Developing An Evidence-Based Interdisciplinary Fall Reduction Program

Developing an Evidence-Based Interdisciplinary Fall Reduction Program

Final Evaluation of Practicum Experience

Jennifer Smith

NUR 590B

July 8, 2012 2

Developing an Evidence-Based Interdisciplinary Fall Reduction Program

The purpose of this paper is to evaluate the overall learning of the practicum experience of planning, implementing, and evaluating an interdisciplinary fall program. This project enhanced my professional career by allowing me to function in the role of nurse leader. Through the process, I gained an understanding of the role and responsibilities of the Chief Nursing Officer

(CNO), learned collaboration and team building skills, and build relationships with both formal and informal leaders.

The fall reduction program was designed to support the hospital’s commitment to providing a safe environment for their patients by reducing preventing falls and reducing fall related injuries.

I learned the value of designing nursing division goals to support the hospital’s mission vision and values. The nursing division’s mission supports the organization’s vision to provide high quality, compassionate care supporting the patient’s mind, body, and spirit through human to human caring. Nursing care is patient-centered based on Jean Watson’s Caring Theory. The nursing staff collaborates with other health team members to meet the psychosocial, physical, and spiritual needs of the patient and their families. Important concepts such as shared governance, evidence-based practice, Lewin’s Change Theory, and Jean Watson’s Theory of

Human Caring were used to develop the fall reduction policy. The development of this project allowed me to have better understanding of these important concepts and their application to nursing practice. The application of theory to practice is a central theme that I learned through the University of Phoenix curriculum.

Falls that occur in the hospital setting are a risk management problem that decreases patient satisfaction and the perception of the quality of care. A fall may increase the patient’s length of stay, cost of hospitalization, and utilization of resources (Fonda, Cook, Sandler, Bailey, 2006). 3

Emerging reimbursement methods such as pay for performance penalizes for negative consequences such as fall-related injuries during hospitalization. This project gave me a better understanding of the effects of a fall on the organization, patient, and their families.

The fall reduction project was consistent with evidence-based practice; literature review indicates that fall reduction programs are more effective when they involve interdisciplinary teams and consider multifactorial reasons for patient falls. The project created a feasible low cost solution to increase surveillance, optimize the environment, and improve the management of patients at-risk for falls. The program consisted of the development of a fall reduction policy, revision of fall-assessment tools, education of staff, and evaluation of outcomes.

Effectiveness of the Project

The effectiveness of the fall reduction program data will be measured by monitoring data on fall incidence, severity of injury, percentage of repeat fallers, and number of days between major injuries. Fall rates will be analyzed for overall facility using the following formula (number of patient falls/number of patient bed days) x 1000. This method adjusts for fluctuation in census and is the recommended method by the American Nurses Association (ANA). The disadvantage to this method is that it calculates all falls including the number of repeat fallers. The number of repeat falls will be measured to determine what percent of the falls are second, third, fourth, or more falls. The injury rate will be measured by using the following formula (number of injuries/number of falls) x 100. This method is recommended by the Department of Veteran

Affairs, calculating the injury rate per 100 falls produces a meaningful rate. The number of days between major injuries will indicate the program’s overall success if the length of time between major injuries increases (Quigley, Neily, Watson, Wright, & Strobel, 2007). Data will be further analyzed by unit to determine opportunities for improvement. I learned the importance of 4 evaluating and measuring the outcomes of an organizational quality improvement project. I reviewed evidence-based practices for analyzing fall reduction programs and developed a tool to assist with the collection of the required data.

The effectiveness of the education program was evaluated by staff completing a post-test. The staff completed the post-test scoring at least 95% or better. Fifty charts were analyzed after implementation to assess for the correct use of the Morse Fall Scale Risk Assessment, appropriate care plans completed, documentation of patient/family education, and use of appropriate interventions such as wrist band/non-skid socks. There were two charts that fell out on reassessment after change in patient condition. The development of the educational program and post-test allowed me to function in the role of nurse educator.

