1. • Falls are the most common reported adverse event
in an inpatient setting in the United States, and up to
33% result in injury (Choi et al., 2011).
• On average, 424,000 individuals die from falls
annually, and 37.3 million falls require immediate
medical attention (Ishigaki, Ramos, Carvalho, &
Lunard, 2014).
• Falls create dependency, disability, decreased
quality of life for fallers, increased risk of injury to
caregivers, risk of fall recurrence, and higher
hospital costs associated with falls (Powell-Cope et
al., 2014).
• Currently, we are practicing on the medical
surgical unit, 5C, at New York Presbyterian, Lower
Manhattan where the fall rate is approximately 3
falls per month. Since October 2015, three of these
falls resulted in injury.
• Due to the high rate of falls, it is imperative to
improve the current fall prevention interventions in
place. The current protocol consists of bed alarms,
fall risk bracelets and a fall risk sign outside the
patient room. By implementing a designated “falls
champion” on each shift, we hope to improve patient
safety by reducing fall rates.
Evidence Based Practice Improvement: Falls Champion, Preventing Falls For All
Suraiya Chow, Karen Dwelley, Tess Farenwald, Zackary Hipsman, Donna Hughes, Anne Kim, Claudine Pearson
Pace University, College of Health Professions, Lienhard School of Nursing
PICO Question
Background
Search Strategy
Review of Literature
Major EBP Recommendations Methods of Implementation for Proposed
Practice Change
Evaluation of Proposed Practice Change
References.
For patients that are on a medical surgical
unit, would the implementation of a falls
champion, compared to the current falls
protocol, reduce the occurrence of falls?
• Clinical guidelines published within the past five years
were searched using “Fall Prevention” as a keyword in:
• National Guidelines Clearinghouse
• National Quality Measures Clearinghouse
• Clinical guidelines were chosen based on their suggestions
on fall prevention methods utilizing a falls champion.
• Systematic reviews and single studies were searched using
terms “fall prevention” and “falls champion”:
• Medline via EBSCO host
• PubMed through NCBI
• CINAHL
• Nursing and Allied Health Collection.
Keywords used: Fall prevention, falls champion, falls safety
champion, expert unit coordinator, fall risks, elder adult,
accidental falls, hospital fall prevention.
Figure . [Nurse]. Retrieved April 4, 2016 from http://lemerg.com/967393.html
• Our clinical setting is a medical surgical unit located at
New York Presbyterian Hospital, Lower Manhattan.
• Our target audience consists of all nursing staff on the 5C
unit. Several variables were taken into account when
considering the implementation of a “falls champion”.
• The independent variable is the implementation of a falls
champion and the dependent variable is the number of falls
experienced
• Since nurses already have a busy workload, we must
ensure time and motivation to carry out the tasks of the falls
champion. We propose reducing the patient load for that
shift for the designated nurse, therefore he/she does not
have additional work.
Figure 1. [Untitled]. Retrieved on April 4, 2016 from
http://www2.providence.org/pages/continuum_adultdaynursing_elderplace_portal.aspx
• The desired outcome is a reduction in the number of
falls for geriatric patients in the experimental group as
compared to the control group.
• The incidence of falls on the medical surgical unit will
be monitored over the course of a 6 month period.
• Morse Fall Scale scores will be calculated by nurses at
the time of admission to the floor and reports on the
number of hospital falls will be conducted on a monthly
basis.
• Authors propose statistical analysis involving rate ratios
to determine the effectiveness of the Falls Champion.
Researchers will use a rate ratio and 95% confidence
interval (CI) to compare the rate of falls (e.g. falls per
person year) between experimental and control groups
(Godlock, 2016).
• Based on current research by the National Guideline
Clearinghouse, the following protocols are suggested to be
implemented:
• A fall risk assessment
• Visual identification of individuals at high risk for falls
• Fall risk factor directed interviews
• Standardized multifactorial education for staff, patients
and their families.
• Teach back method for the patient. This involves asking
the patient to explain to the nurse, the most important factor
to prevent falls. (National Guideline Clearinghouse, 2012).
• If a falls champion is implemented these key points would
be addressed and reinforced by the appointed registered
nurse.
• If a falls champion is implemented these key points would
be addressed and reinforced by the appointed registered
nurse.
• The entire Med-Surg nursing staff will be required to attend
an in-service training on fall safety prevention and
interventions, to include a review of the agency fall safety
bundle and protocol (Miake-Lye, Hempel, Ganz, & Shekelle,
2013). Upon completion they will qualify to be randomly
selected as the unit falls safety champion.
