2.50
Hdl Handle:
http://hdl.handle.net/10755/622186
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Prevalence and Trends of Falls on a Surgical Unit
Other Titles:
Preventing Falls Using Evidence-Based Practice
Author(s):
Byrnes, Tru
Lead Author STTI Affiliation:
Gamma Iota
Author Details:
Tru Brynes, MSN, RN, CNL, CMSRN, Professional Experience: 1999-2013 Staff nurse on Medical Surgical Unit, 5T Medical Surgical, Carolinas Medical Center-Charlotte NC 2013- August 2014 Patient Care Leader, Charlotte, NC Responsible for care coordination, implement evidence based practice at the bedise to improve patient outcomes and decrease admission rate. August 2014-Present, Clinical Nurse Leader Patient Care, Charlotte NC Responsible for a cohort of patietns with a focus on evidence based practice, safety, quality, risk reduction, and cost containment. July 2015-Podium Presenter at STTI 26th International Nursing Research Congress, Puerto Rico Jan 23 2015-- Podium Presentor at Clinical Nurse Leader Research Symposium Dec 2014 - Podium Presentor at Queens University Of Charlotte Sept 2015- Poster Presenter at the Academy of Medical Surgical Nurse 24th Annual Convention, Las Vegas, Nevada Jan-2014- Poster Presenter at the Clinical Nurse Leader Summit. Sep 2013-Poster Presenter at the Academy Medical Surgical Nurses. July 2013 WOW card winner. 2012-KEPT aware Winner Author Summary: Tru Byrnes received Master of Nursing in Clinical Nurse Leader at Queen University of Charlotte. She has been working at Carolinas Medical Center for 8 years. As a Clinical Nurse Leader, she provides clinical leadership directly at the point of care to ensure safe, evidence-based, high-quality care delivery that produces optimal patient outcomes.
Abstract:

Background

Falls are the most common adverse events in hospitalized patients contributing to pain, suffering, morbidity, and mortality (Aydin, Donaldson, Aronow, Fridman, Brown, 2015). Falls increases healthcare costs, with each fall ranging from $14,000 to $ 35,000. The rate of falls in United States (US) hospitals is approximately 3.1 to 11. 5 per 1,000 patient days, varying by unit type. Neurosurgery, neurology, and medical units have the highest fall rates (Bouldin et al., 2014). Many falls risk factors identified include intrinsic, extrinsic, and environmental factors (Urquhart Wilber, 2013). Henceforth, fall prevention strategies should include a multimodal action plan to promote patient safety (Williams, Szekendi, Thomas, 2014). 5 Tower’s fall performance ranges from 1.28 to 3.54 per 1,000 patient days from 2014 to 2016. In 2016, the patient fall rate has consistently underperformed compared to the national benchmark.

Purpose

The purpose of this quality improvement project was to examine the trend of patient falls on a post-surgical unit at an 11,000-bed hospital in the US to develop interventions based on the findings to prevent falls. The purpose of this project is follows:

  • Assess and analyze the staffing pattern when patients fell
  • Determine the times and days patient falls are more likely to occur
  • Examine common risk factors related to patient falls

Description of method

Seventy post-fall records were reviewed from 2014-2016 utilizing the electronic medical record (EMR). The post-fall records indicated time, date, unit census, medications, injury, and number of registered nurses (RNs) and certified nursing assistants (CNAs)/ health care tech (HCTs).

Results:

The data showed that females were at a slightly higher risk than males for falling (51% compared to 49%). Most falls occurred during dayshift. The times patient falls occurred were 1 AM, 5 AM, 6 AM, 10 AM, 1 PM, 3 PM, 4 PM, and 7 PM. It appeared that the unit would have a fall about every 2-3 hours. The peak times were at 1AM and 1 PM with the highest number of patient falls. Interestingly, most falls occurred when the unit was staffed adequately (1:5 nurse to patient ratio and 1:12 HCT/CNA to patient ratio). The common risk factors for patient falls were age, confusion, impulsiveness, and toileting assistance. The highest risk age group were geriatric patients age 65 years and older with 44%. The remaining risks per age group were 27% for age group range from 50-64 years old, 29% for age group range from 30-49 years old, 4% for age group range from 18-29 years old. The most common reason for patient falls was bathroom help. The data showed 39% of the time patients fell in the bathroom or went to the bathroom alone without assistance. Patients who were confused and impulsive were also most likely to fall. Only nine percent of patients who fell were 24-hours post-anesthesia during this period.

