IMPROVING A FALL PREVENTION PROGRAM 1

Capstone Project Change Proposal

Roshanda Dixon

Grand Canyon University: NRS-490

August 13, 2018

IMPROVING A FALL PREVENTION PROGRAM 2

Improving a Fall Prevention Program in a Clinical Environment

Falls are very important and preventing these falls are the most important goal and plan

for every patient’s safety that encounters healthcare settings. There are many ways in preventing

falls such as new trainings, new bed alarm tones and even hourly rounding. Daily improving to

bedside reporting is another suggestion this field of study. Failing to increase measures in

implementing change can lead to death and or longer hospitalization stays. Detecting problems

early and adjusting to change will help with improvement of falls. Patients will build confidence

and a trusting relationship that will help secure a solid foundation for the healthcare setting.

Background

University of Louisville Hospital is a Level Trauma 1 Center in the state and nearby

surrounding states. Admissions records over 3,000 patients a year and half of them are from

outside of the county. Decreasing patients falls is the most important. In order to promote this

proposition we need to set up teams that are willing to work together and communicate.

University of Louisville hospital has had a total of 45 falls this year from January thru May.

According to research, falls have been around for over 50 plus years. Incident reports are

avoided when these happen the best thing is adverse events. Healthcare facilities need to make

sure they understand the interventions and not focus on the quantity of falls which is very

important. Inpatient fall rates range from 1.7 to 25 falls per 1,000 patient days, depending on the

care area, with geropsychiatric patients having the highest risk (NCBI, 2007). Falls inpatient has

increased in some facilities. The facility that I am employed at fall cases have decreased through
IMPROVING A FALL PREVENTION PROGRAM 3

interventions and hourly rounding. Falls may never be fixed but we can all work together to

decrease the chances and give the proper teachings.

Problem Statement

According to research falls have been around for over 50 plus years. Incident reports are

avoided when these happen the best thing is adverse events. Falls in hospital are associated with

excess financial and opportunity costs (Oxford Academic, 2008). The majority of falls in

healthcare facilities are patients over 70 years of age and the youth between 18-39 years of age.

Falls inpatient has increased in some facilities and this is why interventions are needed. Falls can

be very costly towards everyone’s pockets and also their health. Prolonged hospital and even

injuries such as fractures and death can occur if proper precautions are not in place. Liabilities

can also occur which can cost the hospital more funds than actually receiving to improve better

care. Consequently, various hospitals falls, prevention programs have been implemented in the

last decades (BMC Health Services Research, 2006). Fall cases have decrease over time at the

facility that I am employed at and this was all through hourly rounding and building a rapport

with you patients. We as a team can always help fix the issues at hand, falls may never be

completely solved but they can be decreased through teamwork and dedication. Falls may never

be fixed but we can all work together to decrease the chances and survival rates through proper

teachings and statistical facts.

Change Proposal

In order to promote safety and prevent falls within all healthcare facilities the plan of care

that promotes, reassurance, full assessment and communication. The purpose to change fall
IMPROVING A FALL PREVENTION PROGRAM 4

prevention strategies in our facility is to decrease falls and provide advance care through

evidence based research. The proper education and research will introduce more expected

outcomes. There will be some challenges and barriers that may interfere with this intervention.

There will be multiple ways that this research will be used in order to be successful.

Encouraging engagement and participation will affect the quality improvement process such as

implementing small scale demonstrations which are less difficult to manage. Small-scale

demonstrations or small tests of change also allow you to refine the new processes, demonstrate

their impact on practices and outcomes, and build increased support by stakeholders (AHRQ,

2017). It is important to understand that many changes will be made along the way and learning

from these experiences will help with adding change to any obstacles that take place.

PICOT

PICOT is used to help people clarify answers for any problems they may encounter. This

will be used in research and evidence based practices that can be used and implemented on a

daily basis. The P in PICOT stands for the population or specific cohort that is included in the

study. The I in PICOT stand for the interventions that are used for in treatments during this

study. The C in PICOT stands for the comparison in the study of research. The O in PICOT

stands for the objectives in the research study. The T stands for the time frame which is not

always included in the study.

The inpatient population such as the sick and elderly (P) for the study of prevention in

falls in an inpatient setting. The intervention (I) for this study and intervention of falls is the

revision of the post debriefing forms and training for bedside report along with hourly rounding.

The comparison (C) in this study is to reduce the risk for falls such as hourly rounding and
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improved training for staff. The outcome (O) for this study is to reduce falls in an inpatient

facility. The time frame (T) in this study would be decreasing of falls over a three to six month

period.

Literature Search

Falls can be related to intrinsic and extrinsic factors. Intrinsic factors are disorders,

mental problems anything that is preventable through health. Extrinsic factors are made up of

environmental things such as spills, rugs, and cluttered areas. All falls are important and it’s even

more important to understand the causes. Morse falls scale is very important and our hospital

uses this scale for every patient that is admitted to the hospital. Medical errors are another way

falls can occur. Nurses or even ancillary staff may forget to give a patient a call light and patient

may have to use the restroom and attempt to get up and fall. Making sure that the patient has

worked with physical therapy and communication has been documented and transcribed

accurately. Identifying those at risk allows targeted assessment and intervention such as a review

of medications and environmental modifications (BMC Medicine, 2004).

