31 Oct Students will review the facility procedure/clinical protocol. Students will locate an evidence-based practice article on the assigned procedure/protocol
ASSIGNED TOPIC: PREVENTING FALLS IN THE ACUTE CARE FACILITY
ASSIGNED HOSPITAL: OVERLOOK MEDICAL CENTER: Address: 99 Beauvoir Ave, Summit, NJ 07901
Task:
Students will review the facility procedure/clinical protocol.
• Students will locate an evidence-based practice article on the assigned
procedure/protocol and compare and contrast this information with the facility
procedure/protocol.
• Students will identify whether evidence-based practice is utilized and identify barriers
or challenges with implementing evidence-based practice in the clinical setting.
• Students will create an assignment discussing their findings.
• A copy of the procedure and the evidence-based article will be submitted to the
faculty along with the assignment.
•APA format and include a bibliography.
The assignment must be authentic, a plagiarism device will be used.
Rubric attached
Sources that must be included have been attached to this request
When using articles please include the source and citations
Notable interventions/procedures for fall prevention:
1. Assessment
a. All patients are assessed for fall risk using the Johns Hopkins Fall Risk Assessment tool on admission
b. Reassessments required every shift, upon transfer, on change in patient condition, and post-fall.
2. Interventions
a. See Appendix A for complete list
b. Use of Fall ID bands
c. High fall risk signs posted outside the room (white/yellow for high fall risk, red for patients who fell during their admission)
d. Bed alarms
i. Centrella smart beds: Our newer beds featuring lights allows at-a-glance checking if side rails are up, bed alarms on, and if bed is in lowest position. Note green light for active (in-use), yellow for inactive.
e. Hourly rounding: Shared responsibility between PCT and RN; frequently address pain, toileting, positioning, etc. during hourly rounds to reduce risk for falls. Reaching for out-of-reach items and needing to the toilet are common pre-fall activities.
f. Chair alarms (Posey chair alarm)
i. For use for fall-risk patients who are OOB to chair
ii. Connects to our call bell system, producing a loud alert and sending high-priority alarms to nursing stations while flashing the call light outside the patient room when triggered
g. Use of roll belt (not considered a restraint) and/or lap belts (when OOB to chair)
h. Patient spotters/sitters: a PCT or staff member tasked with staying with patient at all times to ensure patient safety
i. Incident reports and post-fall evaluations for quality improvement
3. Unit-specific fall initiatives (10CD)
a. Case review during staff meetings: RNs present their fall incident during staff meetings to raise awareness of commonly occurring issues leading to falls, and what processes/workflow can be improved on the unit
b. Early Mobility Initiative
i. LPNs and/or PCTs focus on mobilizing all abled patients with the idea of reducing fall rates by preventing functional decline during their stay at the hospital
c. Mobility board: located on patient's white board, communicates mobility function of patients (i.e. 2-person assist vs 1-person assist, bedpan vs OOB to toilet/commode, etc.). Informs any staff member responding to a patient's call how patient toilets, walks, and identifies any mobility issues and restrictions.
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Administrative Policy & Procedure
Subject: Adult Fall Risk Assessment and Management – (Inpatient/Observation and Emergency Department (ED))
Effective Date: 02/20/2023
Primary Responsibility: Chief Nursing Officers
Executive Summary:
It is the policy of Atlantic Health System (AHS) to implement a fall risk assessment and fall management plan which outlines risk reduction strategies to prevent patient falls and a safe environment.
The purpose of the policy is to provide a fall risk assessment and individualized fall prevention interventions for emergency department (ED) patients and Inpatient/Observation patients 18 years of age and older, who have been identified as a falls risk. An individualized fall prevention plan will be established for patients identified at risk for falls.
Definitions:
Patient fall: an unplanned descent to the floor or extension of the floor (e.g., trash can or other equipment), with or without injury to the patient. All falls are to be included whether they result from physiological reasons (fainting) or environmental reasons (slippery floor). Also included are assisted falls, when a staff member attempts to minimize the impact of the fall.
