Geriatric Nursing Commons^™

Falling Star Program: A Visual Cue Intervention To Reduce Falls In Long-Term Care, Maggie Shanahan

Evidence-Based Practice Project Reports

Falls among older adults in skilled nursing and long-term care settings remain a leading cause of injury, functional decline, and increased healthcare utilization, contributing significantly to morbidity and mortality in this population (Centers for Disease Control and Prevention [CDC], 2023; Agency for Healthcare Research and Quality [AHRQ], 2022). The primary purpose of this project aimed to implement and evaluate a structured visual cue–based fall prevention intervention to reduce fall rates among high-risk residents in a long-term care facility in Northwest Indiana. The project included 23 participants aged 65 years and older who were identified as high risk for falls. Using …

Implementation Of A Pressure Injury Prevention Bundle To Reduce Hospital-Acquired Pressure Injuries In The Intensive Care Unit, Xibo Lan

Doctor of Nursing Practice Final Project Abstract

Purpose

The goal of this quality improvement project was to utilize the SKINSAFE pressure injury prevention bundle during 12 weeks of implementation to increase evidence-based pressure injury prevention practices adherence and decrease risk of hospital-acquired pressure injury (HAPI) in the intensive care units (ICU).

Background

ICU patients experience high risk for hospital acquired pressure injuries (HAPIs) secondary to immobility and device related pressure. Initial adherence to SKINSAFE bundle was 55-56%. There was inconsistent use of heel offloading devices, wound photography and documentation. Prevention bundles were affected by staffing fluctuations and leadership turnovers.

Methodology

The Plan-Do-Study-Act cycle for this project included …

A Multicomponent Quality Improvement Initiative For The Early Identification, Prevention, And Management Of Delirium In The Medical-Surgical Setting, Sarah K. West

Doctor of Nursing Practice Scholarly Projects

Hospital-acquired delirium affects older adult patients, across the healthcare continuum. The incidence in frail older adults is high, costly, and often deemed preventable. Hospital-acquired delirium is associated with a multitude of short- and long-term complications, resulting in an increased rate of morbidity and mortality. The challenges of early recognition and management are prevalent in healthcare literature. While published guidelines exist, hospital systems continue to struggle with the standardization of geriatric delirium care. Given medical-surgical nursing is the cornerstone of hospital care, it is imperative to establish a standardized delirium prevention and management guideline, at this level of care, to optimize …

Older Adult's Fall Prevention Program, Myles Butler, Rebecca King

Fall 2024 OTD Capstone Symposium

The decline in bodily functions with aging increases older adults' vulnerability to falls, which is a leading cause of death within this population. The poster presents an educational based fall prevention program focused on safety awareness and risk management for older adults. In conclusion, implementing a fall prevention program leads to increased awareness regarding risk factors that are detrimental to the safety and well-being of the older adult community

Effectively Addressing Hospital-Acquired Pressure Injuries With A Multidisciplinary Approach, Nicki Roderman, Shandlie Wilcox, Andrew Beal

HCA Healthcare Journal of Medicine

Background

Hospital-acquired pressure injuries (HAPIs) result in patient harm, discomfort, and even death, with an estimated 2.5 million HAPIs occurring annually in the United States. These pressure injuries from prolonged pressure on the skin and deeper tissues cause reduced blood flow and the breakdown of skin and tissues, resulting in wounds. Additionally, these injuries contribute to longer hospital stays and increased health care costs. Hospitals have programs aimed at reducing HAPIs as well as ongoing surveillance to identify new trends early on. This ongoing monitoring revealed a trend early at our institution that HAPIs were 66% higher than the national …

Assessing The Effectiveness Of A Non-Punitive Fall Prevention Program, Nicki Roderman, Shandlie Wilcox, Cynthia Lang

HCA Healthcare Journal of Medicine

Background

Our single-center, quality improvement project evaluated the impact of a fall reduction plan while using a Just Culture Algorithm that included weekly fall reviews involving front line staff using a non-punitive structure. The project has shown successful results.

Methods

Prior to starting the program, data at this institution indicated falls were higher than the national fall rate of 3-5 per 1000 patient days. To achieve the goal of reducing the fall rate to below 3.1, an interdisciplinary fall committee was formed, consisting of nurses, nursing leaders, patient care technicians, pharmacists, and physical therapists. The committee operated in a non-punitive …

Process Improvement To Reduce The Incidence Of Delirium In An Overflow Unit, Raquel G. Chong

Master's Projects and Capstones

Abstract

Problem: This quality improvement project aims to reduce the incidence of hospital-acquired delirium in an overflow unit, which serves a diverse patient population from medical-surgical and telemetry microsystems. The unit averages 96 delirium episodes annually, costing approximately $3,456,000. The goal is to reduce delirium incidence by 25%, decreasing monthly cases from 8 to 6 by October 31, 2024, and annual cases to 72 by April 2026.

Context: Delirium is a prevalent and severe neuropsychiatric syndrome that significantly affects older hospitalized patients, characterized by acute disturbances in attention, awareness, and cognition.

Interventions: The project introduced a bundle of four interventions …

Reducing Delirium And Functional Decline In Hospitalized Older Adults: Implementation Of Cocare Help, Kara Marie Roman, Aaron Mestemaker

Masters Projects

Background: Delirium is a common disturbance in cognition among older adults in the hospital setting. It is associated with negative outcomes and high costs for patients, families, and hospital systems. Use of a reliable screening tool and evidence-based strategies such as CoCare: HELP demonstrates delirium prevention and functional decline in many geriatric hospitalized patients.

