Reducing Falls Among Targeted Patients with Toileting Needs

Taylor Ballard, Shaila Ellis, Deisy Herrera, Brooke Roane, Tracey Tran
Bon Secours Memorial College of Nursing

Abstract Data and Analysis of the Issue Root Cause Proposed Solution
In-hospital falls are a critical problem to patient safety. Insufficient compliance by patient care staff
The prevalence of falls associated with toileting on ❑ On CVSU, patients fall rates are above Hypothesis: We predict that if targeted toileting
related to targeted toileting, as evidence by development is supported by staff nurses and
step-down care units range from 38% to 47% (Fridman, Magnet mean goal based on National
2019). On the Cardiovascular Services Unit (CVSU), fall NDNQI scores and nursing staff not patient care techs on the unit then fall rates will
Database of Nursing Quality Indicators
rates are above Magnet mean. To ensure the fall implementing the visual management board. decrease by 5% by Quarter 2 (2020).
(NDNQI)
prevention initiatives are optimized, consistent, and Contributing barriers:
❑ The average patient who suffers a fall is:
transformational, the current practice was ❑ Lack of communication ❑ Unit based council
investigated. The purpose of this project was to ▪ A&O x4
❑ Lack of awareness ❑ Toileting shift champion (PNAP points)
explore the gap between the current practice of ▪ Ambulating to or from the
targeted toileting and patient fall rates. Current
❑ Competing priorities ❑ Targeted toileting check off list outside of all
bathroom
targeting toileting guidelines are not being fully ❑ Staffing challenges targeted toileted patient rooms
❑ Variables contributing to falls include:
implemented consistently. We predict that if targeted
toileting development is supported by staff nurses and
▪ New medication regimens Logistics
▪ Immobility - audits - incentives - required education Evidence: According to Tzeng (2010), it is
patient care techs on the unit then fall rates will
decrease. ▪ Nurses and patient care techs - monthly unit meetings important to examine and understand barriers
report inconsistencies with - improved NDNQI and apply safety equipment to the patients at
Introduction and Description of the quarterly scores risk.
implementation of targeted Stakeholders
Issue toileting. - nurses - patient care technicians
Macro Description: ▪ Education with patients. - nurse manager - patients
-Toileted-related activities are associated with 38% to ▪ Unmotivated staff buy-in - hospital leadership - fall committee Conclusion
47% of patient falls (Fridman, 2019). Current targeted-toileting guidelines are not
-The prevalence of falls in acute care facilities range Potential Costs being implemented consistently. With improved
from 3.3 to 11.5 falls per 1000 patients days (Fridman, -dry erase markers - laminated check off list
- incentives - compensated meeting times engagement of CVSU staff, we hypothesize a
2019).
decrease in fall rates.
Micro Description:
-According to the NDNQI report, during the 8 quarters Timeline
from Quarter 2 (2017) to Quarter 1 (2019) patient fall - Nov 1, 2019: I-aspire module completion References
rates were above national Magnet hospital mean. - Dec 1, 2019: assign shift champion Fridman, V. (2019). Redesigning a Fall Prevention Program in
- Out of 8 quarters, CVSU outperformed the magnet - Jan 2020: evaluation of staff members Acute Care: Building on Evidence. Clinics in geriatric medicine,
- Mar 2020: evaluation of unit’s compliance
mean once (NDNQI). 35(2), 265-271. doi:10.1016/j.cger.2019.01.006
- Falls with injury: CVSU outperformed the magnet
Data Collection Tzeng, H. M. (2010). Understanding the prevalence of inpatient
mean 3 out of the 8 quarters (NDNQI).
- NDNQI quarterly scores falls associated with toileting in adult acute care settings.
- Reported falls Journal of Nursing Care Quality, 25(1), 22-30. doi:
10.1097/NCQ.0b013e3181afa321