Practitioner: a physician, dentist, podiatrist, fellow, resident, certified nurse midwife, advance practice nurse, or physician assistant, credentialed to perform the procedures described in this document.
Procedure:
Assessment:
Patients will be assessed for a fall risk utilizing an approved evidenced based fall risk assessment tool.
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Reassessment:
• Patients will be reassessed for fall risk by a nurse every shift. • Patients will be reassessed for fall risk upon transfer to another level of care within the facility. • Patients will be reassessed for fall risk when there is a noted change in the patient’s condition.
This may include but is not limited to: a. Alteration in mental status, i.e., as a result of delirium, sedation, change in medication. b. Alteration in vital signs. c. Post fall.
Interventions:
1. Patients who are identified as a fall risk will be provided appropriate recommended interventions, per nursing clinical judgment, as outlined in Appendix A.
2. Post Fall Interventions a. Assess the patient’s condition, complete a post fall assessment, and document
findings b. Provide immediate supportive care c. Contact the practitioner for medical assessment/intervention d. Report if a fall is unwitnessed to a practitioner to discuss consideration of routine vital
signs and neurological assessments e. Schedule and perform any ordered post fall assessment or diagnostics STAT f. Hold any routine care and testing until patient is cleared by a practitioner g. Initiate high risk interventions, if not already implemented h. Complete post fall evaluations (i.e., “Swarm” – post fall huddle) i. Notify manager or designee of all falls j. Notify risk manager of all falls resulting in moderate to severe injury
Documentation:
1. Documentation of fall risk assessment/reassessment is completed by utilizing the fall risk assessment tool.
2. Document Fall Prevention Plan of Care/Interventions 3. Document education provided to the patient and/or family 4. If a fall occurs, record each occurrence in the patient’s electronic health record and
include: a. Description of the event and date and time of occurrence b. Notification to practitioner including date and time notified c. Notify designated family member/emergency contact when applicable. d. Complete post fall patient assessment e. Follow up diagnostic procedure or treatment
f. Protective measures and/or additional interventions instituted/changed after fall
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5. Complete a report with the electronic event reporting system, pursuant to the Atlantic Health Event Reporting policy.
Quality Monitoring:
1. Determination of the program effectiveness will be evaluated by each site and at the system level, based on overall hospital fall rates.
2. Report out at unit or site-specific huddle.
References:
Joint Commission 2023 Hospital Accreditation Standards – Provision of Care – PC.01.02.08 EP 1 & 2
https://www.jointcommission.org/sea_issue_55/ Sentinel Event Alert 55: Preventing falls and fall-related injuries in health care facilities
Johns Hopkins Fall Risk Assessment tool www.hopkinsmedicine.org/institute_nursing reviewed 5/2017
National Database for Nursing Quality Indicators (NDNQI) reviewed 5/2017
Preventing Falls in Hospitals: A Toolkit for Improving Quality of Care (Agency for Healthcare Research and Quality) reviewed 5/2017
CMS Resident Assessment Instrument -MDS 3.0 RAI Manual v1.14 and MDS forms, effective October 1, 2016; https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment Instruments/NursingHomeQualityInits/MDS30RAIManual.html
Review/Approval Summary: AHS Practice Council (APC) AHS Policy Oversight Committee (APOC) and AHS Nursing Leadership
Origination Date: 02/08/2018 APC Approval Date: 02/17/2023
Last Revision Date: 12/05/2019 APOC Approval Date: 02/01/2023
AHS Nursing Leadership Approval Date: 02/17/2023
Page 3 of 4 APPENDIX A – Fall Prevention Intervention by Risk Category
Low Fall Risk Moderate Risk High Risk
Fall Risk Score: 0-5 points Fall risk score 6-13 points Fall Risk score > 13 points
Maintain Safe Environment, including • Remove excess equipment/ supplies / furniture from rooms and hallways • Bed in the lowest position • Assure adequate lighting especially
at night • Keep floors clutter / obstacle free
with attention to path between bed bathroom/commode
• Coil and secure excess electrical and telephone wires
• Clean all spills in patient rooms or in hallways immediately. Place signage to indicate wet floor danger.