Falls can be very costly towards everyone’s pockets and also their health. Prolonged

hospital and even injuries such as fractures and death can occur if proper precautions are not in

place. Liabilities can also occur which can cost the hospital more funds than actually receiving to

improve better care. Consequently, various hospitals falls, prevention programs have been

implemented in the last decades (BMC Health Services Research, 2006). Coming up with

reasoning to why a person fall is the leading answer to the problem. Every patient is different

and their reasons are going to be different as well so making sure that the proper assessment is

given then falls should be prevented.

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Literature Evaluation

Information that was collected from journals and articles to help promote fall preventions

in an inpatient facility has been very beneficial. There are so many issues that can relate to falls

such as bad lightening, shoes are not flat, irregular eye exams and even clothing that’s not fitting

appropriately can help with falls. Understanding the causes of falls is very important and factual.

The older population tends to have a higher risk for falls then that of the youth population. Falls

also occur often among older people in hospital and the sickly ill patients. Our hospital uses the

Morse Falls scale to assess every patient that is admitted into our doors which is part of a detail

assessment of the patient. Medical errors are another way falls can occur which is caused by

either shortage of nurses, work overload or even lack of education. Nurses or even ancillary staff

may have times where they may not give the patient a call light and then the patient may attempt

to get up and fall which can lead to death or even broken bones. It’s also relevant that patients

have worked with ancillary staff such as physical therapy and other therapies that play a role in

activities of daily living. Communication is very important and vital information that has to be

documented and transcribed accurately; if not, then many errors can occur. There are many

suggestions such as bed alarming sounds changing and a new call light sound becoming more

distinct giving that familiar sound to focus on the patient. Orienting the patient through

assessments every 2-4 hours throughout shift depending on level of consciousness will help with

fall preventions. Fall rates will decrease in our inpatient medical surgical and progressive care

units. Focusing on post fall forms will help after the revision take place and orienting all staff

new and old will help with the these goals of safety and reliability. Coming up with reasoning to

why a person fall is the leading answer to the problem. Every patient is different and their
IMPROVING A FALL PREVENTION PROGRAM 7

reasons are going to be different as well so making sure that the proper assessment is given then

falls should be prevented.

Patient engagement is another suggestion if it’s going to prevent falls in the future.

Introducing safety huddles have been suggested to reduce fall in hospitals which helps with

communication and knowing each patient. Intentional rounding will help with patients that are at

higher risk of falling. Falls inpatient has increased in some facilities. The facility that I am

employed at fall cases have decreased through interventions and hourly rounding. Falls may

never be fixed but we can all work together to decrease the chances and give the proper

teachings. Falls seem to be one of the most major problems in older adults. In the United States

one in three people aged 65 or more living in the community fall at least once a year (BMJ,

2006). Research and clinical programs in hospital fall prevention should pay more attention to

study design and the nature of interventions (Wiley Online Library, 2015). Research will be very

beneficial to the hospital and the elderly population. Collecting all information on the patient will

help with eliminating falls.

Nursing Theory

Nursing theories are very important when implementing evidence base practices. There

will be two change theories that will be factored in this healthcare setting. Model and role model

theory has it’s concept from Piaget’s Theory of Cognitive Development. Erickson's theory helps

nurses care for their patients by recognizing each individual’s uniqueness, and focusing on the

individual patient's needs (Nursing Theory, 2016). It is also a self-care method of nursing,

which means it is based on the patient's perceptions of the environment, and adapts based on
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individual stressors for that patient (Nursing Theory, 2016). Understanding the patient in order to

maintain safety measures will help reach goals and also allow the patient to feel secure.

Next theory that can help with the improvement of this research will be the novice to

expert theory. Patricia Benner developed a concept known as "From Novice to Expert." This

concept explains that nurses develop skills and an understanding of patient care over time from a

combination of a strong educational foundation and personal experiences (Nursing Theory,

2016). She was based off of clinical experience through learning the patient over time. This

Theory had five levels novice, advance beginners, competent, proficient, and expert. Different

levels of skills will show the changes that need to take place in the healthcare facilities (Nursing

Theory, 2016). Both theories are both beneficial in learning the patient’s cognitive skills and

also building a confidence in each individual allowing them to heal and be safe. Changes are

instilled in both theories and depending on the changes in the future.

Implementation

Medicines have side effects understanding these effects and communicating with your

doctor along with the nurse the feelings that you are experiencing will help prevent any cases of

falls. Nurse need to make sure that the call light is in reach and they give the proper teaching of

what medicine they are giving their patient along with an understanding. Routine rounding is

very important in the hospital which can be shared amongst the nurse and nursing assistant.

Blood pressure medications are one of the most serious falls because of the dizziness that it can

cause. Making sure the patient has proper footwear can also prevent falls, non skid socks and

even slippers will help. Making sure the patient has a bed alarm under the patients and patients

are aware of the call light being in reach.

