1
Developing an Evidence-Based Interdisciplinary Fall Reduction Program
Final Evaluation of Practicum Experience
Jennifer Smith
NUR 590B
July 8, 2012
2
Developing an Evidence-Based Interdisciplinary Fall Reduction Program
The purpose of this paper is to evaluate the overall learning of the practicum experience of
planning, implementing, and evaluating an interdisciplinary fall program. This project enhanced
my professional career by allowing me to function in the role of nurse leader. Through the
process, I gained an understanding of the role and responsibilities of the Chief Nursing Officer
(CNO), learned collaboration and team building skills, and build relationships with both formal
and informal leaders.
The fall reduction program was designed to support the hospital’s commitment to providing a
safe environment for their patients by reducing preventing falls and reducing fall related injuries.
I learned the value of designing nursing division goals to support the hospital’s mission vision
and values. The nursing division’s mission supports the organization’s vision to provide high
quality, compassionate care supporting the patient’s mind, body, and spirit through human to
human caring. Nursing care is patient-centered based on Jean Watson’s Caring Theory. The
nursing staff collaborates with other health team members to meet the psychosocial, physical,
and spiritual needs of the patient and their families. Important concepts such as shared
governance, evidence-based practice, Lewin’s Change Theory, and Jean Watson’s Theory of
Human Caring were used to develop the fall reduction policy. The development of this project
allowed me to have better understanding of these important concepts and their application to
nursing practice. The application of theory to practice is a central theme that I learned through
the University of Phoenix curriculum.
Falls that occur in the hospital setting are a risk management problem that decreases patient
satisfaction and the perception of the quality of care. A fall may increase the patient’s length of
stay, cost of hospitalization, and utilization of resources (Fonda, Cook, Sandler, Bailey, 2006).
3
Emerging reimbursement methods such as pay for performance penalizes for negative
consequences such as fall-related injuries during hospitalization. This project gave me a better
understanding of the effects of a fall on the organization, patient, and their families.
The fall reduction project was consistent with evidence-based practice; literature review
indicates that fall reduction programs are more effective when they involve interdisciplinary
teams and consider multifactorial reasons for patient falls. The project created a feasible low
cost solution to increase surveillance, optimize the environment, and improve the management of
patients at-risk for falls. The program consisted of the development of a fall reduction policy,
revision of fall-assessment tools, education of staff, and evaluation of outcomes.
Effectiveness of the Project
The effectiveness of the fall reduction program data will be measured by monitoring data on
fall incidence, severity of injury, percentage of repeat fallers, and number of days between major
injuries. Fall rates will be analyzed for overall facility using the following formula (number of
patient falls/number of patient bed days) x 1000. This method adjusts for fluctuation in census
and is the recommended method by the American Nurses Association (ANA). The disadvantage
to this method is that it calculates all falls including the number of repeat fallers. The number of
repeat falls will be measured to determine what percent of the falls are second, third, fourth, or
more falls. The injury rate will be measured by using the following formula (number of
injuries/number of falls) x 100. This method is recommended by the Department of Veteran
Affairs, calculating the injury rate per 100 falls produces a meaningful rate. The number of days
between major injuries will indicate the program’s overall success if the length of time between
major injuries increases (Quigley, Neily, Watson, Wright, & Strobel, 2007). Data will be further
analyzed by unit to determine opportunities for improvement. I learned the importance of
4
evaluating and measuring the outcomes of an organizational quality improvement project. I
reviewed evidence-based practices for analyzing fall reduction programs and developed a tool to
assist with the collection of the required data.
The effectiveness of the education program was evaluated by staff completing a post-test. The
staff completed the post-test scoring at least 95% or better. Fifty charts were analyzed after
implementation to assess for the correct use of the Morse Fall Scale Risk Assessment,
appropriate care plans completed, documentation of patient/family education, and use of
appropriate interventions such as wrist band/non-skid socks. There were two charts that fell out
on reassessment after change in patient condition. The development of the educational program
and post-test allowed me to function in the role of nurse educator.
