The present paper is devoted to one of healthcare quality indicators: patient fall rates. It involves the analysis of the statistical data on the fall of patients in a Telemetry Unit that was recorded during four months. The purpose of this paper is to use the data to develop a plan for the improvement of patient fall rates with a discussion of the leadership characteristics that would facilitate the process.
The case study offers a breakdown of patient falls data in the Telemetry Unit for different weekdays and time of the day. The greatest number of falls takes place on Sunday (11 throughout the four months). Friday and Saturday follow it with nine falls each; Monday has the lowest number of falls, which amounts to the total of three incidents. The distribution of falls between the days of the week needs to be investigated; it is possible that there are staffing issues or other difficulties that can be discovered during a close examination.
The total numbers of falls indicate that the period between 7A and 11A is the most dangerous one (15 falls) followed by the period between 3A and 7A. During the night, issues with lighting may occur; apart from that, all the periods are associated with toileting needs (Agency for Healthcare Research and Quality [AHRQ], 2013; Johnson et al., 2011). The number of falls between 11A and 7P is the lowest: they were marked by two cases of falls each. The period that accounts for the greatest number of falls is Sunday night (3A-7A) followed by Saturday morning (7A-11A).
The falling patients were both male (32%) and female (68%) with the average age of 72.4 years. 94% of them took diuretics, 100% of them had a cardiac issue, and 12% had confusion or disorientation diagnosed. This data demonstrates that the falling patients were in risk groups (AHRQ, 2013): they had frequent toileting needs due to diuretics, they might have experienced difficulties in walking because of their age, and cardiac medications may have had the side effects of dizziness, lightheadedness, and fatigue (Chen, Zieve, & Ogilvie, 2015). The fact that the number of patients with diagnosed confusion is relatively small might indicate that more attention is paid to these patients, but to make a final conclusion, more information is required (on the percentage of patients with these diagnoses in the Unit).
Quality Improvement Plan
The data provided for the Unit indicates the periods that require close attention, and some suggestions on the interpretation of the distribution can be made, but a more detailed investigation is recommended. Indeed, the present information does not provide any data on the current fall prevention practices in the Unit, and the factor that has not been measured cannot be improved as stated by AHRQ (2013). As a result, the first step in quality improvement in the Unit would involve the assessment of the existing practices and the investigation of the issues highlighted by the data analysis.
The key practices that need to be investigated include the nursing assessment of risks and the specific nursing interventions (for example, wet floor signs). The environment and equipment are also to be assessed; they may include, for example, the availability of wheelchairs, handrails, sufficient lighting, and so on. Also, staff training and forms of quality monitoring and control are of importance; they can also facilitate the change management process. Finally, policies need to be studied very closely (AHRQ, 2013; Johnson et al., 2011).
The evaluation of the mentioned elements of fall prevention practices will provide the information for the decision concerning their improvement. The decision should employ best practices in the field, for example, those defined by AHRQ (2013). Also, the customization of the practices can be regarded as a best practice that is also recommended by AHRQ (2013). To manage change, AHRQ (2013) recommends appointing the Implementation team, defining the goals and aims clearly, setting timelines, and finding a way to engage the staff.
Nurse administrators and leaders play a crucial part in patient safety improvement (Fagan, 2012; Johnson et al., 2011). Moreover, according to the nursing Code of Ethics, every nurse is ethically obliged to advocate for and participate in the improvement of patient safety (Fowler & American Nurses Association, 2008). Therefore, nursing leadership is likely to greatly enhance the process of patient falls reduction in the Unit.
The leadership characteristics that appear to be required for the innovation include the commitment to quality and safety and readiness to take action and innovate (Fagan, 2012; Fowler & American Nurses Association, 2008). Also, interpersonal and teamwork skills matter, including supportiveness, ability to encourage and engage other nurses, willingness to communicate (provide feedback, consider and discuss suggestions, and so on). Goh, Chan, and Kuziemsky (2013) highlight the positive effect of a non-blaming attitude towards errors that would foster collaborative learning. All these skills, characteristics, and mindset elements would be helpful for the improvement of the Unit’s patient falls statistics.
The solution to the challenge of patient falls reduction that is presented in this paper is comprehensive and offers customized decisions. It includes the stage of additional investigation of the Unit’s practices and issues that is followed by specific interventions, which are supposed to be designed to catch up with the best practices in the areas of policies, staff training, equipment, and the environment.
Since the provided information indicates areas of concern but still might be misinterpreted, more research is required to enable the improvement of Unit’s practices. Nursing leadership will become the second enabling factor due to the nurses’ commitment to quality and crucial interpersonal skills.
Agency for Healthcare Research and Quality. (2013). Preventing falls in hospitals. Web.
Chen, M.A., Zieve, D., & Ogilvie, I. (2015). Heart failure – medicines. Web.
Fagan, M. (2012). Techniques to improve patient safety in hospitals: What nurse administrators need to know. The Journal of Nursing Administration, 42(9),426–430.
Fowler, M. D., & American Nurses Association. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association Silver Springs, MD: Nursesbooks.org.
Goh, S., Chan, C., & Kuziemsky, C. (2013). Teamwork, organizational learning, patient safety and job outcomes. International Journal of Health Care Quality Assurance, 26(5), 420–432.
Johnson, J., Veneziano, T., Green, J., Howarth, E., Malast, T., Mastro, K.,…Smith, A. (2011). Breaking the fall. The Journal of Nursing Administration, 41(5), 538–545.