Running head: FALL REDUCTION PROPOSAL 1

Fall Reduction Proposal

Jamie Myers

University of Saint Mary

Abstract

This research topic is about giving education to nursing staff on telemetry units in order to

reduce falls by 20%. The common problems with falls is that they create an unsafe place for

patients and staff that are getting injured and creates a secondary issue of increasing cost for an

organization with falls with injury. Participants included all of the nursing staff from the

telemetry units. Method of instruction was teaching in person to nursing staff how to use

interventions to reduce falls with teach back approach. Results of the project indicated that the

education and interventions picked to help reduce falls did reduce the falls on telemetry.

Interventions used were gait belt, bed alarm, and hourly rounding to help reduce falls by 38% on

telemetry units. Conclusion of the project is that education to nursing staff on what tools to use

and how to use the tools was successful in reducing falls on telemetry.

Key words: reduction of falls, telemetry, intervention

Fall Reduction Proposal

Falls are on an upward trend within this organization, a large medical center located in

the Midwest of the United States, and there is a need to change interventions and fall awareness

of staff in order to reduce falls. This project will focus on the telemetry units at the studied

organization to implement education on new interventions. Falls can be costly to an organization

when injury happens due to a fall and increases patients stay. According to the organizations

computerized audit from Vizient, falls are happening to thirteen percent of patients on telemetry

units which can cost the hospital money to treat any injuries due to the fall. The purpose of this

project was to identify the need to focus on reducing falls and how to achieve that goal.

Statement of Purpose

Within the studied organization, falls were at an average of 26 falls per month. Falls with

injury can increase the cost of the patients stay by $4,000, which the facility will have to pay

(Inouye, Brown, & Tineti, 2009). The organization has a goal of reducing falls within the

telemetry units by 20%. Some of the problems within the telemetry units were that falls were not

a high priority when they should have been considering a fall with injury costs the facility

money. Bed alarms were not used, gait belts were not used, and just the awareness to staff was

not there. Education was built around a class room setting and simulation to properly educate the

staff on how to use interventional tools such as bed alarms, gait belts, and implementing hourly

rounding. The organization developed a committee that included key stakeholders that discussed

interventions and reviewed literature on interventions that would help reduce the fall rate. Key

stakeholders would include telemetry director, chief nursing officer, staff nurses, clinical

educator, and products. Key stakeholders discussed how to implement intervention tools to the
FALL REDUCTION PROPOSAL 4

nursing staff by education. Providing education to staff on intervention tools decided on by the

committee, the expectation was that falls would be reduced in the organization.

Problem Significance

The problem significance is related to patient safety and the cost of injuries to the facility.

Falls can create bruising, scratches or other wounds, hematomas, fractures, or internal bleeding

to the patient causing increased pain and potential increased length of stay. Falls not only

damage the patient perception of safety but, if injury occurs, can also be very costly to the

facility. It is estimated that facilities could endure costs of $1.7 billion each year due to injuries

with falls (Ullman, 2014). Reducing falls could increase patient safety and decrease cost to the

facility.

Conceptual Model

Five levels of needs are represented in Maslows theory; the first level must be met

before moving onto the next. The first level is physiological (includes air, food, water, sex, sleep,

and other factors towards homeostasis), second level is safety (includes security of environment,

employment, resources, health, property, etc.), the third level is belongingness (includes love,

friendship, intimacy, family, etc.), the fourth level is esteem (includes confidence, self-esteem,

achievement, respect, etc.), and the fifth level is self-actualization (includes morality, creativity,

problem solving, etc.) (Learning Theories, 2014). This theory will guide the project as nursing

addressed the second level of creating safety and security by keeping patients safe by

implementing interventions to keep them from falling and having an injury.

