Kari Congenie

Scholarly Project Advisor: Sandra Scheidenhelm DNP, RN, NEA-BC

Affiliated Organization where the project occurred: Advocate Health, Downers Grove IL

Any Funding you received for the Project: None.

External Dissemination of the Project (Podium or Poster): Advocate Health hospital site:

• Shared Governance presentation, July 9, 2024
• Fall Committee meeting, presentation, July 10, 2024
• Unit Staff meeting, presentation, July 17, 2024
• Good Samaritan Spotlight on Excellence Research Symposium 10/2024 – Abstract supmitted 7/14/2024

Publication: supmission pending to the Journal of Nursing Care Quality

Introduction/Problem

Falls are a known issue in adult hospitalized patients leading to decreased quality of life and high costs (AHRQ, 2019; Dykes et al., 2020; Dykes et al., 2023). Best practices include a tailored fall prevention plan that is consistently implemented and communicated (Dykes et al., 2020; Lizarondo & Bellman, 2023). A community hospital identified an opportunity to reduce falls. A quality improvement project using an evidence-based fall toolkit was piloted on a neurology unit to understand its effects on patient fall outcomes, nurse knowledge, and nurse perceived efficacy of the intervention to reduce total fall/fall with injury rates over a five-month period.

Methods

Fall Tailoring Interventions for Patient Safety (TIPS), a fall prevention toolkit, was implemented on a neurology medical surgical unit between January and May 2024. Nurses received didactic education during staff meetings or direct patient care with option for questions following the presentation. Patient engagement audits and nurse surveys were conducted, and de-identified monthly fall data was shared. Results were analyzed using descriptive statistics for process outcomes and a two-proportion difference test for patient fall outcomes.

Findings

There was a decrease in total falls (3.51 to 3.12/1000 patient days) and falls with injuries (0.53 to 0.48/1000 patient days) during implementation; however, statistical significance was not achieved (X² = 0.03, df=1, p= .87; X² = 1.71, df=1, p= 1.00). It should be noted that any decrease in patient fall rates is clinically significant. Nurse knowledge remained consistent (M= 74.69, M= 80.00) and patient engagement audits revealed posters were not consistently updated (68.5%); patients were able to verbalize one of their fall risk factors and one of their fall interventions 72.6.% and 80.8% of the time, respectively. Nurse surveys and feedback highlighted challenges with updating posters and workload impact. Phone calls to the nurse for fall information decreased which was clinically significant and a positive aspect of the project. Facilitators included strong leadership and fall champion support, unit Shared Governance participation, and frontline inclusion in project implementation. Barriers included time/budget constraints, leadership/staffing changes, innovation fatigue, competing priorities, and low expectations the intervention could improve falls.

Practice Implication

The Fall TIPS toolkit can reduce falls and falls with injuries; however, contextual factors must be considered when implementing a new quality improvement initiative. Doing this will allow teams to identify facilitators, barriers, and potential strategies for effective implementation, adaptation, and sustainment.