This document provides information on a fall prevention evidence-based practice project conducted by nursing students at Alvernia University. It includes background information on the problem of falls in hospitals, learning objectives of comparing individual versus multi-component interventions, and a review of literature showing that multi-component programs are more effective at reducing falls than individual interventions. The document also outlines specific fall prevention interventions in place at Good Samaritan Hospital, including a fall risk letter, signage, alarms, and post-fall assessment. It emphasizes the importance of continuous re-evaluation of interventions to improve outcomes.
Quality and safety, Vision 2025, Specific challenges of Nursing on quality, Quality improvement division, Fish bone technique,QI model, PDCA, Role of Nurse, Empowerment, Nursing positioning and policies,
Quality and safety, Vision 2025, Specific challenges of Nursing on quality, Quality improvement division, Fish bone technique,QI model, PDCA, Role of Nurse, Empowerment, Nursing positioning and policies,
Fall-related injuries can be some of the most common, disabling, and expensive health conditions encountered by adults, especially older adults. According to researcher Janice Morse, approximately 14% of all falls in hospitals are accidental, another 8% are unanticipated and 78% are anticipated falls. Guideline to prevent falls in the hospital has helped to bring down the numbers and improve patient safety.
Presentations from the patient safety conference held at Teesside University on 1 and 2 September 2014 - Students at the forefront of continuing and improving our culture of safe care
To recognize The National Patient Safety Foundation's Patient Safety Awareness Week #PSAW2015 we asked our colleagues in the Harvard medical community to complete this sentence: "Patient safety is..."
Here are some of their responses.
Simple and Safe Approaches Towards Patient SafetyEhi Iden
A conference presentation on simple approaches and steps in achieving and managing patient safety in health. It talks about team approach, mutual support, just system, leadership commitment, complications of blame game and case study of the popular Kimberly Hiatt story.
Fall preventionApplying the evidence By Kathleen Fowier, MS.docxnealwaters20034
Fall prevention:
Applying the evidence By Kathleen Fowier, MSN, RN, CMSRN Quality Improvement Manager
UPMC St. Margaret, Pittsburgh, Pennsylvania
As told to Janet Boivin, BSN, RN
S u c c e s s f u l fall pre
vention program s use m u lti
m odal interventions, such as detailed
fall risk assessments, fre q u e n t m o n ito rin g by
staff, and a p p ro p ria te use o f equipm en t. Healthcare
facilities typically im p le m e n t best practices in b un
dles, m aking it often d iffic u lt to determ ine which in
terventions are the m ost effective.
UPMC St. M argaret Hospital in Pittsburgh, Penn
sylvania jo in e d the Pennsylvania Hospital Engage
m ent N etw ork (PA HEN) in A pril 2012 to reduce
falls w ith injury. This set us on a path th a t resulted
in a 75% reduction in falls w ith serious injuries.
(See graph.) Here is how we accom plished this
reduction.
Analysis: Role of data and best practices
A fte r jo in in g PA HEN, we fo rm e d a m ultidisciplinary
team tasked w ith review ing and investigating all fall
events, extracting and analyzing data, and evaluat
ing best practices im p le m e n te d as a result o f root
cause analysis.
Case study
This case study illustrates our fall team in action
An 80-year-old fem ale p a tie n t w ith im paired cognitive
function and m u ltip le risk factors— including an
unsteady gait, im paired vision, and m u ltiple
m edications— was assessed as a high fall risk when
a d m itte d to our facility.
The nursing staff im plem ented a bed alarm to alert
them when the p a tie n t was g e ttin g up w ith o u t using
the call light. They also m oved her closer to the nurse's
station and used purposeful rounding to anticipate and
attend to her needs. The average response tim e fo r
alerts w ith this p a tie n t was a rapid 10 seconds. D espite
these steps, the patient's bed alarm sounded several
tim es to alert staff, who fou n d her standing beside
the bed.
The nurses reached o u t to the fall team fo r support.
The team reviewed th e bed-alarm
settings (three sensitivity settings— low,
m edium , and high) and sim ulated alarm
tim e studies w ith the nursing staff. Their
efforts revealed m isperceptions in
em ployee understanding o f bed-alarm
settings. For example, the staff th o u g h t
the bed alarm w ould alert them th a t the
p a tie n t was o ff the p e rim e te r o f the
mattress no m atter what the sensitivity
setting.
The fall team used sim ulated bed-alarm
scenarios to educate the staff and help
to change practice. The nursing staff
learned it's not enough to sim ply engage
the alarm; the alarm also needs to be at the
a p p ropriate setting. The staff began using more
sensitive settings fo r patients w ith im pulsive behaviors.
We learned an im p o rta n t lesson: How well em ployees
understand facility equipm ent, its variations, and how
to use it are im p o rta n t considerations when analyzing
p a tie .