Conclusion / Implications:

This project addressed the clinical questions and helped the unit develop strategies for fall preventions. Developing a bed alarm criteria that would fit the unit population could potentially improve the fall rate. Additionally, we have identified and correlated the time of patient falls with nursing tasks. Patient falls occurred early in the morning when staff were passing medication or morning labs were being drawn and patients got up to use the bathroom without calling for assistance. Bathroom usage after meals and during staff lunches have been identified as the reasons why patients fell. Therefore, it is important to communicate with staff about these findings and provide education to help improve patient safety. Hardwiring the purposeful rounding or toileting program to decrease fall rates could improve patient safety. With the addition of cardiac monitors to the unit in 2015, there was an increase in the geriatric population and medical population with multiple comorbidities admitted to the unit. This could have contributed to the increased number of falls. Currently, there are nurses who underwent geriatric advanced training to become geriatric resource nurses (GRNs) to help improve patient outcomes in geriatric population.

Keywords:
patient falls; patient falls on medical surgical unit; prevalence and trends of falls
Repository Posting Date:
25-Jul-2017
Date of Publication:
25-Jul-2017
Other Identifiers:
INRC17O06
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titlePrevalence and Trends of Falls on a Surgical Uniten_US
dc.title.alternativePreventing Falls Using Evidence-Based Practiceen
dc.contributor.authorByrnes, Truen
dc.contributor.departmentGamma Iotaen
dc.author.detailsTru Brynes, MSN, RN, CNL, CMSRN, Professional Experience: 1999-2013 Staff nurse on Medical Surgical Unit, 5T Medical Surgical, Carolinas Medical Center-Charlotte NC 2013- August 2014 Patient Care Leader, Charlotte, NC Responsible for care coordination, implement evidence based practice at the bedise to improve patient outcomes and decrease admission rate. August 2014-Present, Clinical Nurse Leader Patient Care, Charlotte NC Responsible for a cohort of patietns with a focus on evidence based practice, safety, quality, risk reduction, and cost containment. July 2015-Podium Presenter at STTI 26th International Nursing Research Congress, Puerto Rico Jan 23 2015-- Podium Presentor at Clinical Nurse Leader Research Symposium Dec 2014 - Podium Presentor at Queens University Of Charlotte Sept 2015- Poster Presenter at the Academy of Medical Surgical Nurse 24th Annual Convention, Las Vegas, Nevada Jan-2014- Poster Presenter at the Clinical Nurse Leader Summit. Sep 2013-Poster Presenter at the Academy Medical Surgical Nurses. July 2013 WOW card winner. 2012-KEPT aware Winner Author Summary: Tru Byrnes received Master of Nursing in Clinical Nurse Leader at Queen University of Charlotte. She has been working at Carolinas Medical Center for 8 years. As a Clinical Nurse Leader, she provides clinical leadership directly at the point of care to ensure safe, evidence-based, high-quality care delivery that produces optimal patient outcomes.en
dc.identifier.urihttp://hdl.handle.net/10755/622186-
dc.description.abstract<p><span>Background</span></p> <p dir="LTR" align="LEFT">Falls are the most common adverse events in hospitalized patients contributing to pain, suffering, morbidity, and mortality (Aydin, Donaldson, Aronow, Fridman, Brown, 2015). Falls increases healthcare costs, with each fall ranging from $14,000 to $ 35,000. The rate of falls in United States (US) hospitals is approximately 3.1 to 11. 5 per 1,000 patient days, varying by unit type. Neurosurgery, neurology, and medical units have the highest fall rates (Bouldin et al., 2014). Many falls risk factors identified include intrinsic, extrinsic, and environmental factors (Urquhart Wilber, 2013). Henceforth, fall prevention strategies should include a multimodal action plan to promote patient safety (Williams, Szekendi, Thomas, 2014). 