Current Evidence

Falls with injury can create added cost to the patients stay that is not reimbursed by

Medicare/Medicaid and some insurance companies. Falls with injury will not be reimbursed
FALL REDUCTION PROPOSAL 5

through Centers for Medicare and Medicaid Services (CMS) as they consider this to be a never

event, therefore adding cost to the facility to pay for patients injury. Never events are defined as

"non-reimbursable serious hospital-acquired conditions" - in order to motivate hospitals to

accelerate improvement of patient safety by implementation of standardized protocols (Lembitz

& Clarke, 2009). Falls with injury can increase the length of stay for the patients, result in

malpractice lawsuits, and add more than $4,000 in additional charges to the patient (Inouye,

Brown, & Tineti, 2009). Kirkpatrick (2017) in Leading Hospital Improvement discussed the

possibility of zero falls and if this is an achievable goal for hospital. This article discusses how it

is possible to have no falls with the following strategies: engaging stakeholders by leveraging

existing shared governance strategies, identifying unit champions, holding training sessions for

all staff, and implementing auditing tools to assess and provide feedback to staff on protocol

adherence (Kilpatrick, 2017). The Joint Commission (2017) Targeted Solutions Tool for

Preventing Fall discusses the tools to use to help prevent falls such as measuring the current

state, analyzing and discovering causes, implementing targeted solutions, and sustaining and

spreading improvements. These tools could help the organization decrease falls by using some

of the tools suggested in the article and help save money. By using these tools it is estimated that

costs could be cut by $1 million (The Joint Commission, 2017).

The Joint Commission (2016) Preventing Patient Falls: A Systematic Approach from the

Joint Commission Center for Transforming Healthcare Project looked at fall risk assessment

issues. Some of the issues that arise are handoff communication, toileting with patients, call

lights not being utilized by patients, education for patients and family, and medications that can

contribute to falls (Joint Commission Center for Tranforming Healthcare, 2016). Using this tool

can help to identify what is working with the current assessment tool or if there needs to be
FALL REDUCTION PROPOSAL 6

change to the assessment tool. Some of the interventions that would be implemented to cover

these tools and save cost would be the use of gait belts, bed alarms, and implementing hourly or

more frequent rounding.

Outcomes of Interest

The desired outcomes were to implement gait belt use, bed alarms with all identified fall

risk patients, and hourly round on all patients; the organization will reduce falls on telemetry

units by 20% in 12 weeks by implementing these interventions. This overall goal is to increase

patient safety and decrease the cost for falls with injury within the hospital.

Purpose Statement

The first part of the purpose is the motivation. The motivation for this project is to help

keep patients safe. Falls happen to be the leading cause for why elderly go to long-term skill-care

facilities from acute care (The Trustees of Indiana University, 2004). Other impacts that falls

have on patients can be long term pain, loss of self-esteem and mobility leading to decreased

activity, fear of getting hurt again, and loss of independence (The Trustees of Indiana University,

2004). The other part of motivation is to reduce cost to the organization. Falls could cost a

facility $174 billion by 2021 if there are not interventions done to reduce the number of falls

within the facility (Health Works, 2014).

The research plan was to find out more about how to prevent falls by educating staff,

patients, visitors and implementing interventions. The research question is What interventions

help reduce falls? Data has been reviewed and barriers have been identified through an

evaluation process (see Appendix A). Interventions have been identified that will help reduce

falls such as implementing hourly rounding for all patients, bed alarms and gait belt use with all
FALL REDUCTION PROPOSAL 7

identified fall risk patients. The identified tools from stakeholders will help the telemetry unit

reduce falls by 20% within 12 weeks.

Methods

This project had nurses assess patients for fall risk when admitted to the telemetry unit.

Interventions were implemented with the identified fall risk patient to help keep them safe and

free from falling. Data was collected during the patients stay based on interventions used and if

there is a fall or not. Timeline for the project was July 10, 2017 to October 31, 2017. There were

no ethical considerations in this project.

Intervention Activities

Intervention activities were implementing identified interventions and education on how

and when to use intervention for fall risk patients. Currently staff identify fall risk patients by

using an assessment tool from Hendricks, this assessment has not changed. Education was

provided to staff on how and when to use gait belt, how and when to use bed alarms, and what to

address on hourly rounding. Interventions used were measured by using an audit tool to see what

interventions each fall risk patient had in place and comparing them to the number of falls that

occurred on telemetry units.