Fall preventionApplying the evidence By Kathleen Fowier, MS.docxmglenn3
Fall prevention:
Applying the evidence By Kathleen Fowier, MSN, RN, CMSRN Quality Improvement Manager
UPMC St. Margaret, Pittsburgh, Pennsylvania
As told to Janet Boivin, BSN, RN
S u c c e s s f u l fall pre
vention program s use m u lti
m odal interventions, such as detailed
fall risk assessments, fre q u e n t m o n ito rin g by
staff, and a p p ro p ria te use o f equipm en t. Healthcare
facilities typically im p le m e n t best practices in b un
dles, m aking it often d iffic u lt to determ ine which in
terventions are the m ost effective.
UPMC St. M argaret Hospital in Pittsburgh, Penn
sylvania jo in e d the Pennsylvania Hospital Engage
m ent N etw ork (PA HEN) in A pril 2012 to reduce
falls w ith injury. This set us on a path th a t resulted
in a 75% reduction in falls w ith serious injuries.
(See graph.) Here is how we accom plished this
reduction.
Analysis: Role of data and best practices
A fte r jo in in g PA HEN, we fo rm e d a m ultidisciplinary
team tasked w ith review ing and investigating all fall
events, extracting and analyzing data, and evaluat
ing best practices im p le m e n te d as a result o f root
cause analysis.
Case study
This case study illustrates our fall team in action
An 80-year-old fem ale p a tie n t w ith im paired cognitive
function and m u ltip le risk factors— including an
unsteady gait, im paired vision, and m u ltiple
m edications— was assessed as a high fall risk when
a d m itte d to our facility.
The nursing staff im plem ented a bed alarm to alert
them when the p a tie n t was g e ttin g up w ith o u t using
the call light. They also m oved her closer to the nurse's
station and used purposeful rounding to anticipate and
attend to her needs. The average response tim e fo r
alerts w ith this p a tie n t was a rapid 10 seconds. D espite
these steps, the patient's bed alarm sounded several
tim es to alert staff, who fou n d her standing beside
the bed.
The nurses reached o u t to the fall team fo r support.
The team reviewed th e bed-alarm
settings (three sensitivity settings— low,
m edium , and high) and sim ulated alarm
tim e studies w ith the nursing staff. Their
efforts revealed m isperceptions in
em ployee understanding o f bed-alarm
settings. For example, the staff th o u g h t
the bed alarm w ould alert them th a t the
p a tie n t was o ff the p e rim e te r o f the
mattress no m atter what the sensitivity
setting.
The fall team used sim ulated bed-alarm
scenarios to educate the staff and help
to change practice. The nursing staff
learned it's not enough to sim ply engage
the alarm; the alarm also needs to be at the
a p p ropriate setting. The staff began using more
sensitive settings fo r patients w ith im pulsive behaviors.
We learned an im p o rta n t lesson: How well em ployees
understand facility equipm ent, its variations, and how
to use it are im p o rta n t considerations when analyzing
p a tie .
Fall-related injuries can be some of the most common, disabling, and expensive health conditions encountered by adults, especially older adults. According to researcher Janice Morse, approximately 14% of all falls in hospitals are accidental, another 8% are unanticipated and 78% are anticipated falls. Guideline to prevent falls in the hospital has helped to bring down the numbers and improve patient safety.
Presentations from the patient safety conference held at Teesside University on 1 and 2 September 2014 - Students at the forefront of continuing and improving our culture of safe care
To recognize The National Patient Safety Foundation's Patient Safety Awareness Week #PSAW2015 we asked our colleagues in the Harvard medical community to complete this sentence: "Patient safety is..."
Here are some of their responses.
Simple and Safe Approaches Towards Patient SafetyEhi Iden
A conference presentation on simple approaches and steps in achieving and managing patient safety in health. It talks about team approach, mutual support, just system, leadership commitment, complications of blame game and case study of the popular Kimberly Hiatt story.
Fall preventionApplying the evidence By Kathleen Fowier, MS.docxnealwaters20034
Fall prevention:
Applying the evidence By Kathleen Fowier, MSN, RN, CMSRN Quality Improvement Manager
UPMC St. Margaret, Pittsburgh, Pennsylvania
As told to Janet Boivin, BSN, RN
S u c c e s s f u l fall pre
vention program s use m u lti
m odal interventions, such as detailed
fall risk assessments, fre q u e n t m o n ito rin g by
staff, and a p p ro p ria te use o f equipm en t. Healthcare
facilities typically im p le m e n t best practices in b un
dles, m aking it often d iffic u lt to determ ine which in
terventions are the m ost effective.
UPMC St. M argaret Hospital in Pittsburgh, Penn
sylvania jo in e d the Pennsylvania Hospital Engage
m ent N etw ork (PA HEN) in A pril 2012 to reduce
falls w ith injury. This set us on a path th a t resulted
in a 75% reduction in falls w ith serious injuries.
(See graph.) Here is how we accom plished this
reduction.
Analysis: Role of data and best practices
A fte r jo in in g PA HEN, we fo rm e d a m ultidisciplinary
team tasked w ith review ing and investigating all fall
events, extracting and analyzing data, and evaluat
ing best practices im p le m e n te d as a result o f root
cause analysis.
Case study
This case study illustrates our fall team in action
An 80-year-old fem ale p a tie n t w ith im paired cognitive
function and m u ltip le risk factors— including an
unsteady gait, im paired vision, and m u ltiple
m edications— was assessed as a high fall risk when
a d m itte d to our facility.