• The unit falls safety champion (FSC) is put in place to
oversee nursing staff’s compliance with agency fall
precaution policy and increase patient safety by ensuring the
accessibility of resources and necessary equipment such as
bed alarms, bedside commodes/bed pans, non-slip socks,
side-rails, adequate staffing, and assistive devices (Miake-
Lye et al, 2013).
• He or she (FSC) will lead post fall huddles to discuss and
determine what safety precautions were or were not utilize
prior to the fall and characteristics of the fall incident that the
interdisciplinary team can learn from.
• On the shift that the registered nurse is selected as the falls
safety champion, he or she will have no more than three low
acuity patients under their direct care and will review the
care plans for each high fall risk patient.
Agency for Healthcare Research and Quality. (2012). National Guideline Clearinghouse. Rockville, MD: Author.
Level of Evidence: Evidenced-based Practice Guideline
Burnett, M., Lewis, M., Joy, T., & Jarrett, K. (2012). Participating in Clinical Nursing Research: Challenges and Solutions
of The Bedside Nurse Champion. MEDSURG Nursing, 21(5), 309-311.
Level of Evidence: Controlled Trials without Randomization
Choi, Y. S., 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):2501-24. doi: 10.1111/j.1365-2648.2011.05672.
Level of Evidence: Systematic Review
Godlock, G. (2016). Implementation of an Evidence-Based Patient Safety Team to Prevent Falls in Inpatient Medical
Units. MEDSURG Nursing, 25(1), 17-23 7p.
Level of Evidence: Meta Analysis
Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., & ... Ganz, D. A. (2013). Hospital Fall
Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness. Journal
Of The American Geriatrics Society, 61(4), 483-494. doi:10.1111/jgs.12169
Level of Evidence: Systematic Review
Ishigaki, E., Ramos, L., Carvalho, E., & Lunardi, A. (2014). Effectiveness of muscle
Strengthening and description of protocols for preventing falls in the elderly: A
Systematic review. Braz J Phys Ther, 18(2), 111-118. http://dx.doi.org/10.1590/S1413-35552012005000148
Level of Evidence: Systematic Review
Johansson, E., Borell, L., & Jonsson, H. (2014). Letting go of an old habit: group leaders' experiences of a client-centred
multidisciplinary falls-prevention programme. Scandinavian Journal Of Occupational Therapy, 21(2), 98-106.
doi:10.3109/11038128.2013.868515
Level of Evidence: Cohort Study
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, 158390-396.
Level of Evidence: Systematic Review
Powell-Cope, G., Quigley, P., Besterman-Dahan, K., Smith, M., Stewart, J., Melillo, C., … Friedman, Y. (2014). A
Qualitative Understanding of Patient Falls in Inpatient Mental Health Units. Journal of the American
Psychiatric Nurses Association, 20(5), 328-339. doi:10.1177/1078390314553269
Level of Evidence: Evidence from Qualitative Studies
• Direct care nurses in optimal position to evoke change in
nursing practice
• Nurses clinical experience ranged from 5-27 years (Burnett,
Lewis, Joy, & Jarrett, 2012).
• Nurse as fall champion contributed positively to better
outcomes due to expertise and direct care experience (Burnett
et al, 2012).
• Teamwork and support from nursing leaders resulted in
notable impact on Champion’s ability to effectively follow
through with fall protocol (Hempel et al, 2013).
• Unit and hospital leader involvement provided profound
impact for Champion success (Hempel et al, 2013).
• Providing Champion with allocated time away from direct
patient care allowed increased efficiency for Champion to
follow through with fall protocol and provide teaching
(Hempel et al, 2013).
• Fall champion as primary fall data collector provides
continuity for system devisement and better meeting needs of
the units and engaging staff (Miake-Lye, Hempel, Ganz &
Shekelle, 2013).
• Data collection and presentation provided heightened
awareness and prompted critical thinking about fall risk
assessment amongst nursing staff (Miake-Lye et al, 2013).
• Knowledge deficits, inconsistencies in assessments, and
variations of interpretation of fall risk tools were discovered
as a result of nurse champion on unit level (Burnett et al,
2012).
• Leader support found to promote atmosphere of teamwork
resulting in good outcomes
• Rewarding experience for the clinical nurse as a fall
champion (Johansson, Borell & Jonsson, 2014).