Medicine and Health Sciences Commons^™

Implementation Of An Education Program To Decrease Inpatient Falls, Elizabeth M. Carpenter, Jewyl Gibson

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

BACKGROUND: Inpatient falls are affecting 1 million patients across the United States every year with 25% of fall resulting in injury. Approximately 25% of falls are preventable with accurate assessment and appropriate fall precaution interventions. According to the literature, obtaining an accurate fall risk assessment is the first step in inpatient fall prevention.

LOCAL PROBLEM: Patient falls increased on 2 cardiac stepdown units in a level III trauma center in Knoxville, Tennessee. From 2020- 2022, the combined units experienced a 48% increase in patient falls. Nursing leadership identified staff knowledge deficits and inaccurate scoring of fall assessments as primary contributors …

Effectiveness Of An Instructional Program On Decreasing Fall Incidents In Geriatric Patients With Psychiatric Disorders, Maurice Washington

DNP Scholarly Projects

Falls occur in 25% of older adults, resulting in over 8 million fatal and nonfatal injuries. In addition to the human suffering, associated medical and legal costs amount to over 50 billion dollars a year. This study examines the impact on fall rates of an evidence-based fall prevention program provided to a multidisciplinary staff on a psycho geriatric unit in Philadelphia, Pennsylvania. Staff knowledge of effective fall prevention interventions was measured before and after their participation in an evidence-based instructional workshop provided by the Project Director using the Falls Prevention Knowledge Test by Dykes et al. (2019). While there were …

Effect Of A Community Hospital’S Sustainable And Enhanced Fall Prevention Quality Improvement Program On Inpatient Falls And Falls With Injury: A Before And After Study, Anne Catino

DNP Scholarly Projects

The frequency of hospital falls is a significant clinical problem and directly related to patient safety. Failure to identify potential risk factors and to implement individualized measures for fall prevention can threaten patients’ safety and lead to increased hospital length of stay, increased hospital cost, and reduced quality of life for patients. The purpose of this project was to enhance an evidence-based, fall prevention program to effect a reduction in falls and falls injury. The project is supported by a multidisciplinary hospital team and builds on a community hospital’s fall reduction program. Falls and falls with injury frequencies for 6 …

Implementing An Evidence-Based Fall Prevention Plan To Address Unintentional Hospital Falls On A Medical/Surgical Unit, David Haskell

Doctor of Nursing Practice Projects

Background: Falling in the hospital setting is a leading cause of death and disability for patients. For many health care organizations, patient fall prevention strategies have become a priority focus to improve patient outcomes and associated costs.

Project Design: The project was designed to implement a quality improvement project on an adult medical/surgical unit, providing educational activities to nursing staff, and applying a standardized fall prevention plan of care “toolkit” for fall prevention interventions.

Results: Audits completed on 863 patient admits to a 36-bed Medical/Surgical unit during the three-month timeframe, showed the implementation of the project resulted in the creation …

Developing A Standardized Process For An Effective, Evidence-Based Fall Management Program To Reduce Falls In A Nursing Home Setting, Katrina K. Little

Doctor of Nursing Practice Projects

Background: Falls among the elderly population, aged 65 years and older, are a significantly growing public health problem. For elderly people residing in residential care facilities and facility administrators, falls are of great concern due to the post-fall associated consequences. Preventing resident falls in long-term care is a priority to reduce injuries and associated costs.

Project Design: This evidence-based quality improvement (EBQI) pilot project focused on fall prevention and was conducted on 1 unit (3 long-term care hallways) at a facility that provides both long-term care (LTC) and short-term rehabilitation services in Utah County, Utah. Interventions chosen for the Falls …

Delirium Screening To Prevent Falls In The Long-Term Care Setting, Jonathan David White, Bsn, Rn, Samereh Abdoli, Phd, Rn

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Abstract

Background

Nearly 30 million people fall in the United States (U.S.) every year with 20% resulting in serious injury. These incidents disproportionately occur in the elderly population. Of the 1.6 million people living in long-term care (LTC) settings in the U.S., between 50-75% experience a fall annually with many experiencing multiple falls. This population is 2 times as likely to experience such an event – and due to increased age, they are least likely to recover. Delirium, a main contributing factor to fall, has been found to go undetected in as many as 66% of individuals in the clinical …

Evidence-Based Change Benchmark: Implementing Intervention Strategies Aimed At Reducing Patient Falls, Victoria Nix

MSN Capstone Projects

This paper provides an overview of an evidence-based change project that arose from the following PICOT: In patients at risk for falls [P], how does implementing fall risk prevention [I] compared to no fall risk prevention [C] affect fall rates [O] within 3 months of implementation [T]? A comprehensive review of primary sources dealing in clinical studies was found to support the case that fall prevention measures, specifically patient-specific bedside tools, have shown to be instrumental in reducing patient falls. The development and implementation of a robust Fall Prevention Program designed around the latest research was the goal; however, the …