Basic safety interventions: • Orient patient to surroundings
including bathroom location use of bed and location of call light.
• Educate patient / family about fall risk assessments, fall injury risk, routine and special interventions for fall prevention
• Encourage patients / families to call for assistance when needed “Call don’t fall”
• Place call bell and frequently needed objects within patient reach • Answer call bell promptly • Keep bed in lowest position • Keep top two side rails up as an enabling device while in bed
• Secure brakes on beds, stretchers and wheelchairs
• Use properly fitting nonskid footwear (encourage personal appropriate footwear)
• Ensure special instructions given for vision and hearing impaired
• For patients that require assistive devices ensure that patient is safe and independent with use prior to leaving device within reach.
• Purposeful rounding
Communicate Fall Risk: • See low fall risk • Identify patient at risk for falling with yellow ID band and room identifier • Communicate fall risk to all providers
including during transport and transfers
• Consider transfer on stretcher when appropriate.
Implement measures listed under low fall risk AND: • Assist with mobilization/ ambulation
and transfers
• Supervise and /or assist bedside sitting personal hygiene (ADL’s) and toileting as appropriate
• Reorient confused patients • Establish elimination schedule, including the use of bedside commode / urinal, raised toilet seats as appropriate
Evaluate need for: • Physical Therapy consult if patient has
a mobility impairment, decreased strength decreased balance and /or decreased endurance
• Activation of bed alarm, chair alarms/ toilet alarms as per nursing judgement
• Consider using restraint alternatives
Communicate fall risk: • See low and moderate fall risk
Implement measures listed under low/moderate risk AND:
Implement the following: • Remain with patient / direct
observation when toileting (in bathroom / using a commode or urinal)
Evaluate need for: • Moving patient to room with best visual access to nursing station
• 24-hour supervision / constant observer
Consult with LIP regarding the need for:
• Physical therapy consult if patient has a mobility impairment, decreased strength, decreased balance and/or decreased endurance.
• Pharmacy review for potential medication changes
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HUDSON COUNTY COMMUNITY COLLEGE NURSING PROGRAM
NURSING 110 – FALL 2024
GRADING RUBRIC FOR EVIDENCE BASED PRACTICE PAPER
CONTENT |
0 Point |
5 Points |
10 Points |
15 Points |
20 Points |
25 Points |
30 Points |
35 Points |
Possible score |
Points earned |
Introduction |
Procedure/ clinical protocol not presented in introduction. |
Procedure/ clinical protocol presented in Introduction. |
5 |
|||||||
Body of Paper/Key Issues (why procedure is important, is EBP practiced) |
Key issues not discussed. |
Alluded to issues but did not fully discuss. |
Discussed some key issues, but did not compare EBP to practice |
Discussed key issues, but barriers and challenges not included |
Discussed all issues, including key concepts including barriers and challenges |
35 |
||||
Summary Paragraph |
No summary paragraph. |
Included a summary paragraph, but did not include suggestions for change based on EBP |
Included a summary paragraph and included suggestions for change based on EBP. |
10 |
||||||
Page Requirement |
Did not meet 2-page requirement. (Max 4 pgs.) |
Met 2-page requirement that included intro, key issues w/ related concepts & summary. |
5 |
|||||||
Bibliography/Articles |
No bibliography or articles included with paper. |
Included a bibliography, but no articles attached |
Included a bibliography and attached protocol/ procedure, but not the article |
Included a bibliography and attached protocol/ procedure and article |
25 |
|||||
Format |
Not APA style. |
Some in APA style. |
Follows APA style. |
10 |
||||||
Spelling/Grammar |
More than 10 spelling/ grammar errors |
One to 9 spelling/ grammar errors |
No spelling or grammar errors |
10 |
||||||
TOTAL POINTS EARNED FOR GROUP PAPER |
100 |
|||||||||
COMMENTS: |
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