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Running head: REDUCING FALLS IN HEALTHCARE SETTINGS 1

Reducing Falls in Healthcare Settings

Katharine Koop

Synthesis of Nursing Practice

Bon Secours Memorial College of Nursing

March 19,2018

“I Pledge”
REDUCING FALLS IN HEALTHCARE SETTINGS 2

Reducing Falls in Healthcare Settings

Introduction

This quality improvement project has been performed to help with the reduction of falls

among the elderly in order to prevent injury and improve patient outcomes in a healthcare

setting. There have been numerous research studies that show falls in the elderly can cause injury

to the individual and some of the injuries can lead to poor patient outcomes including death. As a

skilled nursing facility manager, a staff nurse in long term care and the hospital setting there has

been experience gained related to falls with injury and poor patient outcomes among the elderly.

Education and employee engagement regarding hourly rounding, standard fall precautions and

the use of individualized falls precautions will be addressed in this project in order to provide

improvements on the number of fall rates.

According to The Center for Disease Control (CDC) more than one third of adults 65 and

older fall each year.

The CDC found the following:

Each year, millions of people 65 and older are treated in emergency departments

because of falls.

Over 800,000 patients a year are hospitalized because of a fall injury, most often

because of a broken hip or head injury.

Fall injuries are among the 20 most expensive medical conditions.

The average hospital cost for a fall injury is over $30,000.

The costs of treating fall injuries go up with age. (p. 1)


REDUCING FALLS IN HEALTHCARE SETTINGS 3

Problem

There are currently an increased number of falls at 10-15 falls per month related to

resident’s condition and lack of staff engagement. This increased number of falls produces an

increased number of injuries related to falls. This plan to engage staff and educate them

regarding the importance of increased rounding to reduce the number of falls is imperative to

improve resident outcomes. We aim to reduce the number of falls by 50% from February 1, 2018

by March 27, 2018 for patients at Maryview Nursing Center.

Causes of increased falls have been an ongoing challenge as the nurse to patient ratio

proves to continue to provide insufficient staff for hourly rounding. The trickle-down effect of

insufficient staff causes lack of compliance with standard fall precautions. It has been noted that

fall ID bands and fall risk alert signs were not used consistently.

Implementation

The leadership team provided staff education. Fall incidence was monitored and

documented daily on a monthly chart with the time of fall, whether or not the fall was witnessed,

the reason for the fall and the area of where the fall occurred. Residents with high risk for fall

have been monitored closely and leaders collaborated to create individualized fall prevention

plans. Mandatory continuing education was provided to staff and continued feedback has been

encouraged for ideas to further improve the reduction of the incidence of falls. Collaboration of

the healthcare team to improve staff awareness and engagement to encourage more frequent

rounding has been provided and will be ongoing. Residents have been encouraged to engage in

activities and family members have also be encouraged to participate when available. Staff was

encouraged to ensure fall ID bands and falls risk signs were placed at time of admission.
REDUCING FALLS IN HEALTHCARE SETTINGS 4

The use of colored hourly rounding sheets was provided in February with the intention

that nursing staff would initial every hour to ensure hourly rounding was provided. The

implementation of the above stated hourly rounding sheets was unsuccessful as staff feedback

proved to be unhappy with “extra documentation.” The hourly rounding on the electronic medical

records (EMR) tool was further encouraged and weekly chart audits was implemented.

Outcomes

Chart audits proved to show an increase in compliance of hourly rounding

documentation by 100% in March 2018. Outcomes of reduction of falls were tracked and will

continue to be utilized by using a collection of data from daily and monthly fall charts. The

outcome of reduced falls has been discussed by the leadership team daily and necessary changes

will continue to be produced in the plan as needed. Data tracking has supplied evidence of

improvements. Outcome measure tables have been provided to ensure safety measures are

successful. The number of falls was reduced by 50% by March 27, 2018 as evidenced by data

collected during the quality improvement plan.

Managers accepted the use of monthly fall assessment tracking and a board was created

to track patients who were at high risk for falls.

Barriers

Barriers included limited staff, increased residents of the geriatric population with

dementia and other comorbidities, medications that cause drowsiness and lack of staff

participation with changes. Limited staff has been a real challenge throughout the quality

improvement process and contributes to problems with staff engagement.


REDUCING FALLS IN HEALTHCARE SETTINGS 5

References

Centers for Disease Control and Prevention, National Center for Injury Prevention and Control

Web-based Injury Statistics Query and Reporting System. Accessed March 27, 2018.

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