Date of Award

5-2-2017

Degree Type

Evidence-Based Project Report

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

First Advisor

Theresa A. Kessler

Abstract

According to the Joint Commission Center for Transforming Healthcare (2016), moderate to severe injuries from falls on average add 6.3 days to a hospital stay and cost approximately $14,056 per patient hospitalization. The purpose of this evidence-based practice (EBP) project was to implement a multifactorial approach to identify patients at risk for falls on admission to the orthopedic/neurosurgical unit and provide individualized interventions necessary to prevent falls. The Iowa Model of Evidence-Based Practice and Orlando’s Nursing Process Discipline facilitated the implementation of this project. A total of 45 staff members on the unit were educated on the multifactorial fall protocol with a PowerPoint® presentation prior to implementation. The nurses utilized the Fall Risk Algorithm, which provided a stepwise approach to fall risk assessment and interventions. Pre and post-implementation data were collected to compare fall and fall injury rates. The desired outcomes for this project were to reduce the fall and fall injury rates in hospitalized patients. Another desired outcome was to improve staff and patient compliance with the multifactorial fall prevention interventions. Staff compliance consisted of visual checks that demonstrated improved results when comparing the items to pre and post implementation. The gait belt in the patient’s room (p = 0.000) and the presence of a walking device (p = 0.043) had a significant improvement between pre and post implementation. There was improvement from pre to post implementation for patient wristbands (p = 0.313), socks or footwear use (p = 0.579), bed or chair alarms (p = 0.229), bed locked in the low position (p = 0.316), call light and items within reach (p = 0.155), and patient validation of understanding (p = 0.147). Staff compliance included nursing documentation. Staff demonstrated a slight improvement for fall education documentation from pre (n = 52) and post (n = 54) implementation (χ²(1) = 0.080, p = 0.777). The nursing staff received pre and post-test questions after the educational session. There was a significant improvement between the means of the two groups for question one (p = 0.001) and for question three (p = 0.012). There was no significant difference between the groups for question two (p = 0.142). There were significant findings found for patient compliance. Frequency of falls occurring with alert and oriented patients and confused patients produced a significant deviation from the hypothesized values (p = 0.022); more alert and oriented patients fell. A significant deviation was found (p = 0.050) when comparing frequency of falls occurring with opioids; more patients on opioids fell. The mean fall number during the months of October, November, and December from 2014 and 2015 (p = 0.802) and 2015 and 2016 (p = 1.000) showed no significant difference. The frequency of falls occurring with injury was examined. Significant deviation from the hypothesized values was found (χ²(1) = 9.783, p = 0.002); injuries rarely occurred with falls. There were no significant differences among the fall rate and injury rate throughout October, November, and December and the years of 2014, 2015, and 2016; however there was improved use of fall risk interventions demonstrated by the improved rates of the visual checks following the multifactorial approach. Implications for practice include the nursing staff continuing to demonstrate the multifactorial approach to fall prevention with the fall risk algorithm that will be used on the unit and implemented on other units in the hospital system.

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