Evaluation of Data Collection
For implementation and evaluation the fall team will use the Plan-Do-Study-Act (PDSA).
The PDSA cycle allows the group to assess the outcomes of interventions and formulate changes
based on data. Joint Commission standards require an organization to have a fall risk reduction
program and continually monitor its effectiveness (JCAHO, 2006). The fall team will continue to
monitor the effectiveness of the fall reduction policy. Results for the first month after
implementation indicate a reduction in falls and fall related injuries. The average rate of monthly
falls prior to implementation were 20 and one month after the program there were 11 falls
resulting in no injury or minor injury. I learned about the Quality Improvement Cycle PDSA and
developed a guideline to determine if the project was successful or not. The team will use the
PDSA cycle to continually evaluate the fall reduction program.
5
Evidence-Based Practice
Evidence-based practice was used to develop this project, a total of 25 peer reviewed articles
were researched on fall reduction programs, fall-risk assessment tools, and the importance of
interdisciplinary collaboration. The Morse Fall Scale was chosen to assess adult patients and
The Humpty Dumpty Scale for pediatric patients. These fall risk assessment scales have been
proven to be effective at identifying patients at risk for falls. The literature review allowed me to
support the change in policy and practice to staff members and administration.
The Rosswurm & Larrabee model will be used to guide nurses through the change in practice
and behaviors. According to Pipe (2007), this model is an implementation strategy that has been
proven to assist organizations with the successful application of introducing evidence-based
practice. The model has six steps to assist with the promotion of change: (1) assess the need for
change, (2) link the problem with interventions, (3) synthesize best evidence, (4) design practice
change, (5) implement and evaluate the change in practice, (6) integrate and maintain the change
in practice.
Leadership and Advocacy Skills
This project allowed me to function in the role of nurse leader and advocate for a patient
safety program that supported the hospital’s mission, vision, and values. I had to prove to
administration the cost-benefit factor of implementing the program.
It gave me a better
understanding of the budget process and how to effectively present the data from my literature
review to support the change in practice.
Lewin’s Change Theory was chosen to assist with the development of the implementation
plan. Kurt Lewin developed a three-step model to assist with organizational change which
includes the following steps: unfreezing, movement, and refreezing (Kristsonis, 2004). The first
6
step of the process, unfreezing consisted of analyzing the current fall policy and making the
employees realize that change needed to occur to align our fall policy with best practices. The
second step is movement, which involved persuading employees to agree that the current policy
is not meeting best practice standards and involving them in the process by brainstorming and
providing feedback during the development of the policy. The third step, refreezing is necessary
to sustain changes so the employees do not revert back to old behaviors and practices. This step
will be particularly important for the project to maintain the effectiveness of the fall reduction
program.
Conclusion
The practicum project allowed me to gain experience in teamwork, communication, and
conflict resolution. It took both commitment and collaboration between administration,
interdisciplinary leaders, and staff members to create an evidence-based fall reduction program.
The fall reduction program met my learning need objectives and supported the organization’s
strategic plan to become the preferred provider in the community. I would like to continue to
monitor the effectiveness of the program and if the project is successful and the data considered
reliable an article for publication may be written related to the process of developing a
collaborative interdisciplinary fall reduction program.
7
References
Fonda, D., Cook, J., Sandler, V., Bailey, M. (2006). Sustained reduction in serious fall related
injuries in older people in the hospital. The Medical Journal of Australia, 184(8), 379-382.
Joint Commission on Accreditation of Healthcare Organization (2006). Top five sentinel
events by setting of care. January 2001 to July 2005.
Kristsonis, A. (2004). Comparison of change theories. International Journal of Scholarly
Academic Intellectual Diversity. 8(1).
Pipe, T. (2006, August). Optimizing nursing care by interpreting by integrating theory-driven
Evidence based practice. Journal Nursing Quality Care, 22(3), 234-238.
Quigley, P., Neily, J., Watson, M., Wright., Strobel, K. (February 28, 2007). Measuring fall
Program outcomes. Online Journal of Nursing. 12(2). doi: 10.3912.OJIN.Vol12No02PPT01.