5 Tower’s fall performance ranges from 1.28 to 3.54 per 1,000 patient days from 2014 to 2016. In 2016, the patient fall rate has consistently underperformed compared to the national benchmark.</p> <p dir="LTR" align="LEFT">Purpose</p> <p dir="LTR" align="LEFT">The purpose of this quality improvement project was to examine the trend of patient falls on a post-surgical unit at an 11,000-bed hospital in the US to develop interventions based on the findings to prevent falls. The purpose of this project is follows:</p> <ul> <li>Assess and analyze the staffing pattern when patients fell</li> </ul> <ul> <li>Determine the times and days patient falls are more likely to occur</li> </ul> <ul> <li>Examine common risk factors related to patient falls</li> </ul> <p>Description of method</p> <p dir="LTR" align="LEFT">Seventy post-fall records were reviewed from 2014-2016 utilizing the electronic medical record (EMR). The post-fall records indicated time, date, unit census, medications, injury, and number of registered nurses (RNs) and certified nursing assistants (CNAs)/ health care tech (HCTs).</p> <p dir="LTR" align="LEFT">Results:</p> <p dir="LTR" align="LEFT">The data showed that females were at a slightly higher risk than males for falling (51% compared to 49%). Most falls occurred during dayshift. The times patient falls occurred were 1 AM, 5 AM, 6 AM, 10 AM, 1 PM, 3 PM, 4 PM, and 7 PM. It appeared that the unit would have a fall about every 2-3 hours. The peak times were at 1AM and 1 PM with the highest number of patient falls. Interestingly, most falls occurred when the unit was staffed adequately (1:5 nurse to patient ratio and 1:12 HCT/CNA to patient ratio). The common risk factors for patient falls were age, confusion, impulsiveness, and toileting assistance. The highest risk age group were geriatric patients age 65 years and older with 44%. The remaining risks per age group were 27% for age group range from 50-64 years old, 29% for age group range from 30-49 years old, 4% for age group range from 18-29 years old. The most common reason for patient falls was bathroom help. The data showed 39% of the time patients fell in the bathroom or went to the bathroom alone without assistance. Patients who were confused and impulsive were also most likely to fall. Only nine percent of patients who fell were 24-hours post-anesthesia during this period.</p> <p dir="LTR" align="LEFT">Conclusion / Implications:</p> <p dir="LTR" align="LEFT">This project addressed the clinical questions and helped the unit develop strategies for fall preventions. Developing a bed alarm criteria that would fit the unit population could potentially improve the fall rate. Additionally, we have identified and correlated the time of patient falls with nursing tasks. Patient falls occurred early in the morning when staff were passing medication or morning labs were being drawn and patients got up to use the bathroom without calling for assistance. Bathroom usage after meals and during staff lunches have been identified as the reasons why patients fell. Therefore, it is important to communicate with staff about these findings and provide education to help improve patient safety. Hardwiring the purposeful rounding or toileting program to decrease fall rates could improve patient safety. With the addition of cardiac monitors to the unit in 2015, there was an increase in the geriatric population and medical population with multiple comorbidities admitted to the unit. This could have contributed to the increased number of falls. Currently, there are nurses who underwent geriatric advanced training to become geriatric resource nurses (GRNs) to help improve patient outcomes in geriatric population.</p>en
dc.subjectpatient fallsen
dc.subjectpatient falls on medical surgical uniten
dc.subjectprevalence and trends of fallsen
dc.date.available2017-07-25T21:59:55Z-
dc.date.issued2017-07-25-
dc.date.accessioned2017-07-25T21:59:55Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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