2.50
Hdl Handle:
http://hdl.handle.net/10755/157508
Type:
Presentation
Title:
VISUALIZING STRATEGIES FOR REDUCING FALLS THROUGH A WORK DOMAIN ANALYSIS
Abstract:
VISUALIZING STRATEGIES FOR REDUCING FALLS THROUGH A WORK DOMAIN ANALYSIS
Conference Sponsor:Western Institute of Nursing
Conference Year:2010
Author:Gephart, Sheila, RN, BS
P.I. Institution Name:The University of Arizona
Title:Doctoral Student
Contact Address:1305 N. Martin, Tucson, AZ, 85721-0203, USA
Co-Authors:Judith Effken
PURPOSES/AIMS: In this presentation we report the RESULTS: of the Work Domain Analysis (WDA), through which we identified hospital and unit safety goals and the work processes, strategies, information, and technology nurse managers use to prevent falls.
RATIONALE/CONCEPTUAL BASIS/BACKGROUND: Falls are the fifth leading cause of death for people over 75 and the second leading cause of mortality. The Joint Commission's National Patient Safety Goal to reduce risk of harm from falls has reinforced the need for hospitals to prioritize fall prevention on their units. We conducted a Cognitive Work Analysis (CWA) to clarify how nurse managers are attempting to reduce falls on their units. The CWA included an analysis of the nurse manager's work domain, decision-making procedures, decision making strategies, social organization/ collaboration, and worker skill level.
METHODS: Taped, structured interviews of ten Nurse Managers (NMs) in three Arizona hospitals were conducted. Managers were asked about hospital and unit safety goals and how they resolved a quality issue on their unit. The interviews were transcribed and analyzed using qualitative data analysis. Priorities, constraints, work functions, object-related processes and physical objects were mapped onto a grid in which the vertical dimension included purpose and environmental constraint, function, priority, process, and object; and the horizontal dimension included hospital, division, and unit. Analyses were checked for consistency by two reviewers, and then transcribed to a computerized graphical display. The RESULTS: were analyzed for similarities and differences across units and hospitals.
RESULTS: Specific safety goals differed across units, even in the same hospital, although all units focused on fall prevention to some degree. Some hospitals had adopted a goal of zero falls, which most viewed as unrealistic. NMs used a variety of strategies, technology and information tracking to reduce falls, although both within and across hospitals these lacked consistency. Hourly rounding by staff was common, but with inconsistent compliance. Some NMs modified staff hours for better change-of-shift coverage. Some hospitals gave awards to the unit with the fewest falls. Others conducted daily unit meetings to remind staff of today's safety focus or reminder. NMs described the use of brightly colored bracelets or slippers, motion detectors, door magnets, bed alarms, and the use of sitters or family to watch patients at risk, and the limitations of each. NMs tracked falls using multiple software programs, web-based quality data, computerized variance reports, and in-depth investigations of the adverse event.
IMPLICATIONS: NMs in these three hospitals have adopted many of the same fall prevention strategies, but with limited evidence and mixed results. Decision support tools that could enable them to test initiatives prior to implementation and predict the likelihood of success on their units could be extremely helpful.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleVISUALIZING STRATEGIES FOR REDUCING FALLS THROUGH A WORK DOMAIN ANALYSISen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157508-
dc.description.abstract<table><tr><td colspan="2" class="item-title">VISUALIZING STRATEGIES FOR REDUCING FALLS THROUGH A WORK DOMAIN ANALYSIS</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Gephart, Sheila, RN, BS</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">The University of Arizona</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Doctoral Student</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">1305 N. Martin, Tucson, AZ, 85721-0203, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">sgephart@nursing.arizona.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Judith Effken</td></tr><tr><td colspan="2" class="item-abstract">PURPOSES/AIMS: In this presentation we report the RESULTS: of the Work Domain Analysis (WDA), through which we identified hospital and unit safety goals and the work processes, strategies, information, and technology nurse managers use to prevent falls.<br/>RATIONALE/CONCEPTUAL BASIS/BACKGROUND: Falls are the fifth leading cause of death for people over 75 and the second leading cause of mortality. The Joint Commission's National Patient Safety Goal to reduce risk of harm from falls has reinforced the need for hospitals to prioritize fall prevention on their units. We conducted a Cognitive Work Analysis (CWA) to clarify how nurse managers are attempting to reduce falls on their units. The CWA included an analysis of the nurse manager's work domain, decision-making procedures, decision making strategies, social organization/ collaboration, and worker skill level. <br/>METHODS: Taped, structured interviews of ten Nurse Managers (NMs) in three Arizona hospitals were conducted. Managers were asked about hospital and unit safety goals and how they resolved a quality issue on their unit. The interviews were transcribed and analyzed using qualitative data analysis. Priorities, constraints, work functions, object-related processes and physical objects were mapped onto a grid in which the vertical dimension included purpose and environmental constraint, function, priority, process, and object; and the horizontal dimension included hospital, division, and unit. Analyses were checked for consistency by two reviewers, and then transcribed to a computerized graphical display. The RESULTS: were analyzed for similarities and differences across units and hospitals. <br/>RESULTS: Specific safety goals differed across units, even in the same hospital, although all units focused on fall prevention to some degree. Some hospitals had adopted a goal of zero falls, which most viewed as unrealistic. NMs used a variety of strategies, technology and information tracking to reduce falls, although both within and across hospitals these lacked consistency. Hourly rounding by staff was common, but with inconsistent compliance. Some NMs modified staff hours for better change-of-shift coverage. Some hospitals gave awards to the unit with the fewest falls. Others conducted daily unit meetings to remind staff of today's safety focus or reminder. NMs described the use of brightly colored bracelets or slippers, motion detectors, door magnets, bed alarms, and the use of sitters or family to watch patients at risk, and the limitations of each. NMs tracked falls using multiple software programs, web-based quality data, computerized variance reports, and in-depth investigations of the adverse event. <br/>IMPLICATIONS: NMs in these three hospitals have adopted many of the same fall prevention strategies, but with limited evidence and mixed results. Decision support tools that could enable them to test initiatives prior to implementation and predict the likelihood of success on their units could be extremely helpful.</td></tr></table>en_GB
dc.date.available2011-10-26T19:56:12Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T19:56:12Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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