The nursing staff im plem ented a bed alarm to alert
them when the p a tie n t was g e ttin g up w ith o u t using
the call light. They also m oved her closer to the nurse's
station and used purposeful rounding to anticipate and
attend to her needs. The average response tim e fo r
alerts w ith this p a tie n t was a rapid 10 seconds. D espite
these steps, the patient's bed alarm sounded several
tim es to alert staff, who fou n d her standing beside
the bed.
The nurses reached o u t to the fall team fo r support.
The team reviewed th e bed-alarm
settings (three sensitivity settings— low,
m edium , and high) and sim ulated alarm
tim e studies w ith the nursing staff. Their
efforts revealed m isperceptions in
em ployee understanding o f bed-alarm
settings. For example, the staff th o u g h t
the bed alarm w ould alert them th a t the
p a tie n t was o ff the p e rim e te r o f the
mattress no m atter what the sensitivity
setting.
The fall team used sim ulated bed-alarm
scenarios to educate the staff and help
to change practice. The nursing staff
learned it's not enough to sim ply engage
the alarm; the alarm also needs to be at the
a p p ropriate setting. The staff began using more
sensitive settings fo r patients w ith im pulsive behaviors.
We learned an im p o rta n t lesson: How well em ployees
understand facility equipm ent, its variations, and how
to use it are im p o rta n t considerations when analyzing
p a tie .
Fall preventionApplying the evidence By Kathleen Fowier, MS.docxmglenn3
Fall prevention:
Applying the evidence By Kathleen Fowier, MSN, RN, CMSRN Quality Improvement Manager
UPMC St. Margaret, Pittsburgh, Pennsylvania
As told to Janet Boivin, BSN, RN
S u c c e s s f u l fall pre
vention program s use m u lti
m odal interventions, such as detailed
fall risk assessments, fre q u e n t m o n ito rin g by
staff, and a p p ro p ria te use o f equipm en t. Healthcare
facilities typically im p le m e n t best practices in b un
dles, m aking it often d iffic u lt to determ ine which in
terventions are the m ost effective.
UPMC St. M argaret Hospital in Pittsburgh, Penn
sylvania jo in e d the Pennsylvania Hospital Engage
m ent N etw ork (PA HEN) in A pril 2012 to reduce
falls w ith injury. This set us on a path th a t resulted
in a 75% reduction in falls w ith serious injuries.
(See graph.) Here is how we accom plished this
reduction.
Analysis: Role of data and best practices
A fte r jo in in g PA HEN, we fo rm e d a m ultidisciplinary
team tasked w ith review ing and investigating all fall
events, extracting and analyzing data, and evaluat
ing best practices im p le m e n te d as a result o f root
cause analysis.
Case study
This case study illustrates our fall team in action
An 80-year-old fem ale p a tie n t w ith im paired cognitive
function and m u ltip le risk factors— including an
unsteady gait, im paired vision, and m u ltiple
m edications— was assessed as a high fall risk when
a d m itte d to our facility.
The nursing staff im plem ented a bed alarm to alert
them when the p a tie n t was g e ttin g up w ith o u t using
the call light. They also m oved her closer to the nurse's
station and used purposeful rounding to anticipate and
attend to her needs. The average response tim e fo r
alerts w ith this p a tie n t was a rapid 10 seconds. D espite
these steps, the patient's bed alarm sounded several
tim es to alert staff, who fou n d her standing beside
the bed.
The nurses reached o u t to the fall team fo r support.
The team reviewed th e bed-alarm
settings (three sensitivity settings— low,
m edium , and high) and sim ulated alarm
tim e studies w ith the nursing staff. Their
efforts revealed m isperceptions in
em ployee understanding o f bed-alarm
settings. For example, the staff th o u g h t
the bed alarm w ould alert them th a t the
p a tie n t was o ff the p e rim e te r o f the
mattress no m atter what the sensitivity
setting.
The fall team used sim ulated bed-alarm
scenarios to educate the staff and help
to change practice. The nursing staff
learned it's not enough to sim ply engage
the alarm; the alarm also needs to be at the
a p p ropriate setting. The staff began using more
sensitive settings fo r patients w ith im pulsive behaviors.
We learned an im p o rta n t lesson: How well em ployees
understand facility equipm ent, its variations, and how
to use it are im p o rta n t considerations when analyzing
p a tie .
Capstone Project Change Proposal Presentation for Faculty Review a.docxbartholomeocoombs
Capstone Project Change Proposal Presentation for Faculty Review and Feedback
Assessment Description
Create a 10-15 slide Power Point presentation of your evidence-based intervention and change proposal to be disseminated to an interprofessional audience of leaders and stakeholders. Include the intervention, evidence-based literature, objectives, resources needed, anticipated measurable outcomes, and how the intervention would be evaluated. Submit the presentation in the digital classroom for feedback from the instructor.
