The main measurable patient-centered practice problem I encounter in our Med-Surg/Covid/Cardiovascular unit is the frequency of falls. The problem of falls is related to safety and leads to negative outcomes for both patients and healthcare providers. Falls occur relatively often (once or twice a week) in my practice setting and might be considered as a common preventable hospital-acquired condition (HAC). The Centers for Medicare and Medicaid Services (CMS) determined falls as a never event (King et al., 2018). Yoder-Wise (2019) states that adequate nursing care is associated with decreased falls and increased patient satisfaction. Thus, the measure implemented by CMS encouraged many hospitals to adopt zero fall strategies and increase nurse staffing levels to reduce patient falls.
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The problem was selected because it influences safety and impacts patient outcomes. Considering the current healthcare burden of the COVID-19 pandemic and a significant number of high-risk elderly patients, I would like to see improvements in the patient fall rates. The interview with the key leader confirmed my assumption that the issue of fall rates is relevant in the Med-Surg/Covid/Cardiovascular unit. Recent falls data analysis from my practice area demonstrates that the total number of inpatient and outpatient falls in April 2021 was 25 (versus 26 in March 2021). The total number of falls on NDNQI-reporting units was 24 (versus 21 in March 2021).
The overall rate of falls per 1,000 patient days decreased from 3.45 in May 2020 to 2.01 in April 2021. The percentage of RNs in the zone at the time of fall was 58%, with only 8% of assisted falls. The problem might be prevented by increasing nurse staffing levels or by purchasing additional bed alarms (Spath, 2018). Therefore, the quality improvement strategy should recognize the progress achieved by April 2021 and continuously address the issue of inadequate nurse staffing.
King, B., Pecanac, K., Krupp, A., Liebzeit, D., & Mahoney, J. (2018). Impact of fall prevention on nurses and care of fall risk patients. The Gerontologist, 58(2), 331–340. Web.
Spath, P. (2018). Introduction to healthcare quality management (3rd ed.). Health Administration Press.
Yoder-Wise, P. S. (2019). Leading and managing in nursing (7th ed.). Mosby.