The analysis of the data from the dashboard of the nursing-sensitive quality indicators of the Adams 5 Inpatient Rehab Unit demonstrates that its patient falls rate exceeds the target one. The purpose of this paper is to explain the significance of this indicator and suggest the action plan which incorporates best practices that could be of use for the improvement of the Adams 5 Inpatient Rehab Unit performance in this respect.
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Analysis of the Data
The performance indicators of the Adams 5 Inpatient Rehab Unit appear to be largely satisfactory and improving in many areas, especially in the terms of nurses’ qualification, which is a key factor for quality healthcare (Kavanagh, Cimiotti, Abusalem, & Coty, 2012). However, the TOTFALLS indicator results, which define the number of total falls per 1000 days, remains dissatisfactory. This area saw the most significant drop in performance in the latest time period presented; the drop was greater than that of the Nurse-Sensitive Patient Satisfaction Survey Indicators, which also deteriorated significantly. Before that, the Q3 FY09 saw an improvement in the area, but since then the situation was worsening for two time periods with the mean number of falls almost reaching the pre-Q3 FY09 level, and the actual figure exceeding it. It is noteworthy that patient falls indicator is one of the NDNQI indicators, which are an accepted and valuable form of healthcare quality measurement (Simon, Klaus, & Dunton, 2009). Therefore, the incidence patient falls in the Adams 5 Inpatient Rehab Unit needs to be examined and decreased.
Nowadays, nurses have the access to the extensive information concerning patient fall prevention that was being gathered throughout the decades of practice. Nowadays, institutions can choose methods that suit them. Also, the prevention of falls is greatly dependent on nurses and is a complex activity, which can involve a number of practices (Kavanagh et al., 2012). An example of a comprehensive and customized approach to the issue is the Magnet Model framework for prevention falls that involves an action research, which should provide a unit with tailored and continuously modified quality improvement tools (para. 84). However, the specific details and activities of the best practices in the sphere are also noteworthy. Here, separate areas of improvement with the examples of best practice activities will be suggested.
The Agency for Healthcare Research and Quality (2013) highlights the primary best practice that needs to be implemented in the Adams 5 Inpatient Rehab Unit: the measurement of the falls, prevention processes, and infrastructure meant to support prevention. The Agency for Healthcare Research and Quality (2013) provides guidelines (what and how to calculate) and tools for the most successful measurement practices and promotes the motto: “if you can’t measure it, you can’t improve it” (Fitzpatrick et al., 2011, para. 84-84). Therefore, the first activity that is necessary for the improvement of the situation is the implementation of valid measurement and monitoring practices that involve prevention measures as well as their outcomes. Given the significance of data produced, such an approach will ensure sustainable improvement based on identifying and eliminating issues continuously (Simon, Klaus, & Dunton, 2009).
Another important area of this action plan includes best practices of risk assessment (Fitzpatrick et al., 2011; Kavanagh et al., 2012). They presuppose the comprehensive evaluation that focuses on the patients, medications that are given to them, activities that are expected from them (for example, exercise), and the environment in the hospital. One of the recently developed tools for the assessment of the changes of a person’s mental status includes the “short portable mental-status questionnaire” that should be employed daily (Fitzpatrick et al., 2011, para. 70). Indeed, innovations will always remain a tool for nursing excellence, and it can be used for risk control as well (Kavanagh et al., 2012). The examples include gait belts or safety rails for beds, technology-assisted tools like alarms that track patients’ movements, and complex high-tech ones like smart beds and modern wheelchairs (Fitzpatrick et al., 2011, para. 116-132). It is important that nurses know how to use the equipment available.
Naturally the most advanced equipment is likely to be costly. Generally, best practice activities and especially the processes of their implementation are going to require resources (Fitzpatrick et al., 2011). It might be seen as a barrier in the light of the specifics of the US healthcare that does not typically demonstrate cost-efficiency (Kavanagh et al., 2012). However, patient falls are directly connected to the quality of healthcare (Fitzpatrick et al., 2011. Therefore, the nurses of the Adams 5 Inpatient Rehab Unit should advocate for the implementation of related practices and acquisition of better equipment to improve the quality of care and ensure safe practices (Cole, Wellard, & Mummery, 2014).
Here, the teamwork and leadership should be mentioned as well. Coordination, communication, advocacy, and timely education are also tools for the reduction of fall rates and the improvement of care quality in general (Fitzpatrick et al., 2011, para. 52, 62-67; Kavanagh et al., 2012, p. 387).
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The presented plan is aimed at addressing the complex fall prevention agenda from various perspectives. The paper outlines the key areas and emphasizes the best practices that exist for them, providing the Unit with the ideas concerning risk assessment and safe practices, teamwork and leadership, and performance monitoring that are aimed at better patient outcomes. Also, the importance of the comprehensive approach is highlighted. Given the significance of the issue and the fact that the performance of the Adams 5 Inpatient Rehab Unit in the area is to be improved, the suggested practices need to be considered.
Agency for Healthcare Research and Quality. (2013). Preventing Falls in Hospitals. Web.
Cole, C., Wellard, S. & Mummery, J. (2014). Problematising autonomy and advocacy in nursing. Nursing Ethics, 21(5), 576–582. Web.
Fitzpatrick, M.A., Jorgensen, J., Forte, J., Kulik, C., Payson, C., Currier, A.,…Cardente, R. (2011). Special supplement to American Nurse Today – best practices for falls reduction: A practical guide. American Nurse Today, 6(3). Web.
Kavanagh, K.T., Cimiotti, J.P. Abusalem, S. & Coty, M.B. (2012). Moving healthcare quality forward with nursing-sensitive value –based purchasing. Journal of Nursing Scholarship, 44(4), 385–395. Web.
Simon, M., Klaus, S. F., & Dunton, N. E. (2009). Using NDNQI data to manage CAUTI. Nurse Manager, 40(6), 16–18.