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Capstone Project Reflection Paper Brittany Bentley Dixie State University

LEADERSHIP ASSOCIATED WITH FALL PREVENTION Abstract This paper reflects the experience of job-shadowing a nurse manger to gain more leadership skills, while preventing and decreasing the number of falls that take place in a hospital setting. This paper will discuss the purpose of the project, goals, activities, and conclude with an

evaluation of the overall project. The results of the project are also reported. This project began May 30, 2013 and concluded July 15, 2013.

LEADERSHIP ASSOCIATED WITH FALL PREVENTION Capstone Project Reflection Paper When a fall occurs in a hospital, the patient can be seriously hurt. These injuries could lead to a longer hospitalization or even death. A study that Graham conducted showed that

patients stayed up to 7.5 days longer if they fell during their hospitalization (2012). About a year and a half ago a patient assigned to my unit fell and was seriously injured. I was the first nurse that responded to the fall. This experience had a lasting impact on me. Due to this experience, I have taken the time to research literature on fall prevention in the hospital setting. This project has given me the chance to gain leadership skills and implement changes in my hospital unit to prevent future falls. Goals Before starting this project, I had to set goals for myself and my unit. My first goal was to find time to shadow my nurse manager. We scheduled the days for me to shadow her when she had meetings and education classes on her agenda to provide me with more learning opportunities. Before starting the project, I developed my leadership plan and completed my literature review. Completing the literature review helped me identify best practices for preventing falls in the hospital setting. My manager and I discussed these practices to ensure our facilitys fall policy addressed these interventions. My next goal was revising our policy. Our facility recently received the Careview System. This is a camera system set up so all patients can be seen from the nurses station. This new system is going to help prevent falls if used appropriately. We made sure this was added to the facilitys fall policy. Description of Activities The first activity that I performed was a literature review. This was beneficial because I was able to research best practices to prevent falls in the hospital setting. Through this, I learned that frequent rounding was a key strategy in preventing falls. When patients are being checked

LEADERSHIP ASSOCIATED WITH FALL PREVENTION on frequently, they are less likely to attempt to get out of bed on their own and fall. This literature review also emphasized the importance of accurately assessing the patients fall risk scores. I chose to focus on these two areas during my leadership project. I took the time to

educate my staff regarding our facilitys fall policy. This education took place during scheduled in-service. In our companys policy it states that rounding will be done every hour from 6:00 AM until 10:00 PM. It also states that from 10:00 PM to 6:00 AM rounding can be done every two hours. There are white boards in every patients room (Figure 1). In addition to documenting when rounding occurs with each patient, on the white boards in the bottom right corner is where the nurse or CNA can sign their initials along with any task that was completed during that hour of rounding. These tasks could include pain medication given, toileted, vital signs taken, etc. This serves as documentation as well as a form of communication of what is being done with the patient. This also provides essential information for all staff members that come in contact with this patient. It also forces the nurses to be more accountable for checking on their patients. During day shift our nurse manager randomly checks patients boards to make sure that they are being completed correctly. Our Chief Nursing Officer (CNO) has also been making rounds to evaluate these boards and started a competition throughout the hospital to see which unit had the highest number of white boards completed correctly. My unit won! Figure 1


On these white boards we also see the assistance level of each patient. This helps staff in safely transferring the patient. This is why it is crucial that these boards are being completed and continually updated. Frequent rounds, knowing the patients assistance level and having updated boards will prevent falls from occurring. Once my literature review was completed, I obtained my facilitys fall policy to make sure we were doing all we could to prevent falls. The hospitals fall policy was written based on evidence based practice. The changes that I needed to make to my facilitys fall policy were achieved by adding our new Careview System. This is a camera system located in each patients room. At the nurses station there is a screen that shows each room and the patient in their bed. Through this system the admitting nurse is able to assess the patients fall risk score and then draw bed rails. The camera has a sensor to detect if the patients arm or leg crosses the safe zone and sends an alarm sound to the nurses station. The nurses station can immediately check on the patient. This project has given me the opportunity to work with the Careview System and educate my staff on how to use it properly. This new system is the best technology available. Utilizing it properly in the hospital setting will help prevent many falls from occurring. Another activity that was completed during this project was job shadowing my nurse manager. I learned so much from the time spent with her. I was able to see her role as the manger of inpatient services. I had the opportunity to see her evaluate staffing and listen to her communicate with the house supervisor. She took the time to explain to me what she typically does on a daily basis. We attended several meetings which included: case management meetings, the meeting of directors, and interdisciplinary team (IDT). Out of these three meetings my favorite was the meeting of directors. This meeting was run by our CNO, others in attendance were my manager, the emergency room director, the surgical director, the director of

