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Quality Improvement Proposal

Quality Improvement Proposal

Jordan McKaley Boney, RN

Bon Secours Memorial College of Nursing

NUR 3241: Quality and Safety in Nursing Practice

Dr. Sangha, DNP, MSN, MBA, RN

April 16, 2021

“I pledge that I uphold the Honor Code System and policies of Bon Secours Memorial College
of Nursing”
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Quality Improvement Proposal

Identify the Problem

Morris & O'Riordan (2017) report that falls among inpatients are the number one

reported safety event and result in prolonged hospitalization, harmful injury to the patient, and

increased cost for the hospital. They add that identification of high-risk factors paired with

meaningful fall precautions has been shown to reduce the rate of falls by 20-30%. With this

being said, I saw an opportunity for growth and improvement on my unit. I realized that falls

were an issue on my unit approximately one month ago when I had my first personal experience

with a patient fall. When talking to other staff on the unit after my incident, I noticed that this

was a recurrent event and the processes already in place were not as effective as needed.

I work in a 22 bed ED with a 1:6 nurse patient ratio. With this high ratio, nurses aren’t

able to spend much time with each induvial patient, so a new plan needed to be formed. On the

particular day of my event, I was very busy with my other patients, one of which was very sick

and unstable. I was pulled out of the room by another nurse to be informed that my patient,

whom I had not yet met, climbed out of the bed and fell. The triage nurse had placed the patient

in the bed with both side rails up and no call bell within reach. There was no fall band or non-slip

socks on the patient. The patient had a history of falls and even wore a helmet for frequent

seizures. You can understand that this patient was a very high fall risk. The patient was alert and

oriented and just needed to use the restroom. If the appropriate precautions were in place, this

fall may have been prevented.

Contributing factors

When I think about contributing factors to these events, I think about my personal

experience with a patient fall. The patient was over 65 years of age, had an IV, used a walker for

ambulation, and was taking multiple contributing medications. Other contributing factors include

patients who forget their own limitations, non-compliance with the current policy, and non-

compliant staff. We also need to consider the pace of the shift and nurse patient ratio. Busy

shifts, just like the day of my occurrence, play a huge role in the event and high nurse patient

ratios. Also, on this particular shift, there were no techs.

Plan and Do

My plan to fix this broken process and compliance with the policy was developed solely

on what I think could have made a difference on the day my patient fell. 1. “Mercy Health-

Anderson Hospital in Cincinnati, OH reduced its fall rate in their med/surg unit from 10 falls per

1,000 patient days to 2 falls per 1,000 patient days over three years.5 They did this by following

a Transforming Care at the Bedside (TCAB) program that targeted patient falls,” (Performance

Health, 2020). They add that some of the strategies include easy identification of high fall risk

patients, bed alarms, safety rounds, keeping patients busy, providing safety companions, and

implementation of universal fall precautions. The specific aim of the study is to reduce the

number of falls in the ED by at least 30% by obtaining a standardized fall risk assessment for

every patient upon being triaged and implementing universal fall risk precautions such as yellow

fall band, yellow socks, fall magnet, keeping the bed in low position and the call bell within

reach, performing hourly rounding sheets/checks, use bed alarms, and ensuring appropriates
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Quality Improvement Proposal

nurse to patient ratios within a 3 month time period. After finding supporting research that

reduces fall, I came up with a plan to implement an hourly safety rounding sheet that needed to

be signed each hour by any ER staff. The purpose of the rounding sheet was to check on the

patient each hour and ensure the call bell was within reach and assess needs to use the restroom.

I also plan to place yellow fall bands and non-slip sock in each room in the cabinets for easy

access. On my unit the fall risk screening questionnaire is done in the secondary triage, I plan to

work with IT to implement this in the initial triage and have socks and bands placed in the triage

room as well. Typically, it is a task to find a bed alarm and we usually have to call other units. I

would like our unit to purchase 3 bed alarms that are designated to our unit.

Timeline

Fall audits will need to be collected 3 months prior to implementing the new process. For

the months of January, February, and March 2021 there was a total of 12 patient falls within the

unit. In January there were 4 falls. In February there were 6 falls. In March there were 2 falls.

Fall audits will need to be collected throughout the study, which will last a total of three months.

After 3 months of implementing the new process, we will assess the need for any changes that

need to be made, make them and implement the changes for another 3 months. After three

months of the changed process, we will reassess.

Small Test of Change

A small test of change can be made by creating a survey on the unit. The survey will ask

the following questions.

1. (Staff) Are you easily able to access the initial fall screening in the triage section?
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Quality Improvement Proposal

2. (Staff) Do you have any suggestions on ways to get staff to comply with fall

precautions such as maker sure high risk fall patients are wearing yellow bands and

yellow socks?

3. (Patient) Did staff keep the call bell within reach and answer call bells accordingly?

The survey will also provide an opportunity for staff to discuss their thoughts, comments,

concerns, and suggestions for the new process.

Change is an Improvement

We will know that the changes have made an improvement by continuing to monitor the

number of patients falls within the unit. Once the goal of reducing the number of patients fall by

at least 30% is met, then we will know if the changes have been successful. There will also be an

open meeting allowing staff to speak about the new process to talk about what went well and

what did not. There are always opportunities for growth and improvement.

Summary

Safety, Teamwork and Collaboration, Informatics, Patient Centered Care, Evidence

Based Practice, and Quality Improvement are all implemented into this study. The purpose of the

entire study is to promote patient safety through patient centered care. The patient is the reason

for the study. We determined that most falls are due to patients attempting the use the restroom,

so we assess their needs through hourly rounding and ensuring the call bell is within reach.

Informatics comes into play when we assessed the need for a change. We determined the number

of patients falls for the previous 3 months, and we will need to continue to monitor them

throughout the study. Evidence based practice was used to determine what is working in other

hospitals. We are using some of their ideas and implementing them into our own practice to
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Quality Improvement Proposal

improve quality of care for our patients. The entire success of the study is based on teamwork

and collaboration. Without participation of all staff involved, the process to improve care for the

patient would not be possible. Staff will also need to collaborate to discusses new changes that

need to be made and implement them. With this being said, these six concepts are foundation for

a successful study to reduce patient falls on the unit by 30% .

References

Bargamnn, A., Brundrett, S. (2020). Implementation of a Multicomponent Fall Prevention

Program: Contracting With Patients for Fall Safety. Military Medicine, 185(2), 28-42.

https://doi.org/10.1093/milmed/usz411

Dykes, P., Carroll, D., Hurley, A., Lipsitz, S., Benoit, A., Chang, F., Meltzer, S., Tsurikova, R.,

Zuyov, L., Middleton, B. (2010). Fall Prevention in Acute Care Hospitals: A Randomized

Trial. JAMA, 304(17), 1912–1918. https://doi.org/10.1001/jama.2010.1567

Morris, R., & O'Riordan, S. (2017). Prevention of Falls in Hospital. Clinical Medicine (London,

England), 17(4), 360–362. https://doi.org/10.7861/clinmedicine.17-4-360

Performance Health. (2020). Fall Prevention Strategies in Hospitals.

https://www.performancehealth.com/articles/fall-prevention-strategies-in-hospitals