This is an original excerpt written by our team to show structure, depth and referencing. It is modelled on the course named above but is not a university document. Use samples as a study guide and follow your school's academic integrity policy.
The problem
On the 28-bed medical-surgical unit in this plan, falls have run at about 4 per 1,000 patient-days for the past year. Each patient has a fall risk score on admission, but the score rarely changes what happens at the bedside: most patients get the same general precautions whatever their risk factors. The unit and its figures are illustrative.
The evidence
A cluster randomized trial in four urban US hospitals tested a fall prevention tool kit on eight units with 10,264 patients. Using the nurse's fall risk assessment, the tool kit tailored interventions to each patient's risk factors and produced bed posters, patient education handouts and plans of care. Falls were less frequent on intervention units than on usual-care units (3.15 vs. 4.18 per 1,000 patient-days), and the tool kit was particularly effective for patients aged 65 or older. It had no significant effect on fall-related injuries (Dykes et al., 2010).
The Model for Improvement
The plan follows the Model for Improvement, which asks three questions and then tests changes in Plan-Do-Study-Act (PDSA) cycles (Langley et al., 2009):
- What are we trying to accomplish? Reduce falls on the unit from about 4 to 3 per 1,000 patient-days within six months.
- How will we know that a change is an improvement? By tracking the measures below on run charts.
- What change can we make that will result in improvement? A bedside poster and plan of care tailored to each patient's fall risk factors, reviewed with the patient and family.
PDSA cycles
| Cycle | Test | What we learn |
|---|---|---|
| 1 | One nurse makes tailored posters for three patients on one day shift | Whether the poster is quick to make and easy to read |
| 2 | All day-shift nurses for one week, with teach-back on the poster | Time taken, and what patients and families understand |
| 3 | All shifts, with the poster updated after every fall risk reassessment | Whether the posters stay current around the clock |
Measures
- Outcome: falls and injurious falls per 1,000 patient-days.
- Process: share of patients with a tailored poster and plan in place within 8 hours of admission, from a weekly audit of 10 patients.
- Balancing: nurse time spent on admission documentation, since the change mustn't take time away from care.
Leading the change
The BSN nurse leads as a unit champion: sharing the evidence at huddles, coaching colleagues during the first cycles, posting the run charts where staff can see them, and bringing the results to the unit's quality meeting so the team decides together whether to adopt, adapt or abandon the change.
References
Dykes, P. C., Carroll, D. L., Hurley, A., Lipsitz, S., Benoit, A., Chang, F., Meltzer, S., Tsurikova, R., Zuyov, L., & Middleton, B. (2010). Fall prevention in acute care hospitals: A randomized trial. JAMA, 304(17), 1912–1918. https://doi.org/10.1001/jama.2010.1567
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.