Methods of Evaluation

Data was evaluated by using quantitative research. Data was collected on how many falls

occurred prior to interventions being in place. After interventions were in place and education to

staff on how and when to use them, data was collected on how many falls occurred and collect

data on what interventions were in place at the time of fall. This allowed the organization to see

what interventions worked and analyze data to see if falls were reduced by the interventions put

in place.
FALL REDUCTION PROPOSAL 8

Analysis

The type of project completed was evidence-synthesis. There is research within the

literature review from the Joint Commission that helped to identify what intervention tools

would help reduce falls. Synthesis of the literature involves making the best evidence easily

available to health-professional staff (Bonnel & Smith, 2014). Reviewing literature of like

organizations that have produced positive results in fall reduction has helped set interventions

that are used for the project to reduce falls within the telemetry units.

Results

Achievements

After completion of education to telemetry nursing staff, observation of interventions

used were shown to be used more often than prior to the education. As a result of interventions

being used, the rate at which patients fell decreased. Patient fall record for telemetry units went

from thirteen percent to five percent of patients falling based on the computerized audit. This

means for one month telemetry units reduced their average fall rate by 38%. Telemetry unit met

and exceeded the goal of reducing patient falls by 20%.

Evidence of Change

The evidence of change can be found in the fact that prior to education on interventions

to help reduce falls, the fall rate was higher and the use of fall prevention equipment was low.

The assessment tool to identify fall risk patients was not changed during this pilot; current tool

used to identify patients at risk for falling is the Hendricks score. After education, the use of fall

equipment went up and the number of falls decreased.

Discussion

Summarization

Motivation for the project was to reduce falls that would cause injury in order to create a

safer environment for the patient and to reduce cost to the organization by decreasing injury-

causing falls with injury. The number of falls with injury was zero post education and the

number of falls went from thirteen percent to five percent. This data helped reduce cost and

increase safety for the patients. The education on interventions to telemetry staff was successful

in reducing the amount of falls on the unit.

Results

The results showed improvement in use of intervention tools along with improvements in

decreasing patient falls. Using methods from the literature review like in Kirkpatrick (2017)

Leading Hospital Improvement gathering all stakeholders to make decisions, implementing tools

that would work for the organization, and implementing solutions with education all helped to

reach the goal of lowering falls by at least 20% on telemetry by the end of October. The

interventions that were implemented and educated on helped to reach the goal. Before the

education tools were rarely used or not used at all and after education tools were being used at

90% or higher (see Appendix A). The amount of falls on telemetry units were reduced from

thirteen percent to five percent (see Appendix B).

Strengths/limits

Strengths of the project include many individuals with good buy in to improve the

number of falls that were happening. Stakeholders were interested in the project and wanted to

see improvement. Nursing staff participated in the education and started using and implementing
FALL REDUCTION PROPOSAL 10

tools right away. Limits of the project were time for post education collection of data and that the

project was limited telemetry inpatient units.

Implications

Education to staff and implementing the right tools for the organization helped reduce

falls. This project will be rolled out to the rest of inpatient units for further data collection.

Implementing hourly rounding was the most impactful tool as it helped reduce the amount of call

lights and the amount of patients attempting to get up without assistance to use the restroom.

This helped reduce falls by giving those patients the assistance that they needed. The bed alarm

notified staff that if a patient at risk was attempting to get up without staff assistance, they could

immediately go to the patient and help them. The gait belt helped reduce falls by giving the staff

a tool to assist patients in transfers and ambulation.

Usefulness

The project was useful in reducing falls to one unit of the organization. The project will

go throughout the inpatient units of the organization to help reduce all falls within the

organization. The expectation is that the organization will produce the same results as the

telemetry units just by implementing education on how to use intervention tools such as gait

belts, bed alarms, and hourly rounding. Benefits to the organization would be to have a safer

environment for patients and reduce overall cost to organization by reducing injury related falls.
FALL REDUCTION PROPOSAL 11

References

Bonnel, W., & Smith, K. (2014). Proposal writing for nursing capstones and clinical projecs. New York, NY:

Springer Publishing Company.

