REDUCING PATIENT FALLS IN THE MEDICAL-SURGICAL UNIT 1

Change Project: Part 1

Reducing Patient Falls in the Inpatient Medical-Surgical Unit

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REDUCING PATIENT FALLS IN THE MEDICAL-SURGICAL UNIT 2

Background

One of the most cited and expensive adverse events in the healthcare context is patient

falls, and in particular, it proves more dangerous in medical-surgical in-patient wards. The

Agency for Healthcare Research and Quality (AHRQ) estimates that about 700,000 patients

experience falls in healthcare institutions across the United States every year (AHRQ, 2019).

Such high incidence rates not only endanger the safety of patients, but also result in severe and

fatal injuries such as internal bleeding, head trauma, and hip fractures among others (AHRQ,

2019). Subsequently, falls pose a grave risk to patient outcomes, negatively affect nursing

morale, and generate a negative perception of healthcare institutions.

The last one year has recorded a significant increase in fall related incidents at the

inpatient medical surgical wards. A recent review of the fall incidents in the revealed that most

falls happened during movement to the restrooms, patient transfers, and as patient tried to walk

independently after treatment without adequate assistance. The primary causes associated with

majority of the falls include poor fall risk identification during shift changes, late responses to

call lights, and insufficient patient monitoring (LeLaurin & Shorr, 2019).

The increasing rates of patient falls is not only alarming due to its physical harm to the

patients but also the emotional trauma, extended hospital stays, and the subsequent financial

costs. The financial burden also weighs on the hospitals as they cannot be reimbursed for

expenses incurred for hospital-acquired injuries that are preventable such as falls as stipulated by

the Centers for Medicare & Medicaid Services (CMS) guidelines (Dykes et al., 2017). Thus,

establishing and enforcing interventions that reduce patient falls is both an operational and

clinical imperative.
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Stakeholders

To achieve optimal results, the interventions aimed at reduce patient falls require the

collaboration among multiple stakeholders who bring in different views, undertake various

obligations, and provide the necessary resources. The success of the fall prevention intervention

demands the support of both internal and external stakeholders.

Internal Stakeholders

a. Nurses

Nurses are the most critical group in preventing patient falls. This is primarily because

they have the responsibility of evaluating patient fall risk, educate them on safety measures,

carry out fall protocols, and record any changes in the ability of a patient to move independently.

Nonetheless, due to shortage of the workforce, assignment of straining duties, nurses

compromise the consistent responsiveness to signs of immobility and calls for assistance.

b. Unit Managers

Unit managers in collaboration with charge nurses will contribute significantly to the

implementation of the proposed interventions since they allocate resources, assess performance,

and ensure policy compliance. They will, therefore, play a central role in holding the nurses

accountable and enforcing the required protocols.

c. Quality Improvement and Risk Management Teams

The quality improvement and risk management teams will contribute by collecting and

analyzing data on patient falls and subsequently providing feedback. This will be crucial in

providing evidence-based interventions.

d. Physicians
REDUCING PATIENT FALLS IN THE MEDICAL-SURGICAL UNIT 4

Physicians will take part in evaluating sedatives and that increase the risk of falls and

subsequently adjust where needed.

e. Occupational Therapists

Occupational therapists will assess the mobility level of patients, and provide

recommendations for assistive exercises or devices.

f. Patients and their Families

Educating patients about the risk of falls and preventive strategies is critical in

implementing the proposed interventions. Caregivers, who, in most cases, involve family

members, contribute significantly in supporting a patient for mobility and raising alarm when

they observe changes in a patient’s mobility capability.

External Stakeholders

a. Hospital Administration

The proposed safety initiatives require significant resources, which calls for the support

of senior leaders to oversee system-wide enforcement.

b. Accrediting Bodies

The proposed interventions ought to meet regulatory standards and hence require the

approval of regulatory organizations to ensure adherence.

c. Advocacy Groups and Community Partners

The implementation of the proposed changes will need the support of rehabilitation

centers, non-profit organizations, and other partners to ensure the fall preventions efforts are

sustainable.

Benefits

Internal Stakeholders External Stakeholders

a. Enhanced Patient Outcomes a. Lower Financial Costs

Fewer or no injuries, reduced hospital stays, Less extended hospital stays, fewer

enhanced recovery process litigations, fewer surgical interventions

b. Improved Employee Morale b. Enhanced Institutional Perception

Lower emotional burden and stress and Lower fall rates will improve patient

enhanced job satisfaction satisfaction rates

c. Operational Efficiency c. Safety Standards Compliance

Improved workflow, lower investigative Meet regulatory standards and accreditation

workload, reduced paperwork

Challenges

Notwithstanding the numerous benefits expected, the implementation of the fall

prevention project faces several challenges, particularly because it involves diverse stakeholders

and has projected operational restraints.

Internal Challenges External Challenges

a. Employee Resistance to Change a. Cost Benefit Analysis

Employees tend to be skeptical of new Leaders involved may be skeptical about the

policies and view them as extra burden. It cost of proposed interventions

may require training and effective

communication.

b. Training b. Regulatory Pressure

Successful implementation will need Regulatory bodies my impose very high

consistent training which requires limited standards to be met before issuance of

funding and time allocations. compliance certificates

c. Communication Barriers c. Community Follow-Up

Training in proper communication especially Primary care providers and community health

during shift changes will help promote a partners will play a central role in ensuring

culture of active listening. patient safety post-discharge which can be

complex for individual institutions.

d. Limited Resources

Fall prevention efforts require significant

resources which may not be readily available

Conclusion

An intervention to reduce patient falls in the medical-surgical unit is a critical and timely

change project that aligns with quality improvement needs and patient-centered holistic care.

Since the project involves multiple stakeholders, the project will address both systemic and

human causes and hence develop interventions capable of enhancing safety, reducing harm, and

optimizing care delivery. Notwithstanding the projected challenges, particularly in allocating

resources, the expected benefits are overwhelming to patients, providers, and the institution at

large making it worthwhile and essential. To achieve the optimal outcomes of the project, there

is need for transformative leadership, effective communication, and collaboration.

References

Agency for Healthcare Research and Quality. (2019). Preventing falls in hospitals: A toolkit for

improving quality of care. U.S. Department of Health and Human Services.

[Link]

Dykes, P. C., Carroll, D. L., Hurley, A. C., Lipsitz, S., Benoit, A., Chang, F., Meltzer, S.,

Tsurikova, R., Zuyov, L., & Bates, D. W. (2017). Fall prevention in acute care hospitals:

A randomized trial. JAMA, 318(4), 351–359. [Link]

LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: State of the

science. Clinics in Geriatric Medicine, 35(2), 273–283.

[Link]