PICOT Question (See other file uploaded)
Interventions
Falling incidences can cause several complications, including health care costs, severe health issues, immobility, etc. With the severity of this issue, appropriate interventions should take place. In this context, proper monitoring is one of the significant interventions to prevent this incidence (Huang et al., 2020). Hence, incorporating educated and efficient technicians while providing patient care can be an essential step. Yet, due to decreased mobility or functionality, older people often require help in doing basic activities, in this aspect, providing help to the patients while changing to hospital-approved gowns (Liu-Ambrose et al., 2019). In addition, one significant and effective intervention is providing quick education to the patient regarding fall prevention strategies (Radecki, Reynolds & Kara, 2018). Another critical aspect is providing a safe environment for clinical care. Outpatient clinics should improve their workflow and environmental condition, such as removing hazardous materials, and keeping the floor clean and dry, so that the clinic can provide a safe area for older patients. These interventions can help prevent falls (Guirguis-Blake et al., 2018).
Benchmark - Capstone Change Project Objectives
1. Prevent elderly falls in an outpatient radiology clinic.
Rationale: Falls occur as age advances due to individual risk factors or environmental factors. For example, gait or balance deficits, chronic conditions, medications, and footwear the patient is wearing. Assisting these patient populations can prevent falls in the department.
2. Educate patients and people in the community on how to prevent falls.
Rationale: Educate patients regarding physical changes and chronic health conditions that cause or probability of falls.
3. Provide a safe environment for clinical care in the outpatient clinical setting.
Rationale: Design the clinical area accessible to patients in wheelchairs, with assistive devices, and with mobility deficits. Have handrails on walls and hallways for support, clean, non-skid floors, and lighted pathways in hallways, rooms, and bathrooms.
4. A patient care technician (PCT) is available in the outpatient clinical area for patients.
Rationale: Having a PCT in the clinical area, especially around the dressing rooms, would benefit the patients needing help when changing to hospital-approved gowns and monitoring patients for risk.
Essentials of Evidence Based PracticeMAIN POSTIntroduction.docxSANSKAR20
Essentials of Evidence Based Practice
MAIN POST
Introduction
It is estimated that patient falls in hospitals occur among 700,000 to 1,000,000 people in the United States. As well, approximately one third is preventable (Agency for Healthcare Research and Quality [AHRQ], 2013). Fall risk assessment tools, and alarm systems which alert staff when patients attempt to leave the bed or chair unassisted, are two methods among others utilized to reduce falls incidences. Evidence-based practice (EBP) in accordance with patient falls and the applicability to the author’s organization are the topics of this paper.
Patient Care Experience
Recently, an 83 year old male with dementia was hospitalized for pneumonia and under my care, on the night shift. As part of the routine admission process, all patients are evaluated for fall risk. In this patient’s case, a fall risk evaluation tool was one EBP method used to predict and prevent such an incident. High risk status was concluded due to mobility issues, dementia, and incontinence, in accordance with the Hendrich Fall Risk Assessment tool in the electronic health record. Research by Hendrich, Bender, and Nyhuis, in 2003, as cited by Schmidt (2012, April 5) found that intrinsic factors such as “confusion, altered elimination needs and impaired gait and mobility” among others were predictors of falls (para 6). A second intervention used was a bed alarm. Evidence based research for this method showed mixed results. Ward-Smith, Barret, Rayson and Govro (2014) concluded that use of a bed alarm system did not prevent falls, with one reason being the frequency of false alarms caused ignorance by staff, over time. The authors also stated further research in evaluating which patients would be appropriate for the alarm use would be beneficial. Shorr, Chandler, Mion, Waters, Liu, Daniels, Kessler and Miller, (2012), cited a cluster randomized trial which supported a reduction in falls with alarms in use. Still, in searching CINAHL, no studies in the past 5 years were found in support of bed alarms as a fall reduction method. I surmise the use of bed alarms in my facility came as a result of the elimination of the previous routine practice of waist and vest restraint application.
Background and PICOT Questions
Since support of the use of alarm systems was either mixed or nonexistent, and given the previously mentioned in-hospital high incidence of patient fall statistics, more effective measures for reduction must be researched. In formulating an EBP research question, background definitions must be delineated and general knowledge questions answered. For example, in researching best practices for dementia patient fall reduction in acute care hospitals, I would answer the following questions
· What constitutes a patient fall?
· What is dementia?
· What are some common signs and symptoms of dementia?
· What factors place dementia patients at risk for falling?
· What are the effects of hourly ...
January-February 2016 • Vol. 25/No. 1 17
CPT (R) Gwendolyn Godlock, MS-PSL, BSN, RN, AN, CPHQ, is Field Representative Nurse
Surveyor, The Joint Commission, Oakbrook, Terrace, IL.
CPT Mollie Christiansen, BSN, RN, AN, CMSRN, is Clinical Nurse Officer in Charge, Burn
Progressive Care Unit, United States Army Institute of Surgical Research, Joint Base San
Antonio Fort Sam Houston, TX.
COL Laura Feider, PhD, RN, is Dean, School of Nursing Science and Chief, Department of
Nursing Science, Army Medical Department Center and School, Health Readiness Center of
Excellence, Joint Base San Antonio Fort Sam Houston, TX.