Health Works. (2014). Consequences of falls. Retrieved from Government of Western Australia

Department of Health: http://ww2.health.wa.gov.au/Articles/A_E/Consequences-of-falls

Inouye, S., Brown, C., & Tineti, M. (2009). Medicare nonpayment, hospital falls, and unintended

consquences. Retrieved from Medable: http://www.nejm.org/doi/full/10.1056/NEJMp0900963

Joint Commission Center for Tranforming Healthcare. (2016). Preventing patient falls: A systematic

approach from the joint commission center for transforming healthcare project. Retrieved from

Joint Commission:

http://www.centerfortransforminghealthcare.org/just_published_preventing_patient_falls_a_s

ystematic_approach_from_the_joint_commission_center_for_transforming_healthcare_project

Kilpatrick, A. (2017). Leading Hospital Improvement. Retrieved from Joint Commission:

https://www.jointcommission.org/zero_falls_it's_possible/

Learning Theories. (2014). Maslow's hierarchy of needs. Retrieved from Learning Theories:

https://www.learning-theories.com/maslows-hierarchy-of-needs.html

Lembitz, A., & Clarke, T. (2009). Clarifying never events and introducing always events. Retrieved from

National Center for Biotechnology Information:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2814808/

The Joint Commission. (2017). Targeted solutions tool for preventing falls. Retrieved from Joint

Commission: http://www.centerfor transforminghealthcare.org/tst_pfi.aspx

The Trustees of Indiana University. (2004). Falls: How big is the problem! Retrieved from Indiana

Univeristy: http://www.indiana.edu/-

bioofag/module2/kw_unit3_HAA2/falls/content/01_03_impact.htm

Ullman, K. (2014). Preventing falls curbs costs and risk. Retrieved from Means Business:

http://www.healthcarefinancenews.com/news/preventing-falls-curbs-costs-and-risk
FALL REDUCTION PROPOSAL 13