The Use Of Video Monitoring To Decrease Falls, Marie Elizabeth Mo

Doctoral Dissertations and Projects

Fall prevention is a constant challenge for inpatient nursing staff. The purpose of this project is to demonstrate that falls in hospitalized patients will decrease with the initiation of video monitoring. A fall while in the hospital can lead to increased length of stay, increased cost to the organization, lack of reimbursement from Medicare, and the worst outcome is the patient never returning to baseline. Nursing staff struggle with fall prevention daily and are often unsuccessful. One to one sitters are often utilized as a fall prevention measure; this can be draining to hospital resources. Identified best practices of one-to-one …

Dnp Final Report: Reducing The Rate Of Falls With A Stuctured Fall Program, Elanda L. Douglas

DNP Final Reports

Background: Fall rates continue to be a significant problem in health care facilities despite all the research and tool kits created to prevent falls. Hospitals that have successfully reduced fall rates find it challenging to sustain a reduction in the fall rates. During hospitalizations, 3%-20% of patients fall, with 30%-50% resulting in injury (Joint Commission, [JC], 2015).

Internal Evidence: Despite Medical City Alliance (MCA) having an evidence-based fall program, the fall rate has not decreased. Falls are one of the quality measures identified at the division level that needs improvement.

PICOT: In adult patients in a progressive care unit (P), …

Fall Prevention: Remote Video Monitoring, Shawna Moser

MSN Capstone Projects

Patient safety is a top priority for all healthcare organizations, but as a healthcare facility, is everything, within the means of the facility, being done to ensure patient safety? Challenges exist for all healthcare organizations when faced with patient safety, but there it is a necessity for these healthcare organizations to overcome these challenges and protect their patient population. A common challenge within the acute care setting is the prevention of falls. “Falls during hospitalization harbor both clinical and financial outcomes” (Gringauz et al., 2017, p. 1). Research on fall interventions has shown that a multifocal approach is most effective …

Further Fall Prevention, Kristen L. Janes

MSN Capstone Projects

Falls continue to occur in the acute care setting despite our best efforts. Decreased falls, increased patient safety, decreased cost, and decreased length of stays in the acute care setting are imperative. This is a benchmark study on the concept of an education pamphlet being presented to patients and family members educating on all fall precautions and interventions that are to be expected to be in use during their stay. Study also reflects fall interventions that are in use and have shown to decrease falls.

Impact Of Hourly Rounding On Fall Rates: A Benchmark Paper, Monica D. Smith

MSN Capstone Projects

Falls and fall-related injuries create a significant financial burden on patients and healthcare organizations, particularly in adult inpatient hospital units such as rehabilitation and medical-surgical units. Costs associated with additional hospital days, diagnostic testing, and potentially fall-related surgeries can average about $14,000 per fall (The Joint Commission, 2015). Moreover, falls can be devastating in older adults, impacting their overall quality of life. According to Abou et al., 20% of yearly individual costs associated with falls are among patients with Parkinson's disease (2020). This is a proposal to implement a pre-and post-implementation change project. This paper addresses the use of evidence-based …

Implementation Of A Fall Risk Assessment Tool In Primary Practice May Decrease Fall Frequency In The Aging Population, Regina M. White

Doctoral Dissertations and Projects

The purpose of this evidence-based project was to illustrate the benefits of utilizing a fall risk assessment tool during office visits for the aging population of a Midwestern U.S. primary care practice. Utilization of this tool helped minimize fall frequency, thus improved quality of health. The reduction in falls helped minimize unnecessary healthcare expenses. This manuscript identified a rationale for the project, specific tool utilization, outcome measures before and after implementation, limitations, and future application for practice. Provider compliance with tool utilization and frequency were measured. Multiple potential causes of falls and recommendations to minimize falls were identified with the …

Use Of Delirium Protocols In Decreasing Falls Among Adults In Acute Care: An Integrative Review, Shelly Steverson Thornton

Doctoral Dissertations and Projects

Delirium in elderly hospitalized adults continues to be a common and costly issue in health care today. Various delirium protocols and strategies are available to reduce negative outcomes of delirium such as falls, increased length of stay, pressure ulcers, hospital readmissions, the need for transferal to long-term care, and mortality rates. However, many hospitals have still not implemented routine delirium protocols. Because falls in older hospitalized adults are often linked to delirium, this integrative review was undertaken to examine delirium protocols and approaches that specifically decrease falls among older adults in acute care settings. Several multicomponent, multidisciplinary delirium protocols were …