LEADERSHIP ASSOCIATED WITH FALL PREVENTION womens services, and the critical care director. Human resources (HR) also attended this meeting to discuss some of their concerns with all of the directors. HR was concerned with all of the floating that happens within the hospital. They wanted to know why we float staff so often and if the staff felt comfortable floating to high acuity units. This presented the perfect opportunity for me to voice my opinion and tell them my perspective as a floor nurse. The opportunity to share my opinion helped me grow as a professional and build more confidence within myself and my job duties. Attending this meeting forced me to utilize my developing leadership skills. This project has helped me grow not only as a nurse, but as a professional in general as well. I am becoming more confident in my own skills and abilities. I knew my nurse manager had a lot of responsibilities but it wasnt until I spent time shadowing her that I was able to see this in person. She has so many tasks to accomplish each

day and it seemed as though there was never enough time in the day to get everything done. This reinforced the importance of good time management skills as well as how important it is to be organized. I feel I have always had good time management skills and I am a very organized person. These are qualities I feel I already have and I need to continue to use these skills. Another activity that was completed during my project was educating new employees on our facilitys fall policy. Education promotes competence, confidence, and personal commitment. Continuing education encourages and supports staff members to learn and develop to their greatest capacity, ultimately fostering in them the confidence to be more creative, productive, and satisfied with their work (Koloroutis, 2004). On one specific day of my job shadowing, my manager was scheduled to teach about our facilitys fall policy at a new employee orientation. My manager asked me to complete this teaching in place of her. I was able to teach this policy without looking at any notes. I was also able to answer the new

LEADERSHIP ASSOCIATED WITH FALL PREVENTION employees questions regarding our facilitys fall policy. I discussed with them the importance of accurately assessing each patients fall risk score by using the fall risk assessment tool. Figure 2
Factors History 7 Altered Elimination 3 Confusion Disorientation 3

Fall Risk Assessment Tool


Feels Depressed 2

Dizziness Vertigo 3 Impaired Mobility 4

Diagnosis related

- LE affected - Crutches - Cane - Walker

Poor Judgment 3 Total Score Level 1 (standard risk) is a score of 4 or less Level 2 (high risk) is a score of 5 or more

assistive devices Transfers

(Border & Moore, 2011) I made sure that these new employees understood that if the patient was over the age of 70, our policy states that they are considered to have impaired mobility. I also took the time to review medications that increase the patients fall risk score. The majority of medications given in the hospital setting increases patients fall risk score and the proper interventions need to be implemented. I went through each category in detail to ensure these new employees fully understood how to assess patients fall risk scores accurately.

LEADERSHIP ASSOCIATED WITH FALL PREVENTION Having the opportunity to teach new employee orientation helped me in gaining leadership experience. I was nervous in the beginning because I was so much younger than everyone else, however once I got started, my confidence increased. I have spent such an

abundance of time reading our facilitys fall policy and researching fall prevention in general that I felt comfortable teaching. I also had the opportunity to educate staff at our in-service training on our facilitys fall policy. This consisted of two days of nothing but teaching employees the fall policy and making sure that they understood what needs to be done. Evaluation Looking back over the past three months I am able to evaluate my project and consider it a success. In order to consider my project successful, falls would have decreased on my unit and I would have gained more leadership skills, which is exactly what occurred. Nurses are now assessing patients fall risk scores more accurately along with implementing the proper interventions. The interventions that need to be completed are hanging a fall risk sign in the patients room and placing a yellow fall risk armband on their wrist. Patients white boards are being completed and updated more frequently than before I started this project. The timing of my project was perfect. As I was finishing my project, my manager and administration started checking patients white boards to ensure that they were being completed. When the administration survey was completed regarding the white boards throughout the hospital, my unit had the highest number and won a prize. It was rewarding to see that my efforts were effective and nurses were being compliant and following proper protocol. Shadowing my nurse manager helped me see characteristics of a good leader. She is able to handle whatever comes her way with a smile on her face. Her staff knows that she will be

LEADERSHIP ASSOCIATED WITH FALL PREVENTION supportive with anything that they may face. Through this project, I have become more confident in myself as a leader. I dont let my young age stop me from voicing my opinion and trying to make a difference on my unit.

This project has helped me grow as a person, nurse and professional. I have been able to make a difference on my own unit as well as throughout the hospital. Patients are going to be safer in the hospital because my facility has implemented the new Careview System. I have become a better leader while preventing future falls in the hospital setting.



References Border, V., & Moore, S. (2011, April). Fall risk prevention & safety protocol activities. Retrieved from Graham, B. C. (2012). Examining Evidence-Based Interventions to Prevent Inpatient Falls. MEDSURG Nursing, 21(5), 267-270. Koloroutis, M. (2004). Relationship-based care: A model for transforming practice. Minneapolis, MN: Creative Health Care Management, Inc.