Acknowledgments: The team would like to thank nursing leaders COL (R) Sheri Howell, for-
mer Deputy Commander of Nursing and Chief of Staff; and COL Richard Evans, Assistant
Deputy Chief Army Nurse Corps, for their support. A special acknowledgment for the former
Chief, Medical Nursing Section, COL Vivian Harris, who remained a staunch supporter, advo-
cate, and cheerleader, the Medical Section nursing staff, and the Center for Nursing Science
and Clinical Inquiry.
Note: The view(s) expressed herein are those of the authors and do not reflect the official policy
or position of Brooke Army Medical Center, the U.S. Army Medical Department, the U.S. Army
Office of the Surgeon General, the Department of the Army, Department of Defense, or the U.S.
Government.
Implementation of an Evidence-Based
Patient Safety Team to Prevent Falls
in Inpatient Medical Units
T
he Centers for Medicare &
Medicaid Services identified
falls as a preventable health
care acquired condition (DuPree,
Fritz-Campiz, & Musheno, 2014). A
large portion of the medical-surgical
inpatient population is aging, and
therefore at high risk for falls (Boltz,
Capezuti, Wagner, Rosen berg, &
Secic, 2013). Falls have physical and
emotional implications for patients,
as well as increased financial costs for
facilities. Nationally, medical units
have the highest rates of falls
(Bouldin et al., 2013). Most notably,
falls can cause significant injuries
resulting in increased length of stay,
unexpected surgeries, and even death
(Williams, Szekendi, & Thomas,
2014). Historically medical-surgical
nurses care for a mix of complex
patients with an array of comorbidi-
ties and patient needs (Carter &
Burnette, 2011).
Literature Review
The literature search was limited
to keyword searches on falls, team-
work, patient safety, nursing, hourly
rounding, and communication. Data -
bases included PubMed, EBSCO,
Agency for Healthcare Research and
Quality, CINAHL, and The Joint
Commission for years 2008-2014.
Use of fall prevention teams was an
emerging evidence-based practice
(EBP) intervention to decrease the
incidence of inpatient falls (Graham,
2012). Consistently, the evidence
demonstrated ineffective communi-
cation, situation awareness, team-
work, assessment, hourly rounding,
and environmental challenges as key
factors related to preventable inpa-
tient falls.
Collectively, research.
Many healthcare financial decisions have a direct effect on nursin.docxalfredacavx97
Many healthcare financial decisions have a direct effect on nursing practice and patient care delivery. What are the ethical implications of these financial decisions? Discuss and explain two specific ways to involve nursing staff in financial planning.
Peer 1 Response:
Lauren Van Hemelrijck posted
The ethical implications of financial decisions that have a direct effect on nursing practice consist of the reduction in available money that is spent on staffing in order to ensure there are appropriate ratios at all times as well as cutting costs related to specific equipment and or tools needed to perform our jobs. Specific nurse to patient ratios have been implemented in some places however, it is not currently the norm regardless of numerous studies that have been conducted and shown that the higher the ratio the worse a patient's outcome. Although facilities will save a substantial amount of money when they cut down on staff, which is why they often choose to do so, an immoral and unethical act in and of itself, the end result effects the patients in often times very negative ways. If patients are having poor experiences they are either not likely to return because they are afraid the care that they receive will continue to be less than adequate or they will have to return due to complications that could have been prevented had there been an appropriate nurse to patient ratio when they were being cared for. As a study on this very subject has found "there is already a significant amount of empirical evidence showing the relationship between certain individual and organizational characteristics of hospital nursing and patient outcomes. These characteristics include nurses' level of education, patient-to-ratios, percentage of RNs among all nursing staff (skill mix), and the nurse practice environment" (Simonetti, 2019, p. 79).
Often times, more expensive equipment makes our jobs easier because it is more efficient and or effective. If we begin to "cut corners" in these ways it will undoubtedly have a direct impact on how well we are able to perform our jobs in certain situations. This is unethical because equipment could mean the difference between accuracy and efficiency among other things. This then means that it could then make or break a patient's outcome. If safety is compromised it is completely inappropriate to substitute equipment that might be unsafe thus putting the patient at an increased risk for illness or injury. This is not only incredibly unethical, it will have an all around negative impact on the facility's reputation and financial standing in the long run. Nurses should have a say in how money is spent because they are often times the most knowledgeable about all of the above. One article that looks at lifting equipment or lack there of states that "the results indicate that fewer than 12 percent of the responding nurses told us they have a "No Lift Policy". More than 85 perfect of hospitals have some type of.
Comment 1Development of an evidence-based practice project musJeniceStuckeyoo
Comment 1
Development of an evidence-based practice project must include the direct and indirect impact that will be encountered through implementation. Staff retention of newly hired nurses specific to the night shift is the focus of my project and its impact on the nurses, facility and community that is served. According to published reports, a supportive work environment, especially between managers and employees, creates a strong deterrent to nurses leaving an organization by improving perception of organizational support, employee engagement, team cohesion, and connection to the mission of the health-care setting (Kurnat-Thoma, Ganger, Peterson, & Channell, 2017).
Financial aspect
– staffing cost/turnover cost
Hospital staffing turnover is projected to 5% to 5.8% of total hospital annual operating budget and is largely driven by the loss and necessary replacement of qualified nurses according to Waldman, J., Kelly, F., Arora, S., Smith, H. (2010).