Hourly Rounding: The Effects On Fall Rates In Adult Population In Acute Care Setting, Sheyla J. Pellicier Mercucci

MSN Capstone Projects

Falls are one of fourteen categories of hospital-acquired conditions (HACs) listed by the Centers for Medicare and Medicaid Services (2020). Falls are costly and stressful for everyone involved; patients, families, nursing staff and physicians. According to the United States Department of Health and Human Services (2019), about seven hundred thousand to one million hospital admitted patients fall every year. The estimated cost of a fall is about fourteen thousand fifty-six dollars if an injury occurs and can extend patient’s hospital length of stay (LOS) to up to 6.3 more days (Joint Commission Center for Transforming Healthcare, 2019).

When a patient …

Risk Factors For Falls In Homebound Community-Dwelling Older Adults, Yunchuan (Lucy) Zhao, Jenny Alderden, Bonnie Lind, Jennifer Stibrany

Nursing Faculty Publications and Presentations

Objective: To examine risk factors associated with falls among homebound community-dwelling older adults, a vulnerable population often possessing functional disabilities and chronic conditions.

Design and Sample: The study was a cross-sectional study utilizing round 6 data of the National Health and Aging Trend Study (NHATS). Descriptive statistics and multiple logistic regression analyses were conducted. A total of 1,356 homebound community-dwelling older adults aged 65 and above participated in the NHATS.

Measures: The outcome variable was falls within the last month reported in NHATS. Independent variables were selected based on the NHATS disability conceptual model and literature review, including personal conditions, …

Reducing The Number Of Falls In On Lok Participants By Enhancing Homecare Services, En Zhu

Nursing and Health Professions Faculty Research and Publications

Falls in elderly are one of the major health concerns in the US. They comprise up to 80% of the key risk factors for injuries in the elderly in the US (Spears, Roth, Miake-Lye, Saliba, Shekelle, & Ganz, 2013). The project aims at reduction of falls among the elderly participants in On Lok program. Based on the findings of the literature review and observations conducted, the proposed intervention to address the practice gap will involve emphasizing the need for carrying the mobility devices, such as canes or walkers, along with clearing the participants’ home environment from hazards. The anticipated measure …

Improving Communication To Reduce Patient Falls In A 48-Bed Medical-Surgical Unit, Christian Gella

Nursing and Health Professions Faculty Research and Publications

Abstract

Problem: Patient falls has been associated with increased morbidity, mortality and decreased quality of life. The increase in total patient falls for 2018 relative to 2017, and a spike of 10 patient falls for the month of June 2018 from a baseline of 5.3 falls per month has gained greater attention to reduce patient harm from falls while hospitalized. Prevention of falls minimizes patient exposure to the possibility of being injured. Despite efforts to curtail patient falls, improvement in communication is essential to address the safety issues surrounding improving quality of care practices, and consequentially reduce un-reimbursable hospital costs …

Nursing Skill Mix, Nurse Staffing Level, And Physical Restraint Use In Us Hospitals: A Longitudinal Study., Vincent S. Staggs, Danielle M. Olds, Emily Cramer, Ronald I. Shorr

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Although it is plausible that nurse staffing is associated with use of physical restraints in hospitals, this has not been well established. This may be due to limitations in previous cross-sectional analyses lacking adequate control for unmeasured differences in patient-level variables among nursing units.

OBJECTIVE: To conduct a longitudinal study, with units serving as their own control, examining whether nurse staffing relative to a unit's long-term average is associated with restraint use.

DESIGN: We analyzed 17 quarters of longitudinal data using mixed logistic regression, modeling quarterly odds of unit restraint use as a function of quarterly staffing relative to …

A Pressure Ulcer And Fall Rate Quality Composite Index For Acute Care Units: A Measure Development Study., Diane K. Boyle, Ananda Jayawardhana, Mary E. Burman, Nancy E. Dunton, Vincent S. Staggs, Sandra Bergquist-Beringer, Byron J. Gajewski

Manuscripts, Articles, Book Chapters and Other Papers

Background: Composite indices are single measures that combine the strengths of two or more individual measures and provide broader, easy-to-use measures for evaluation of provider performance and comparisons across units and hospitals to support quality improvement.

Objective: The study objective was to develop a unit-level inpatient composite nursing care quality performance index-the Pressure Ulcer and Fall Rate Quality Composite Index.

Design: Two-phase measure development study.

Settings: 5144 patient care units in 857 United States hospitals participating in the National Database of Nursing Quality Indictors® during the year 2013.

Methods: The Pressure Ulcer and Fall Rate Quality Composite Index was developed …