Running head: QUALITY IMPROVEMENT PROJECT

Quality Improvement Project

Michelle Duesberry-Woody
Bon Secours Memorial College of Nursing
Quality and Safety In Nursing II
NUR 3207
Wendi Liverman
April 23, 2015

On my honor, I have neither given nor received aid on this

assignment or test, and I pledge that I am in compliance
with the BSMCON Honor System.
Quality Improvement Project
Postoperative falls pose a very real problem in every inpatient surgical
setting. There have been many studies concerning the type and number of
falls. In one study of inpatient male postoperative patients done by the
American Journal of Surgery there were some very interesting results. There
were 9,625 surgeries over a 5 year period. Of those surgeries 154 patients

had 190 falls (Church, Robinson, Angles, Tran, & Wallace). That research
would indicate that some patients experienced more than one fall. If this
problem is so prevalent, then it is a problem that needs to be addressed.
This is a problem that cannot be changed with a single process. It is
something with many facets. Preventing postoperative orthopedic patients
from having falls is a safety issue that is truly at the forefront for quality care,
and the orthopaedic unit is actively working to reduce the number of falls.
One way to decrease the instances of falls would be through better
preoperative education. At Mary Immaculate Hospital there is preoperative
education, but the patients do not seem to have clear postoperative
expectations. Quite often the patients convey that the doctors tell them that
they will have no pain following surgery. This leads many patients to
continually request pain medication. According to a lecture in the American
Academy of Orthopaedic Surgeons patient education is critical to ensure
appropriate expectations (Lanting, Lieberman, Callahan, Berend, &
MacDonald, 2015, p. 364). The patient should believe that they will
experience some pain. If they understand that some pain is normal, then
perhaps that will decrease the continual desire to use narcotics. Fewer
narcotics will have fewer side effects including drowsiness and dizziness that
lead to falls. There has been a great deal of work with the physicians and
the preoperative educators to help patients to have more realistic pain
expectations.

QUALITY IMPROVEMENT PROJECT

According to a study published in the Journal of Orthopaedic and Sports

Physical Therapy patients who have had knee replacement have 38.2% fall
rate when compared to other orthopaedic surgeries (Johnson, Duncan, Ahn,
Schroeder, Horlocker, & Kopp, 2014). If there is no additional underlying
condition, knee replacement patients seem to have greater difficulty with
ambulation. This should also be addressed when doing the preoperative
patient teaching. Knee replacement patients need to know the risks
associated with ambulation, and that it should always be performed with
qualified staff to assist. There is a no pass policy on the orthopaedic unit at
Mary Immaculate. This means that any staff member who walks passed a
patients room with a flashing call light is supposed to stop to offer
assistance to that patient. Even if the patient cannot be assisted by that
particular staff member, at least the patient feels as though they have been
heard.
The JOSPT and Journal of General Internal Medicine have studies that
show that more falls are occurring in the restroom. (Hitcho et al., 2004, p.
732-739) In many cases the floor in the restroom can be the surface that is
most slick. As with most hospitals, all patients at Mary Immaculate should
be wearing skid-resistant footwear. There is also an attempt at making sure
that the four Ps are addressed every hour: potty, position, possessions, and
pain. This hourly rounding tool serves as a reminder that if the patient feels
as though their needs are being anticipated, then they may not try to
ambulate on their own.

QUALITY IMPROVEMENT PROJECT

The goal of improving quality and safety for patients is to provide them
with the best possible outcomes. In order to provide the care that decreases
the number of falls, there have been programs implemented that put the
patient first. According to JOSPT the most common types of falls occur on
the surgical floor at Mary Immaculate Hospital (Johnson et al., 2014). MIH is
implementing several plans to keep patients safer on the road to recovery.
These plans provide patient-centered care that continues to move patients
toward an improved state of health.

QUALITY IMPROVEMENT PROJECT

This shows the falls incidence at Mary Immaculate in relation to other

hospitals in our area. The measures that were implemented last year have
allowed us to be well below other area hospitals.

QUALITY IMPROVEMENT PROJECT

6
References

Church, S., Robinson, T. N., Angles, E. N., Tran, Z. V., & Wallace, J. I. (2011,
February). Postoperative Falls in the Acute Hospital Setting:
Characteristics, Risk Factors, and Outcomes in Males. American Journal
of Surgery, 201(2), 197-202.
http://dx.doi.org/10.1016/j.amjsurg.2009.12.013.
Hitcho, E. B., Krauss, M. J., Birge, S., Claiborne Dunagan, W., Fischer, I.,
Johnson, S., ... Fraser, V. J. (2004, July). Characteristics and
Circumstances of Falls in a Hospital Setting: a Prospective Analysis. The
Journal of General Internal Medicine, 19(7), 732-739. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/15209586
Johnson, R. L., Duncan, C. M., Ahn, K. S., Schroeder, D. R., Horlocker, T. T., &
Kopp, S. L. (2014, November). Fall-Prevention Strategies and Patient
Characteristics That Impact Fall Rates After Total Knee Arthroplasty.
Anesthesia and Analgesia, 119(5). http://dx.doi.org/
10.1213/ANE.0000000000000438.
Lanting, B. A., Lieberman, J. R., Callahan, J. J., Berend, M. E., & MacDonald, S.
J. (2015). Ensuring a Winner: The ABCs of Primary Total Knee
Arthroplasty. In C. J. Della Valle (Ed.), Instructional Course Lectures
( ed., p. 364). Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/25745921?report=abstract
Mandi, L. A., Lyman, S., Quinlan, P., Bailey, T., Katz, J., & Magid, S. K. (2013,
February). Falls Among Patients Who Had Elective Orthopaedic Surgery:

QUALITY IMPROVEMENT PROJECT

a Decade of Experience From a Musculoskeletal Specialty Hospital. The

Journal of Orthopaedic and Sports Physical Therapy, 43(2).
http://dx.doi.org/10.2519/jospt.2013.4349. Epub 2013 Jan 14.