Appendix A

Fall Risk Audit

Fall Risk Interventions Audit

Prior to education data

Date # of fall risk # of gait # bed Hourly

Patients belt alarms Rounding

6/28/2017 13 no data no data no data

6/29/2017 10 no data 5 no data

6/30/2017 10 no data 5 no data

7/1/2017 no data no data no data no data

7/2/2017 no data no data no data no data

7/3/2017 19 no data 15 no data

7/4/2017 19 no data 13 no data

7/5/2017 18 no data 15 no data

7/6/2017 14 no data 11 no data

7/7/2017 17 no data 16 no data

7/8/2017 8 no data 6 no data

7/9/2017 10 no data no data no data

7/10/2017 10 no data 4 no data

7/11/2017 13 8 7 no data

7/12/2017 18 no data 14 no data

7/13/2017 no data no data no data no data

7/14/2017 19 12 16 no data

7/15/2017 13 no data 11 no data

7/16/2017 no data no data no data no data

7/17/2017 12 no data 9 no data

7/18/2017 19 13 15 no data

7/19/2017 17 16 14 no data

7/20/2017 16 no data 7 no data

7/21/2017 13 no data no data no data

7/22/2017 13 no data 7 no data

7/23/2017 11 6 9 no data

7/24/2017 12 9 10 no data

7/25/2017 11 9 6 no data

7/26/2017 10 8 5 no data

7/27/2017 10 9 4 no data

7/28/2017 12 10 6 no data

7/29/2017 12 8 9 no data

7/30/2017 9 7 8 no data

7/31/2017 10 7 6 no data

8/1/2017 9 6 4 no data

8/2/2017 8 6 4 no data

8/3/2017 7 4 3 no data

8/4/2017 11 5 5 no data
FALL REDUCTION PROPOSAL 15

8/5/2017 21 10 11 no data

8/6/2017 21 10 9 no data

8/7/2017 21 10 10 no data

8/8/2017 18 13 12 no data

8/9/2017 14 11 9 no data

8/10/2017 14 12 8 no data

8/11/2017 11 8 6 no data

8/12/2017 12 9 10 no data

8/13/2017 10 5 4 no data

8/14/2017 11 7 7 no data

8/15/2017 12 8 8 no data

8/16/2017 10 7 5 no data

8/17/2017 13 10 9 no data

8/18/2017 9 9 6 no data

8/19/2017 11 9 7 no data

8/20/2017 16 9 7 no data

8/21/2017 15 11 8 no data

8/22/2017 15 13 12 no data

8/23/2017 16 15 12 no data

8/24/2017 14 14 6 no data

8/25/2017 15 15 8 no data

8/26/2017 13 13 7 no data

8/27/2017 14 11 7 no data
FALL REDUCTION PROPOSAL 16

8/28/2017 16 13 8 no data

8/29/2017 17 16 5 no data

8/30/2017 20 19 9 no data

8/31/2017 18 18 10 no data

9/1/2017 14 12 9 no data

9/2/2017 15 14 7 no data

9/3/2017 18 16 9 no data

9/4/2017 17 16 6 no data

9/5/2017 12 11 6 no data

9/6/2017 15 12 8 no data

9/7/2017 18 17 7 no data

9/8/2017 21 19 12 no data

9/9/2017 21 21 10 no data

9/10/2017 18 17 11 no data

9/11/2017 17 17 13 no data

9/12/2017 16 14 8 no data

9/13/2017 18 13 12 no data

9/14/2017 17 13 15 no data

9/15/2017 20 15 10 no data

9/16/2017 19 19 9 no data

9/17/2017 18 14 8 no data
FALL REDUCTION PROPOSAL 17

Total 1124 659 466 0

% of 59% 42% 0%

compliance

Classes on interventions start

Post class data

Date # of fall risk # of gait # bed Hourly

Patients belt alarms Rounding

9/18/2017 21 21 14 12

9/19/2017 17 17 14 17

9/20/2017 17 17 13 17

9/21/2017 20 19 17 20

9/22/2017 13 13 11 13

9/23/2017 13 13 13 13

9/24/2017 15 15 14 15

9/25/2017 19 19 18 19

9/26/2017 18 18 13 18

9/27/2017 24 22 20 24

9/28/2017 19 19 12 19

9/29/2017 16 15 13 16

9/30/2017 17 15 15 17

10/1/2017 16 16 14 16

10/2/2017 16 16 15 16
FALL REDUCTION PROPOSAL 18

10/3/2017 20 20 20 20

10/4/2017 24 24 22 23

10/5/2017 22 22 21 22

10/6/2017 21 21 18 21

10/7/2017 14 14 14 14

10/8/2017 16 16 15 14

10/9/2017 15 15 13 15

10/10/2017 19 19 19 19

10/11/2017 22 22 20 22

10/12/2017 24 24 23 24

10/13/2017 23 23 21 23

10/14/2017 25 25 25 24

10/15/2017 22 22 20 22

10/16/2017 19 19 19 19

10/17/2017 18 18 17 16

10/18/2017 19 19 18 19

10/19/2017 17 17 17 17

10/20/2017 17 17 17 17

10/21/2017 19 19 18 19

10/22/2017 21 21 21 20

10/23/2017 22 22 19 20

10/24/2017 20 18 19 20

10/25/2017 16 15 14 16
FALL REDUCTION PROPOSAL 19

10/26/2017 15 15 15 15

10/27/2017 15 15 15 15

10/28/2017 18 18 16 18

10/29/2017 19 19 15 16

10/30/2017 23 23 20 22

10/31/2017 18 18 18 18

Total 824 815 745 802

% of 99% 90% 97%

compliance
FALL REDUCTION PROPOSAL 20

Appendix B

Number of Falls on Telemetry

Percent of falls on telemetry

12

10

8
Falls before education
6 Falls after education

0
Falls before education Falls after education