Proposal direct impact
– hospital revenue/staffing costs,
Proposal indirect impact
– patient outcomes, positive healing environment perception by staff/patients
Quality Aspect
– High turnover in any industry can be a concern, especially those that are customer-centric. Industries that deal with people’s health are in an even more precarious position. Institutions with high attrition must consider how a “revolving door” of care providers affects the quality of care an institution is able to provide, and the satisfaction of patients with their overall experience according to Arena (2018).
Proposal direct impact
–
Separation Costs – Continued benefits, temporary labor, overtime to existing employees
• Recruitment Costs – Job description, posting on job boards, screening candidates, interviewing candidates, assessing candidates
• Onboarding Costs – Orientation and training of new hire
Proposal indirect impact
–
Loss of productivity
• Lack of staff while positions are being filled
• Increased pressure on existing staff to cover and pick up the extra work often leading to burnout
• Patients receiving less attention
• Pressure on current staff to train and then gel with the new employees
• Lack and lag of knowledge with new employees concerning institutional practices, workplace norms, team behaviors, and patient knowledge, familiarity, and care experience
Clinical aspect
– unit cohesiveness/patient care
Many nurses leave their positions because of negative experiences with heavy or unrealistic workloads and due to feeling unheard and undervalued. Clinical nurses' sense of disempowerment can be related to lack of leadership interventions. Clinical nurses may feel that managers are insensitive to their staffing needs, don't support employee well-being, and don't invest enough in staff education or clinical advancement according to Linnen and Rowley (February 2014).
Proposal direct impact
– nurses will see themselves as stewards for their unit. “Nurses are leaders by virtue ...
Slideshow from 2010 Dimensions in Geriatrics conference in May and November 2010, addressing current literature and evidence-bassed practice in preventing patient falls.
Reply week 7 DB4 research1-alberto alfonso Whether you are.docxchris293
Reply week 7 DB4 research
1-alberto alfonso
Whether you are talking about intrapersonal problems or patient care problems, no matter the setting, there will always be something that can be improved. In my facility, I am determined to address the problem that is heavily influencing hospitals: hospital-acquired diseases. This is a serious issue, since a large percentage of patients (over 3%) acquire a hospital-acquired disease at some point during their stay at a given healthcare facility. This can be caused by a variety of reasons, but the most common of which is the absence of proper sterility. By having tools, supplies, and healthcare providers with little or incorrect sterilization techniques, then there is an indeterminate amount of diseases that a patient with a likely already compromised immune system. Furthermore, these hospital-acquired diseases can also affect the healthcare professionals transmitting them, since the providers themselves are the vector for the disease. The project would then consist of a new set of policies that would require more intense analysis of sterilization techniques, including actions before sterilization, during sterilization, and after sterilization (transportation, use, etc.).
By localizing the area, or areas, in which sterilization protocol fails, we will be able to successfully reduce the amount of hospital-acquired diseases an individual patient will experience. Maximum minimization of these diseases is essential to provide a healthcare environment where patient care flourishes, but is also efficient in its usage of funds and time spent by professionals. For example, if a patient receives strep from a medical professional, that patient will require further care; also, the provider will possibly also suffer from the transmitted disease, meaning that person may not be able to practice and therefore put a dent in the hospital’s means. In order to prevent this, implementation of the aforementioned guidelines must take place, since these will allow for a much more strict view of the sterilization techniques. However, a complete rehaul of the methods of sterilization will require time, funds, and strong interprofessional communication to make sure there are no lapses at any point the renewed process. Departmental and funding approving is required, but I believe that this problem is essential enough to solve that it will result in quick approval.
2-sandra jaime
In hospital settings, there exists a plethora of different healthcare that can stem from a large pool of possibilities; for example, anything from hospital-acquired diseases to simple patient comfort are clinical problems that can be addressed either through peer-to-peer collaboration or through patient contact and fulfilling the mastery-prepared nurse responsibility of being the patient’s primary care advocate. Many of the problems in the healthcare field, however, stem from a primary source: a lack of communication. This is the prim.
1. Fall Prevention
An Evidence-Based Practice Project
Alvernia University
Spring 2016
Timothy Espersen, SNALV
Emily DeCampo, SNALV
Briana Austin, SNALV
Amanda Bozzelli, SNALV
2. Learning Objectives
Compare and contrast individual versus multi-component nursing
interventions to decrease inpatient falls.
Discuss nursing interventions that can be implemented without a provider’s
order.
Describe the nurse’s role in decreasing inpatient falls of hospitalized clients.
Evaluate effective nursing interventions to help decrease inpatient fall rates.
