Why the Quality improvement is needed and Expected outcome,
Introduction and overview
In the last one year, the number of patient falls has dramatically increased in Pomerado Hospital. The latest hospital statistics show that there are approximately 15 falls per month. The majority of the patients within my healthcare organization are elderly patients. 75.4% of all the patients are over the age of 65 years with multiple underlying conditions such as hypertension, diabetes, congestive heart failure, and cancer. The increase of falls within the institution is a significant concern to the staff and general organizational management. For decades, the hospital has been widely known and respected for providing high-quality healthcare services to the older members of the community, irrespective of the social status or ability to pay. This menace has resulted in an increase in healthcare costs, reduced patient satisfaction, and reduced levels of patient safety. In the last financial year, the healthcare facility lost almost $100 million in dollars due to patient falls. It is a result of the negative impact of the healthcare issue that a sustainable solution is required to restore the culture of quality, efficiency, and safety within the healthcare organization. To effectively reduce the rate or ultimately eliminate falls, the hospital should implement a quality improvement initiative. The objective of the following paper is to develop a quality improvement plan to address the healthcare issue of falls within the organization comprehensively.
Why the Quality improvement is needed and Expected outcome,
According to the Center for Disease Control and Prevention [CDC], there are approximately 28 000 people annually die as a result of injuries sustained from falls (Salsbury, 2019). Consequently, the CDC asserts that one in every five falls in a hospital setting is likely to result in significant healthcare problems such as head injury or broken bones (Salsbury, 2019). In addition to that, The American Nurses Association [ANA] asserts in the geriatric population, close to 85% of the adverse events and complications are directly related falls (Jenko et al., 2019). Over 3 million people are annually admitted to the emergency department of hospitals due to fall injuries, which remains the most prevalent cause of traumatic brain injuries among the elderly population. Jenko et al., (2019) assert that falls among the elderly population may result in increased mortality, morbidity, increased chances of hip fracture and head injuries.
Consequently, while causing an annual loss of close to $100 million in my healthcare institution, falls result in to increase in healthcare costs to the tune of $40 billion annually (Morgan et al., 2017). Sufficient identification of the risk factors towards patient falls within the healthcare institution will result in the creation of an appropriate plan to reduce the risks of falls. Furthermore, the Agency of Healthcare Research and Quality asserts that implementation of quality initiatives improve patient safety, reduce healthcare costs, and improve patient care outcomes (Morgan et al., 2017). In my organization, where approximately 15 falls occur per month, the result of a quality initiative will be a reduction in the number of fatalities, improved patient care outcomes, reduced duration of hospital stay, and reduced healthcare costs. The joint Commission asserts that implementation of fall evidence-based fall prevention strategies improve the overall healthcare outcome of the United States population. Evidence-based practice shows that implementation of initiatives such as practical risk assessment, hourly Rounding, handoff communication, call light, toileting, and video monitoring, among others, may significantly contribute to a substantial reduction of patient fall rates (Salsbury, 2019). The proposed quality improvement initiative for the organization is hourly patient rounding and automated patient monitoring by installing bed and chair exit alarms for the individual patients. It will, therefore, be fundamental to implement evidence-based strategies to solve the healthcare issue comprehensively.
Previous Research and support quality initiative.
Previous evidence-based research shows the significance of a vast number of interventions and initiatives in effectively reducing the rate of falls in hospitals. According to Morgan et al. (2017), identifying the risk of falls in patients through effective assessments, hourly patient rounding, and use of the automated chair and bed exit alarms within the healthcare institution is useful in fall prevention. According to Morgan et al. (2017), hourly nurse rounding is one of the most effective fall reduction strategies with more than 75% effectiveness. Jenko et al. (2019) assert that hourly Rounding reduces the patient risk for falls by enhancing their comfort, safety, and calmness, knowing that a nurse will always attend to their needs after a specific duration. Hourly Rounding also contributes to the reduction of hospital-acquired infections such as pressure ulcers, which may be a source of discomfort for the patients (Jenko et al., 2019).
According to Salsbury (2019), hourly Rounding decreases patients falls from 7.02 to 3.18 percent per 1000 patients. It addition to that, the evidence-based research article asserts that nurses should utilize the four P’s; position, pain, possession, and potty during the hourly Rounding for enhanced healthcare outcomes (Salsbury, 2019). Hourly Rounding also enables nurses to assess the patient and identify potential safety risks for the patient and effectively eliminate them (Salsbury, 2019). This promotes effective healing environment with optimum patient care. Hourly Rounding also fosters close communication and interaction with the patient, which reduces the patient’s anxiety. A study conducted by Jenko et al. (2019) shows that hourly Rounding decreased patient fall rates from 3.16 to 1.64 after implementation.
Consequently, environmental adjustments such as the installation of bed and chair alarms to alert the nurses when an individual’s patients make attempts to leave their beds or chairs are effective in preventing falls (Shee et al., 2016). Attaching alarms to the patient chair ensures that the patient is carefully monitored, and standby nurses avoid before it occurs. Consequently, Cuttler, Barr-Walker & Cuttler et al. (2017) assert that other environmental modifications may accompany the implementation of this intervention. Such modifications include signage patient beds, non-slip floors, and geriatric-friendly sanitary such as assist bars, handrails, and shower chairs, among others (Cuttler et al., 2017). This fosters effective monitoring of patients at every stage of care to enhance positive healthcare outcomes. Hourly Rounding and installation of bed and chair exit alarms, therefore effectively prevents falls, promotes positive patient healthcare outcomes, and improve patient safety (Cuttler et al., 2017).
Implementation Steps
Implementation of the quality improvement project will follow the Vordenberg et al., (2018) PDSA cycle of implementing organizational quality improvement plans. The PDSA steps include; Plan, Do, Study, and Act, which are approved by the agency for research and quality for the implementation of organizational change (Vordenberg et al., 2018). Under this model, both patients, their families, and internal stakeholders will be intimately involved in the implementation of the quality initiative. During the ‘plan’ stage, an implementation committee comprising of nurses, physicians, hospital technical teams, and executive management (Vordenberg et al., 2018). The team will evaluate the evidence-based guidelines surrounding the quality initiative and comprehensively discuss them. The implementation committee will then first identify the existing organizational resources which can support the quality initiative as well as the necessary additional required resources for implementation.
Consequently, the committee will identify a study site such as the orthopedic unit where the quality improvement initiative will be implemented and evaluated before rolling the program to the entire healthcare institution. This process would take about three months. During the ‘do’ process, the committee and nursing staff will implement the plan on the patients after installation of the bed and exit alarms as well as the establishment of hourly rounding schedules (Vordenberg et al., 2018). Before admission of the patients to the implementation site, tools such as Schmidt score or Morse Fall score can be used for assessment scores higher than three, indicating enhances fall risks. Hourly Rounding accompanied by assessment, provision of the hip protector to curb hip fractures, and surveillance through the bedside alarms will be monitored. Data will be collected periodically and followed to evaluate the effect of the quality initiative. During the ‘study,’ the progress and outcomes will be assessed, and the decision made based on the findings. Lastly, the ‘act’ stage will involve implementing the quality initiative based on the outcomes (Vordenberg et al., 2018).
Evaluation of the Quality Initiative.
To effectively evaluate the effectiveness of the quality Initiative, variables such as the number of patients falls, time, and the severity of effects will carefully be collected and monitored. Consequently, the rate of falls will be compared with the previous organizational statistics. Accordingly, control charts will be created to keep track of the progress as well as