Quality Improvement Project

During hospitalizations, falls are amongst the highest preventable consistent adverse events. Preventing such undesirable events, enhances patient overall experience, as well as increased trust in the health care professional team (Fragata, 2011). The importance of fall prevention lies with the many serious unfavorable health outcomes it can pose on the patient. Falls have the potential increase length of hospital stay, limit mobility, independence, but can ultimately lead to health deterioration, including death. Worldwide, falls are the second leading cause of accidental death. In addition to the life-threatening health and safety risks falls have to the patient, it also as a financial impact,

Falls are one of the major patient safety problems that every facility encounter on a day to day basis. An aging patient population, combined with multiple diagnosis and medications are prime contributing factors for patient fall. Other contributing factors are shortage of nursing and auxiliary staff, ineffective work environment and shortage of appropriate equipment. According to the Joint Commission around 30-50 percent of the falls happening in the hospitals have resulted in injury to the patients. Since Joint Commission started keeping records of fall from 1995 to 2012, it has been reported that there were 659 fall related death or permanent disability, which were voluntarily reported as a

Patient falls in hospitals are a critical problem and are used as a standard metric of nursing care quality. According to the Joint Commission, thousands of patients fall in hospitals each year. Approximately 30-50% of falls result in injuries and prolonged hospital stays. Any patient in a hospital is at risk for falling and certain measures should be in place to prevent this. Preventing falls and injuries are not only important for the patient, but also for their families, the hospital, health care team, and insurance companies. It is estimated the average cost of a hospital admission due to a fall is $20,000 and by 2030, an estimated $54 billion will be spent on health care costs due to falls. The purpose of this paper is to explore the risk factors of falls in hospitals and interventions used to combat this problem.

Problem: Patient falls have long been a common and serious problem in hospitals across the nation, causing

Falls are a great health concern for hospitalized patients since it has been ranked the

This work has significance because staff and patient education can help prevent falls. Specific interventions decrease falls. Nurses have a responsibility to their patients and their facility to be competent and confident in their abilities to do all that they can to prevent falls. Facilities have the responsibility to provide the tools and the training that is required to carry out fall prevention

Capan, K., & Lynch, B. (2007). Reports from the field: patient safety. a hospital fall assessment and intervention project. Journal of Clinical Outcomes Management: JCOM, 14(3), 155-160.

In the healthcare system, Core Measure sets are used to measure quality care. It consists of pneumonia, heart attack, immunizations, emergency department, sepsis, for infection prevention, and others. Evidence-based treatments are used to prevent occurrences using structures, processes, and outcomes. In nursing, they have adopted a similar method of performance measures, known as nursing-sensitive indicators. It includes falls, and this indicator is implemented in each unit of the hospital and managed by the manager and educator along with others like CAUTI and CALBSI. According to the American Hospital Association article (2015) “Falls with Injury,” Patient falls-an unplanned descent to the floor with or without injury to the patient affects between 700,000 and 1,000,000 patients each year.”

At Brigham and Woman Hospital, this fall prevention program has been instituted throughout the facility. The protocol requires all patients to be screened for fall risk factors upon their admission to the hospital. Upon admission, nurses must conduct a throughout medical assessment, and use the Morse Fall Scale to assess patients mobility, muscle strength, gait, vision of patients because those conditions can put patients at increase risk for falls. At the end of each assessment, a number is provided to each patient determining the degree of fall and documented in the patient chart. For example, a patient might be a low risk for fall while another might at high risk for fall. In addition, the nurse must create a plan of care and

Quality improvement is referred to as “the use of data to monitor the outcomes for care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care” (Sherwood & Barnsteiner, 2012). Data is used as the reflection of quality care that is provided by nurses and presents whether or not improvement is needed. In order for nurses to be mindful of the care that they give, they must be taught a systematic process of defining problems, identifying possible causes of those problems, and methods for trying out new solutions to prevent those problems (Sherwood & Barnsteiner, 2012). Currently, quality improvement measures are being utilized throughout hospitals to reduce the risk of patient falls and fall injuries.

The nursing process has been improved along the way, from Orlando’s original four step process in the late 1950’s, then, a separate step of a nursing diagnosis was added. As to the American Nurses Association Scope and Practice (2nd Edition, 2010), there was another important step of expected outcomes to identify patient goals. So, as the nursing process has been re-evaluated and improved the patient is re-evaluated and improved by the improved nursing process-problem solver. My fall prevention project has revealed to me and my readers there are vast numbers of risk factors that are involved in falls including medications, nutrition, cultures (beliefs), mental status and a history of falls. The nursing process has been and will always be used

Falls are considered a leading cause of mortality and injury among older adults and majority of the falls occurs while hospitalized. One would think being in the hospital would be one of the safest places for older adults as far as fall prevention is concern due to the fact that hospitals provide staffing around the clock for patients but more and more falls have been occurring in the hospital especially in the older adult population. Fall is an unintended descent to the ground. It raises public and family care liability; it also decreases patient’s functioning because it causes pain and suffering, and increases medical costs (Saverino et al, 2015). The Center for Disease Control

Fall risk assessments tools, which help to identify those patients at risk of falling, play a vital role in reducing the number of falls. The basis for this assessment is that if patients at high fall risk can be

A fall can make wide spread consequences on the health service or can be affected seriously by the increased health care utilization. Among the fallers approximately 30% of falls result in physical injury leading to extensive hospitalization with significant hospital expenses (Tzeng & Yin 2010). Preventive care phases can support health services to regulate the spare expenditure to a greater extend. A fall in hospital consequently affects the nursing staff, which lead to impaired job satisfaction, additional work load and startling time consume. As the front line of care, nurses can prevent falls and reduce fall injury rates in acute care unit with available resources (Dykes et al. 2013). This literature review aims to assess the efficiency of planned interventions to reduce the incidence of falls in acute medical units. The discussions of the main findings of the review as well as the recommendations for further research are revealed to conclude this study.

The procedures were conducted using the format of questionnaires. The questions on the questionnaire were based on these four main areas: cause of falls, nursing staffs intervention in fall prevention, routines of documentation and report, and experiences and reactions of nursing staff related to fall incidents. The 64 questions were distributed into four different categories of people. The four different categories are registered nurse, enrolled nurses, unskilled nurses’ aid and other professions (Struksness et al., 2011, p.3 ). Out of the 64 questions, 7 were background questions. The other 57 questions were distributed among the four main areas of fall. 28