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3. Background/Problem
“Falls are associated with increased health care use, including increased
length of stay and higher rates of dis- charge from hospitals into long-
term care facilities. Even a fall that does not cause an injury can trigger
a fear of falling, anxiety, distress, depression, and reduced physical
activity." (Miake-Lye, Hempel, Ganz, & Shekelle, 2013)
“Falls are a leading cause of nonfatal injuries and trauma-related
hospitalizations in the United States, and have been linked directly with
the quality of nursing care in the hospital setting. In this literature
review, multiple studies are summarized that found rounding decreased
falls per 1,000 patient days.” (Hicks, 2015)
“Falls are a patient safety priority among hospital inpatients. The
creation of a Patient Safety Team engaged frontline staff in patient
safety and falls prevention. This intervention decreased the fall rate
from 1.90 to 0.69 falls per 1,000 occupied bed days.” (Christiansen, Feider,
Godlock 2016)
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4. Clinical Significance
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MONTH AVERAGE FALLS
PER MONTH
GOAL BASELINE
JULY 2015 2.5 1.8 3.35
AUGUST 2015 1.1 1.8 3.35
SEPTEMBER 2015 1.19 1.8 3.35
OCTOBER 2015 4.75 1.8 3.35
NOVEMBER 2015 2.3 1.8 3.35
DECEMBER 2015 3.79 1.8 3.35
Good Samaritan Hospital
Telemetry Unit- 3S
3S Unit: Inpatient Fall Rate
5. Clinical Significance
5
MONTH FALLS PER 1000
PATIENTS
GOAL BASELINE STATE
OCTOBER 2015 2.5 1.8 2.11 1.8
NOVEMBER 2015 2.1 1.8 2.11 1.8
DECEMBER 2015 1.9 1.8 2.11 1.8
Good Samaritan Hospital
Hospital Wide Inpatient Fall Rate (falls per 1000 patient days)
6. PICO
P= Adult and geriatric hospitalized population
I= Individual nursing interventions
C= A multicomponent fall prevention program
O= Decreasing inpatient falls
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7. PICO Question
In the adult and geriatric population, what is the effectiveness of individual
nursing interventions versus a multicomponent fall prevention program to
decrease inpatient hospital unit falls?
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8. Literature Reviewed
Search Engines Used
EBSCOhost- Health, CINAHL, OVID, PubMed, Cochrane Library, JBI
Date Range Used
2011-2016
Search Limiters
Not Pediatrics
Not Neonates/Infants
Not articles older than 2011
Keywords Used
fall prevention, fall prevention interventions, fall prevention prpgrams, nursing interventions,
nurse’s role, decreasing falls, hospitalized clients, adult clients, adult patients, geriatric clients,
geriatric patients, adult and geriatric population, inpatient falls, decreasing falls, decreasing
inpatient falls, fall risk, bed alarms, bed alarm use, patient education, staff education, nursing
involvement
Articles Reviewed
18 articles reviewed
8 articles selected for inclusion
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9. Literature Review: Levels of Evidence
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Level Of Evidence Number of Articles
found
Summary of Findings
Level I 5 Data found through review of multiple studies
reveals that a multi-intervention approach can
lead to decreased inpatient falls and help
prevent further complications of patients.
Level II 2 Individualized targeted multiple fall
interventions should be implemented in the
acute care setting in addition to fall prevention
strategies that are already in place
Level III 0 N/A
Level IV 1 There is some data that shows correlation
between the use of low-low beds and
decreasing inpatient falls. A randomized
controlled trial is required to give additional
evidence.
10. Fall Risk Safety
Letter-Good Samaritan Hospital
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0
-Letter presented to patients and their
families upon admission if patient is
found to be at a high risk for falls
11. Current Practice-
Fall Prevention Policy/Practice Change (February 2016)- Good
Samaritan Hospital
Effective immediately, if a patient “refuses” a part of the fall prevention protocol (including the use
of the BED ALARM), the following steps must be followed:
1.RN must educate the patient on the safety measures associated with intervention. If the patient still
refuses, the RN must communicate the refusal to the Charge Nurse
2.The Charge nurse must meet with the patient and explain to the patient the need for the safety
intervention. If the patient still refuses, the Charge Nurse must communicate the refusal to the NM
(nurse manage), ANM (assistant nurse manager), or Supervisor
3.The NM, ANM, or Supervisor must meet with the patient and explain the need for the safety
intervention. If the patient still refuses, a 1:1 sitter must be arranged to keep the patient safe.
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12. 1
2
Fall risk Interventions
- Special bracelet to alert staff of the patient being at a high risk for falls.
- A sign placed above the patients bed to encourage staff members to assist with the patients
safety
- Patients instructed to use they call light when they want to get out of bed
- Patients are asked to wear nonslip, footwear, and will be provided if needed
- Patients will be periodically checked on to provide assistance with toileting and positioning
- Keep some of the side rails up to prevent the patient from accidentally falling out of bed.
-Alarms may be used to assist with patients safety
-Patients will have a fall risk rating placed outside their door to alert staff of the level of
assistance that may be needed to ambulate
For patients identified as a high fall risk by the nurse, receives a Fall Risk Safety Letter regarding the
interventions that will be put into place to help prevent the patient from falling during the inpatient
stay.