Evaluation of Data Collection

For implementation and evaluation the fall team will use the Plan-Do-Study-Act (PDSA).

The PDSA cycle allows the group to assess the outcomes of interventions and formulate changes based on data. Joint Commission standards require an organization to have a fall risk reduction program and continually monitor its effectiveness (JCAHO, 2006). The fall team will continue to monitor the effectiveness of the fall reduction policy. Results for the first month after implementation indicate a reduction in falls and fall related injuries. The average rate of monthly falls prior to implementation were 20 and one month after the program there were 11 falls resulting in no injury or minor injury. I learned about the Quality Improvement Cycle PDSA and developed a guideline to determine if the project was successful or not. The team will use the

PDSA cycle to continually evaluate the fall reduction program. 5

Evidence-Based Practice

Evidence-based practice was used to develop this project, a total of 25 peer reviewed articles were researched on fall reduction programs, fall-risk assessment tools, and the importance of interdisciplinary collaboration. The Morse Fall Scale was chosen to assess adult patients and

The Humpty Dumpty Scale for pediatric patients. These fall risk assessment scales have been proven to be effective at identifying patients at risk for falls. The literature review allowed me to support the change in policy and practice to staff members and administration.

The Rosswurm & Larrabee model will be used to guide nurses through the change in practice and behaviors. According to Pipe (2007), this model is an implementation strategy that has been proven to assist organizations with the successful application of introducing evidence-based practice. The model has six steps to assist with the promotion of change: (1) assess the need for change, (2) link the problem with interventions, (3) synthesize best evidence, (4) design practice change, (5) implement and evaluate the change in practice, (6) integrate and maintain the change in practice.

Leadership and Advocacy Skills

This project allowed me to function in the role of nurse leader and advocate for a patient safety program that supported the hospital’s mission, vision, and values. I had to prove to administration the cost-benefit factor of implementing the program. It gave me a better understanding of the budget process and how to effectively present the data from my literature review to support the change in practice.

Lewin’s Change Theory was chosen to assist with the development of the implementation plan. Kurt Lewin developed a three-step model to assist with organizational change which includes the following steps: unfreezing, movement, and refreezing (Kristsonis, 2004). The first 6 step of the process, unfreezing consisted of analyzing the current fall policy and making the employees realize that change needed to occur to align our fall policy with best practices. The second step is movement, which involved persuading employees to agree that the current policy is not meeting best practice standards and involving them in the process by brainstorming and providing feedback during the development of the policy. The third step, refreezing is necessary to sustain changes so the employees do not revert back to old behaviors and practices. This step will be particularly important for the project to maintain the effectiveness of the fall reduction program.

Conclusion

The practicum project allowed me to gain experience in teamwork, communication, and conflict resolution. It took both commitment and collaboration between administration, interdisciplinary leaders, and staff members to create an evidence-based fall reduction program.

The fall reduction program met my learning need objectives and supported the organization’s strategic plan to become the preferred provider in the community. I would like to continue to monitor the effectiveness of the program and if the project is successful and the data considered reliable an article for publication may be written related to the process of developing a collaborative interdisciplinary fall reduction program. 7

References

Fonda, D., Cook, J., Sandler, V., Bailey, M. (2006). Sustained reduction in serious fall related

injuries in older people in the hospital. The Medical Journal of Australia, 184(8), 379-382.

Joint Commission on Accreditation of Healthcare Organization (2006). Top five sentinel

events by setting of care. January 2001 to July 2005.

Kristsonis, A. (2004). Comparison of change theories. International Journal of Scholarly

Academic Intellectual Diversity. 8(1).

Pipe, T. (2006, August). Optimizing nursing care by interpreting by integrating theory-driven

Evidence based practice. Journal Nursing Quality Care, 22(3), 234-238.

Quigley, P., Neily, J., Watson, M., Wright., Strobel, K. (February 28, 2007). Measuring fall

Program outcomes. Online Journal of Nursing. 12(2). doi: 10.3912.OJIN.Vol12No02PPT01.