Nurse-Sensitive Quality Indicator: Nursing Care Plan Strategies to Address Falls

Nurse-Sensitive Quality Indicator: Nursing Care Plan Strategies to Address Falls

Introduction

Medical professionals play a crucial role in addressing community needs by integrating clinical inquiry, bridging clinical practice with scientific knowledge and research findings. Today’s healthcare practitioners possess the ability to synthesize information from diverse sources and disciplines. They cultivate an inquiry-driven mindset and disseminate evidence-based knowledge to drive improvements in medical practice (Lundy & Janes, 2016). This is particularly pertinent when addressing the issue of falls within an inpatient rehabilitation unit. This paper aims to present evidence highlighting the problem of falls in this setting and propose evidence-based solutions to address this concern.

Discussion

Incidence of Falls in the Inpatient Rehab Unit

An analysis of the variation between actual fall incidence and targeted incidence, as indicated by nurse-sensitive quality indicators, reveals a trend of improvement within the inpatient rehab unit. Initially, the unit struggled to achieve its targeted fall incidence, with the highest variation reported in the first quarter of 2006 at 21.44. Over time, there has been progress in reaching the desired figures, with the most favorable variation results recorded in the first quarter of 2010 at -6.05 (refer to Figure 1). Given the evolving variation figures, it becomes evident that protocols need to be established to effectively reduce fall incidence.

An Exploration of Baudrillard’s Ideas on Hyperreality


An examination of falls data in relation to staffing levels reveals a correlation. Notably, there is a negative correlation between the percentage of Bachelor of Science in Nursing (BSN) staff and total falls, indicating that an increase in BSN-qualified nurses is associated with a reduction in falls. Conversely, an increase in the percentage of certificate nurses is linked to a higher number of falls (see Table 1 and Figure 2). This correlation can be attributed to the higher knowledge and proficiency levels of BSN-qualified nurses, making them better equipped to mitigate fall incidents.

Table 1. Correlation between mean falls figures, percentage BSN, and percentage certification
TOTFALLS %BSN % CERT
TOTFALLS 1
%BSN -0.28555 1
% CERT 0.123284 0.586249 1


Understanding the Problem from a Nursing Perspective

The identified problem is the incidence of falls within the inpatient rehab unit. It is essential to identify nursing practice approaches to eliminate these incidents. Natan, Heyman, and Israel (2016) acknowledge specific factors contributing to falls in rehabilitation facilities, particularly among high-risk patients. Patients with unique characteristics at high risk of falls can be identified and targeted for intensified nursing intervention to reduce the likelihood of falling. Consequently, nursing personnel in rehabilitation units can refine their operational procedures to eliminate fall risks (Weber & Kelley, 2013).

Nursing Interventions to Eliminate Risks and Incidents of Falls in a Rehabilitation Unit

Three nursing strategies have been identified to address the presented problem. The first strategy involves increased nursing supervision of high-risk patients based on demographics. This requires the employment of more knowledgeable and proficient nurses, as they are better prepared to reduce fall incidence. It involves reviewing falls data to determine demographic implications such as gender, age, ethnicity, and specific conditions. Patients falling within high-risk demographics should be designated for fall precaution, have this information recorded in their charts, and be subject to restraint use when deemed necessary. For instance, Natan, Heyman, and Israel (2016) report a 14% fall risk among elderly patients in rehabilitation units. The study further highlights that males with a normal BMI, cardiovascular ailments, a history of transfer from internal medicine, and high activity levels during rehabilitation are more susceptible to falls (Natan, Heyman & Israel, 2016). Hunt (2016) similarly emphasizes the importance of identifying high-risk patients through screening tools and providing focused care to reduce fall incidence. Therefore, nursing personnel should closely supervise patients identified as being at the highest risk of falls in rehabilitation units and target them for enhanced supervision.

The second strategy involves engaging patients and their family members during the admission process to inform them about the importance of collaborative efforts in preventing fall incidents. Treatment side effects and deconditioning in the rehabilitation unit can lead to falls, as patients may overestimate their functional abilities and take unnecessary risks. Since nurses can only attend to patients periodically, involving patients and their families in the care planning process can raise awareness of fall risks, educate them on prevention strategies, and encourage active implementation of fall prevention measures even when nursing staff are not present (Vonnes & Wolf, 2017).

The final strategy consists of screening patients for fall risk and orienting them to the rehabilitation environment. This screening assesses mobility and stability skills, including sitting, walking, and standing. It provides insights into patients’ functional abilities, enabling nurses to plan for safety improvements and address areas of concern. Additionally, nursing personnel should review medications to determine whether they increase fall risk and collaborate with the care team to assess the necessity of these medications (Bulechek et al., 2013).

Conclusion

Nurses play a pivotal role in addressing medical needs through their close interactions with patients and their professional expertise. The variation in fall incidence reported within the inpatient rehab unit is a concern, indicating a gap between actual and target fall figures. To address this issue from a nursing perspective, three strategies have been proposed. The first strategy involves increasing nursing supervision for high-risk patients, designating them for fall precaution, and recording relevant information. The second strategy encourages collaborative efforts by involving patients and their families in fall prevention. The final strategy focuses on screening patients for fall risk and familiarizing them with the rehabilitation environment. Overall, implementing these strategies is expected to reduce the incidence of falls in the inpatient rehab unit.

References

Bulechek, G., Butcher, H., Dochterman, J. & Wagner, C. (2013). Nursing interventions classification. St. Louis, MO: Elsevier/Mosby.

Hunt, K., (2016). Keeping our frail and elderly patients out of hospital. Practice Nurses, 46(2), 16-20.

Lundy, K. S. & Janes, S. (eds) (2016). Community health nursing: caring for the public’s health (3rd ed.). Burlington, MA: Jones & Bartlett Learning.

Natan, M., Heyman, N. & Israel, J. (2016). Identifying risk factors for elder falls in geriatric rehabilitation in Israel. Rehabilitation Nursing, 41, 54–59.

Vonnes C, Wolf D. (2017). Fall risk and prevention agreement: engaging patients and families with a partnership for patient safety. BMJ Open Quality, 6(2), e000038. doi: 10.1136/bmjoq-2017-000038. Retrieved from https://bmjopenquality.bmj.com/content/6/2/e000038