Current Practice-
Fall Prevention Policy/Practice Change (February 2016)- Good Samaritan Hospital
13. Post Fall Assessment
Document- Good Samaritan
Hospital
- Form to be completed by the primary
nurse of a patient after an inpatient
fall
- Form helps to identify the possible
root cause of the fall and may be
able to help prevent future falls due
to the same cause
14. Summary of Evidence
The use of low-low beds did decrease the rate of falls, but decreased the
level of injuries that occurred with the falls
Patient education related to their disease process and their increased risk for
falls decreased the rate of falls
Hourly rounding showed promising effects on decreasing patient fall rates
Include interventions such as a toileting schedule, medication review, and a
post fall conference in a multicomponent fall prevention program
Open communication and staff education have a positive influence in
decreasing falls
Exercise interventions and vitamin D/calcium supplementation may show
reduction in the number of falls
15. Summary of Evidence- Cont…
Single versus Multiple intervention fall prevention approaches
The use of using only one fall prevention intervention has shown to help to
decrease inpatient falls, but as the literature suggests, multiple fall interventions
put into place based on the client have proved to be more effective.
Data found through review of multiple studies reveals that a multi-intervention
approach can lead to decreased inpatient falls and help prevent further
complications of patients.
16. Integrating Evidence into Practice
When implementing nursing interventions to prevent falls, a multi-fasciated
approach should be taken and should be individualized based on client need.
Continue to monitor patients that are high fall risks to determine if more
interventions need to be applied and whether or not the initial interventions
are effective.
17. How to Integrate the Evidence Into
Practice
Continue with previous fall prevention measures (bed/chair alarms, signs and
bracelets, 1:1 sitter, instructed to use call bell when patient wants to get out of
bed, wearing nonslip footwear, keeping side rails up)
Add specific client education about how to client’s disease process makes them at
an increased risk to fall without assistance to increase the patient’s knowledge
about their risks and decrease patients ambulating out of bed without calling for
assistance
Implement the use of low-low beds to decrease injuries during a fall
Keep open communication with team members
Provide a toileting schedule for patients whose bowel and bladder habits are
impaired by their disease process
Review medications with patients when appropriate (patients without cognitive
impairment) to decrease their incidence of falls
18. Post-Activity Test
1. List 2-3 nursing interventions that contribute to decreasing
inpatient falls.
2. True or False: Multifaceted fall prevention programs do not show
any benefit versus single interventions in decreasing inpatient
falls.
3. True or False: Nursing interventions, like placing a patient on a
bed alarm, require and MD order.
4. Continuous Re-evaluation of nursing interventions that have been
implemented is necessary for determining effectiveness and
improving patient outcomes. (True or False?)
5. Explain the importance of decreasing inpatient falls, and what
effects falls can have on a patients hospital stay.
6. True or False: Continuous re-evaluation of RN interventions put
into place to prevent falls is key to preventing inpatient falls.
1
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19. Resources
Ang, E., Mordiffi, S. Z., & Wong, H. B. (2011). Evaluating the use of a targeted multiple intervention strategy in reducing
patient falls in an acute care hospital: A randomized controlled trial. Journal of Advanced Nursing, 67(9), 1984-1992.
Retrieved March, 2016.
Barker, A., Kamar, J., Tyndall, T., & Hill, K. (2012). Reducing serious fall-related injuries in acute hospitals: Are low-low
beds a critical success factor? Journal of Advanced Nursing, 69(1), 112-121. Retrieved February, 2016.
Choi, Y., Lawler, E., Boenecke, C. A., Ponatoski, E. R., & Zimring, C. M. (2011). Developing a multi-systemic fall
prevention model, incorporating the physical environment, the care process and technology: A systematic review. Journal
of Advanced Nursing, 67(12), 2501-2524. Retrieved February, 2016
Darlene, H. (2015). Can rounding reduce patient falls in acute care? An integrative literature review. MEDSURG Nursing,
24(1), 51-55. Retrieved February 25, 2016.
Graham, B. C. (2012). Examining Evidence-Based Interventions to Prevent Inpatient Falls. MEDSURG Nursing, 21(5),
267-270. Retrieved March 5, 2016.
Godlock, G., Christiansen, M., & Feider, L. (2016). Implementation of an evidence-based patient safety team to prevent
falls in inpatient medical units. MEDSURG Nursing, 25(1), 17-23. Retrieved February 28, 16.
Godlock, G., Christiansen, M., & Feider, L. (2016). Implementation of an evidence-based patient safety team to prevent
falls in inpatient medical units. MEDSURG Nursing, 25(1), 17-23. Retrieved February 28, 16.
Guo, J., Tsai, Y., Liao, J., Tu, H., & Huang, C. (2013). Interventions to reduce the number of falls among older adults
with/without cognitive impairment: An exploratory meta-analysis. International Journal of Geriatric Psychiatry, 29(7),
661-669. Retrieved March, 2016
Miake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient Fall Prevention Programs as a Patient
Safety Strategy. Annals of Internal Medicine,158(5; Part 2), 390-396. Retrieved February, 2016
Shorr, R. I., Chandler, A. M., Mion, L. C., Waters, T. M., Liu, M., Daniels, M. J., . . . Miller, S. T. (2012). Effects of an
Intervention to Increase Bed Alarm Use to Prevent Falls in Hospitalized Patients. Annals of Internal Medicine Ann Intern
Med,157(10), 692-699. Retrieved February, 2016. 1
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Editor's Notes
DOI
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