Control) approach to reduce falls in the inpatient psychiatric setting.

Method: A prospective study was designed to eliminate the risk of falls by using the Six Sigma DMAIC approaches during January-December 2018. The frequency of falls in every quarter was an index used to determine the efficacy of implementing DMAIC to prevent falls. The study was defined in three phases: a Measurement and determination of baseline data and identification of the potential causes of falls, b) Collection of all fall data during 2018 and analysis of the data, c) Development of strategies and offering recommendations to decrease future falls.
 
Results: There were a total of 82 falls in 2018. Frequency of falls reduced from 27 in the first quarter of 2018 to 12 (decrease 44 %) in the fourth quarter. Most of the falls happened in the first three days of admission. The most common time for a fall was between 9 am and 10 am and, 86% of falls did not result in injury. 

DMAIC, Fall, In patient psychiatry