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Virginia Henderson International Nursing e-Repository > Registry of Nursing Research Conference Abstracts > AACN - American Association of Critical Care Nurses > Jack's Crown and Jill's Hip: A Falls Algorithm to Optimize Best Practices and Resources

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Category: Abstract
Type: Presentation
Title: Jack's Crown and Jill's Hip: A Falls Algorithm to Optimize Best Practices and Resources
Author(s): Smith, Diane
Arnett, Mary
Zimmer, Michele
Author Details: Diane Smith, University of Maryland Medical Center, Baltimore, Maryland, USA, email:; Mary Arnett; Michele Zimmer
Abstract: PURPOSE: The purpose was to develop an algorithm that complements the Morse Fall Risk Assessment and interventions. Patients most at-risk for falling are weak or have an impaired gait and overestimate or forget their limitations. An algorithm provides a guide to: 1) identify the highest risk patients within the High and Critical fall risk groups, 2) select best practices, 3) select interventions to minimize the $130,000 cost of dedicated observers (sitters), and 4) reduce the unfilled sitter orders. Description: Nurses use an electronic Morse assessment tool to level patients into standard, high, or critical fall risk. Interventions are selected per risk level. On some units, nurses are faced with almost all patients scored as high or critical risk. The dilemma is how to prioritize resources. The tendency is to order a sitter from the limited sitter pool. The lack of sitters and patient protection, while minimizing restraints and preventing falls, can be a source of stress and frustration for staff. The prescriber may be reluctant to discontinue a sitter order. Nurses identified a need for guidance in selecting alternative resources such as a lap belt fastened in front, removal lap trays, chair alarms and low beds. An algorithm was developed by staff nurses which 1) quickly identifies patients with both physical and mental vulnerability, 2) maximizes restraint alternatives, 3) engages the family to partner in care, and 4) promotes selection of the best alternative resource before requesting a sitter from the limited pool. EVALUATION: The algorithm helps nurses identify and protect weak or unsteady patients who overestimate their abilities but who may be cognitively intact. It helps to maximize interventions beyond the locked bed, sitters, and restraints. It helps decrease variability of care within and across units. Despite the tool's limited pilot, the overall hospital falls rate is below benchmark - 2.18 (hospital) versus 3.40 (Maryland Hospital Association) and 3.71 (NDNQI). Preliminary impact measures point to nurse satisfaction and reduced fall rates and injuries from falls. It is expected that the use of the algorithm will also decrease sitter costs.
Repository Posting Date: 26-Oct-2011
Date of Publication: 26-Oct-2011
Citation: 2009 National Teaching Institute Research Abstracts. American Journal of Critical Care, 18(3), e1-e17.
Conference Date: 2009
Conference Name: National Teaching Institute and Critical Care Exposition
Conference Host: American Association of Critical-Care Nurses
Conference Location: New Orleans, Louisiana, USA
Note: This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.
Appears in Collections: AACN - American Association of Critical Care Nurses

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