Objectives: This study examines the impact of implementing aspects of CoCare: HELP on two pilot units in an urban Midwestern hospital. Pre- and post-implementation measures of delirium rate, 30-day admission rate, length of stay, falls with injuries, safety attendant orders, restraint numbers, use of antipsychotics, and …

Development Of A Fall Prevention Bundle With Evidence-Based Tools For Hospitalized Adults, Kelly A. Tirone

Master's Projects and Capstones

Problem

One million hospitalized people fall annually in the United States, and up to a third are preventable.

Context

Data from an acute care hospital show one medical-surgical unit reported eight patient falls in 2021, two causing major harm that reached sentinel event criteria.

Interventions

A Clinical Nurse Leader (CNL) leveraged the unique CNL skill set and characteristics of Human-Centered Leadership to engage in horizontal leadership, injury prevention, and team coordination through authentic human connection. The team leveraged documentation for improved fall risk communication. Unavoidable disruptions hindered other planned interventions.

Measures

Outcome measures observe for total fall count and the …

Diabetes Prevention Program, Ashley L. Stine

MSN Capstone Projects

The prevalence of diabetes in Texas has increased 40 percent over the last decade and will continue to rise as of 2019. New onset diabetes, chronic, and children with diabetes has significant rise in hospitalization rates. COVID and its restraints of limiting physical activity, restrictions of gyms and sedentary lifestyles. Chronic diabetics who were frequent flyer hospitalizations rates increase due to poor social support, mental health and stressors increased during COVID also. This diabetes prevention program that consists of 16wks for new and current diabetics would decrease complications of diabetes such as DKA, retinopathy, nerve pain, chronic pain, AMS, amputations, …

Implementation Of Post Falls Huddles In Skilled Nursing Facility, Princess Lomax

Evidence-Based Practice Project Reports

The purpose of this paper is to discuss the quality improvement project, implementation of the post fall huddle in a long-term care facility. Falls are the most common problem in adults 65 years and older. Falls in this population can have devastating effects, often leading to significant changes in morbidity or death. Adults in long term care settings have an increased risk of falling and having a subsequent fall due to an acute illness, weakness, or confusion (CDC, 2015). At the skilled facility, there has been a significant increase in hospitalizations due to injuries sustained from falls. To address this …

Getting To Zero: Creating An Infrastructure To Support Fall Prevention In A Medical–Surgical Unit, Krys Elgarico

Master's Projects and Capstones

Problem: Hospital falls are a growing national patient safety concern that cause anxiety, pain, distress, serious injuries, and increased health care utilization. Despite the presence of a well-developed falls prevention protocol since 2017. Internal data from an inpatient medical-surgical telemetry (MST) unit indicate the largest number of fall-related events among the hospital’s departments.

Context: Practice improvement project was initiated in a 217-bed community hospital to determine barriers and potential success factors. This MST is a dynamic, 48-bed unit providing care to mainly geriatric patients who require continuous telemetry monitoring and complex medical, trauma, and surgical services. Senior leaders in the …

Increasing Prevention And Recognition Of Delirium In A Non-Icu Acute Care Population, Anne Gembrowski

Doctoral Projects

Delirium is associated with increased mortality, nosocomial complications, increased length of hospital stay, and greater chance of readmission, increased hospital costs, and a need for skilled nursing aid after discharge from the hospital. In a hospital, delirium can affect up to 50 percent of older patient 65. The solution is to prevent delirium from occurring and to regularly screen for its presence. The purpose of this paper is to explore the best prevention strategies and screening tool for delirium and to successfully implement a delirium bundle on a medical surgical unit. The question this paper attempts to answer is if …

Using An Online Learning Module In A Nursing Program To Improve Knowledge And Skills To Prevent Falls In The Community Dwelling Older Adult Population, Susan Kane Patton

Graduate Theses and Dissertations

Nationally, 28.4% of older adults fall each year. Falls and resulting injury result in decreased mobility, functional impairment, loss of independence, and increased mortality. Utilization of evidence based protocols by providers to identify older adults at risk of falling is limited and rates of participation by older adults in prevention activities is low. Because of nursing’s increasing role in caring for older adults, development of fall prevention education for nursing students would result in increased awareness of the need for fall prevention in community dwelling older adults and increased access of older adults to falls risk assessment. There is a …

Using Education And A Prevention Protocol Tool To Decrease The Incidence Of Pressure Ulcers In A Nursing Home, Kristina L. Scalzitti

Evidence-Based Practice Project Reports

Over 1.3 million persons are residents in nursing homes (NHs); one in ten have pressure ulcers. The purpose of this evidence based practice project was to determine if implementation of a pressure ulcer prevention tool, along with staff education, decreases the incidence of pressure ulcers within the NH. Florence Nightingale’s Environmental Model and the Stetler Model were used to guide this project. The setting was a NH in northwest Indiana. Eleven nurses attended a 15 minute educational session on pressure ulcer prevention and implementation of the Pressure Ulcer Prevention Protocol Intervention (PUPPI) tool. PowerPoint slides were distributed and flyers about …