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Collecting all information on the patient will help with eliminating falls. We as nurses

need to make sure that patients with the need for assistance devices need to be close to the nurse

station and teachings on falls every hour when rounding. Patient that are on many prescriptions

need to understand that side effects can really cause falls and that’s not good. Bring the entire

team together and communicate will help with fall preventions. Making sure that a checklist is in

place will help with less falls and more awareness. The Morse falls scale will help with

understanding the risk of falls per patient. Making sure you understand the goal and also include

everyone in the plan with an open mind will help with the benefits of the research project.

Educational presentations would be presented to the healthcare and ancillary staff. This would be

to help staff get a clearer perspective and also more education on fall preventions. A revision of

the post fall briefing form adding more detail information will be applied to help with teamwork.

Potential Barriers

Changes brought to the surface will be one of the most difficult challenges on the units at

work. This will have a big impact on the implementation strategies. Lacking structural

guidelines and trainings can prevent falls from decreasing. Communication lacking between

therapist and staff on each individualized patient can also prevent a change from occurring.

Considering time is another barrier that can occur with falls and patient’s timing, how often

they’re getting up and the time they’re falling. Physicians will not look at this situation as

important as diagnosis which is another barrier that can prevent changes to occur. Interference of

parents and visitors can also be a hindrance of growth within the plan of care of the patient.

Some older people considered using assistive devices, such as walking frames, as a stigma,

because they believe that using such aids is a sign of weakness and reflects a change in one's self
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image (BMJ Open, 2015). One HCP perceived that older people normalized falls and consider

them to be part of the normal ageing process. He felt that older people disregarded falls because

they believed they were inevitable in old age (BMJ Open, 2015). Living situations outside of the

facility is another barrier that can occur which the design of the house and the inadequate space

for assistive devices. Admitting weaknesses and balance issues is another difficult task to get

through, patients tend to be in denial of any issues they may be having. We as nurses and

healthcare staff need to make sure that we have the knowledge and skills in managing falls in

order to deliver a safe environment.

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References

O., D., P., A., G., L., . . . G. (2008, October 01). Systematic review and meta-analysis of studies

using the STRATIFY tool for prediction of falls in hospital patients: How well does it work? |

Age and Ageing | Oxford Academic. Retrieved from

https://academic.oup.com/ageing/article/37/6/621/40889

Section 4: Ways to Approach the Quality Improvement Process. (2015, November 16).

Retrieved from https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/4-

approach-qi-process/index.html

Bühler, H., Geest, S. D., & Milisen, K. (2006, June 07). Falls and consequent injuries in

hospitalized patients: Effects of an interdisciplinary falls prevention program. Retrieved from

https://bmchealthservres.biomedcentral.com/articles/10.1186/1472-6963-6-69

Papaioannou, A., Parkinson, W., Cook, R., Ferko, N., Coker, E., & Adachi, J. D. (2004, January

21). Prediction of falls using a risk assessment tool in the acute care setting. Retrieved from

https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-2-1

Oliver, D. (2007, January 11). Strategies to prevent falls and fractures in hospitals and care

homes and effect of cognitive impairment: Systematic review and meta-analyses. Retrieved from

https://www.bmj.com/content/334/7584/82
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Oliver, D., Hopper, A., & Seed, P. (2015, April 27). Do Hospital Fall Prevention Programs

Work? A Systematic Review. Retrieved from

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1532-5415.2000.tb03883.x

“Patricia Benner Novice to Expert - Nursing Theorist.” Biographies of Nursing Theorists

and Their Work - Nursing Theory, 2016, nursing-theory.org/nursing-theorists/Patricia-

Benner.php.

“Helen Erickson - Nursing Theorist.” Environmental Theory - Nursing Theory, 2016,

www.nursing-theory.org/nursing-theorists/Helen-C-Erickson.php.

Loganathan, Annaletchumy, et al. “Barriers Faced by Healthcare Professionals When

Managing Falls in Older People in Kuala Lumpur, Malaysia: a Qualitative Study.” BMJ

Open, British Medical Journal Publishing Group, 1 Nov. 2015,

bmjopen.bmj.com/content/5/11/e008460.
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Appendix A

Falls Assessment Evaluation Tool

The Falls Risk Assessment Tool is a brief assessment tool used to detect the falls risk of the
patient. This assessment tool is used for all patients during assessments.

Falls Risk Score Points

Age 25 or less 25-60 60 and older

(1 point) (2 points) (3 points)

Medications 1 high risk 2 or more high Sedatives (3 Points)

(1 Point) risk (2 Points)

Mobility No Assistance Minimal Assistant Devices

(0 Point ) Assistance (3 points)

( 2 Points)

Fall History No falls (0 Point) 6 months or Last 3months

more (1 point) (3 Points)

Urine and Independent Urgency or Incontinence

Bowel Frequent (3 Points)

(1 Point)
Elimination
Scoring 0-2 Total Points 3-8 Total 9-15 Total Points

is Low Risk Points is is High Risk

Moderate Risk
Total Points
(Falls Risk Assessment for Adult Patients, 2018)

High Risk - History of falls in the last 3 months

Medium Risk- History of falls in 6 month to 1 year
Low Risk –No history of falls