EP1EOa

 

Professional Practice Model EP1EO

 

Using the required empirical outcomes (EO) presentation format, provide one example of an improved outcome associated with an evidence-based change made by clinical nurses in alignment with the organization’s professional practice model (PPM).

  1. Provide a schematic of the PPM

 

 

Example a: Clinical Nurses Incorporate Evidence-based Practice to Decrease Falls

Problem
Catholic Health Initiatives (CHI) St. Vincent Hot Springs (SVHS) 4E Medical/Surgical (4E) unit had an increased incidence of falls in February 2024.

 

Pre-Intervention

The CHI SVHS Falls Committee met in February 2024. It included Kaitlyn Atkins, MSN, RN, CPN, Clinical Director of Nursing; Allison Fitts, RN, CMSRN, Clinical Nurse/Nursing Supervisor 4 East (4E) Medical/Surgical; Chae Brewer, MSN, RN, Clinical Nurse/Nursing Supervisor 2 West Oncology/Renal; Jessica Bray, BSN, RN, Clinical Nurse/Nursing Supervisor 2 East Cardiology; Regina Lopez, BSN, RN, Clinical Nurse/Nursing Supervisor 4 West Medical/Surgical/Pediatrics; Barbara Erby-Ellis, MSN, RN Nurse Manager 5 East Orthopedics/Neurosurgery; Jeannie Roberts, BSN, RN, Nurse Manager 1 East Geripsych; and Lissa Salvatori, BBA, BSN, RN, CPHQ, Quality.


Fitts presented the 4E fall rate for February 2024, which was 4.27 per 1000 patient days. The meeting participants identified the following factors contributing to the increase in falls:

  • Patient blacked out while ambulating with two staff members. The fall could have been prevented by using a gait belt.
  • Patient attempted to get out of bed without pressing the call button. The staff reinforced education on use of the call light.
  • Patient attempted to get out of bed without help. The bed alarm was not turned on. The fall could have been prevented if the fall alarm had been turned on and functioning.

 

The Falls Committee discussed a new falls form from CommonSpirit Health (CSH) (the parent company of CHI SVHS) that was to be incorporated into post-fall huddles conducted with the team working during the time of any falls. Information included on the CSH fall form includes the immediate cause of the fall, which is determined by asking the patient what occurred and noting what they say is the immediate cause. A decision tree is then used to determine the type of fall (accidental fall, anticipated physiological fall, or unanticipated physiological fall). Determining the type of fall helps the team identify proactive strategies to prevent further falls and identify learnings that can be shared with other departments. The nurse caring for the patient at the time of the fall completes the post-fall debrief form and submits it to the unit nursing leader. Decreasing patient falls aligns with the CHI SVHS Professional Practice Model (PPM).

 

The graphic of the PPM that guides CHI SVHS includes a white cross in the center as a reminder that the SVHS ministry is a continuation of the healing ministry of Jesus Christ. Colorful pieces of stained glass surround the cross, reflecting the elements of Relationship Based Care (RBC): Professional Nursing, Teamwork, Care Delivery, Leadership, Caring and Healing Environment, Resources, Outcomes, Quality, and Accountability. The three primary relationships of RBC are with the patient and family, oneself, and coworkers. The PPM includes the motto of SVHS’s patron saint, St. Vincent de Paul, “The Love of Christ Compels Us.” (Evidence EP1EOa-1, CHI SVHS PPM)

 

Goal Statement

Decrease the fall rate on 4E at CHI SVHS.

 

Participants

 

 

Falls Workgroup

 

Name/Credentials

Discipline

Title/Role

Department

Kaitlyn Atkins, MSN, RN, CPN

Nursing

Clinical Director of Nursing

Nursing Administration

Allison Fitts, RN, CMSRN

Nursing

Clinical Nurse/ Nursing Supervisor

4 East Medical/Surgical

Chae Brewer, MSN, RN

Nursing

Clinical Nurse/ Nursing Supervisor

2 West Oncology/Renal

Jessica Bray, BSN, RN

Nursing

Clinical Nurse/ Nursing Supervisor

2 East Cardiology

Barabara Ellis- Erby, MSN, RN

Nursing

Nurse Manager

5 East Orthopedics/ Neurosurgery

Jeannie Roberts, BSN, RN

Nursing

Nurse Manager

1 East Geripsych

Lissa Salvatori BBA, BSN, RN-CPHQ

Nursing

Program Manager – Quality & Patient Safety

Quality

Regina Lopez, BSN, RN

Nursing

Clinical Nurse/ Nursing Supervisor

4 West Medical/ Surgical/Pediatrics

 

Description of the Intervention
March 2024

  • Fitts, the 4E fall champion, educated the 4E clinical nurses and patient care techs during daily safety huddles on the importance of ensuring the new CSH post-fall huddle form is completed during the huddle after each fall to identify areas of opportunity in the moment to prevent other falls. The falls champions are employees who are passionate about and educated on fall prevention; they help to ensure fall precautions are in place for patients on the unit, and they ensure the 4E team is aware of trends in patient falls identified on the unit. The falls champions are key members of the team working to prevent falls on the unit. They participate in reviewing data collected from the post-fall forms and post-fall huddle discussions, which are used to track and trend reasons for falls and ways to prevent them.
  • The CSH fall form and huddle was a new process for the 4E team. Previously, CHI SVHS had a debrief form that was used to gather clinical information on how the fall occurred. The use of the new CSH fall form enhances coworkers’ knowledge and skills in identifying various types of falls and fall prevention strategies based on the type of fall.
  • The education that Fitts provided included the need for the primary caregiver to complete the CSH post-fall huddle form during the post-fall huddle. It is typical for three to four clinical team members, including interdisciplinary members, to participate in post-fall huddle discussions. The post-fall huddles, which last approximately 15 minutes, are conducted within 15 minutes of the fall with the patient and family/caregiver present. The immediate cause of the fall is determined by asking the patient to describe what occurred and the reason for the fall in their own words. Based on the immediate cause of the fall, the Decision Tree for Types of Falls was used to determine the type of the patient’s fall:
    • Accidental fall – Fall that occurs due to extrinsic environmental factors or hazards (spills on the floor, tripping on clutter, tubing/cords on the floor, errors in judgment, etc.)
    • Anticipated physiological falls – Involve factors associated with known fall risks such as loss of balance, impaired gait or mobility, impaired cognition/confusion, or impaired vision. Anticipated falls occur due to the patient’s physiological status, history of falls, or decreased mobility upon assessment.
    • Unanticipated Physiological Falls – Involve factors associated with unknown fall risks that cannot be predicted using a fall risk scale: unexpected orthostasis, extreme hypoglycemia, stroke, heart attack, seizure, etc.

 

Proactive strategies to prevent further falls are also discussed during post-fall huddles. The strategies are shared from shift to shift and documented in the medical record.

  • The post-fall huddles give all coworkers working during the time of the fall an opportunity to discuss how the fall occurred, opportunities for improving patient safety, how the fall could have been prevented, and how to prevent further falls. The post-fall huddles demonstrate teamwork and create a caring and healing environment that can improve outcomes and the quality of care for patients in alignment with the PPM.
  • The incorporation of the fall form and fall huddles was aligned with evidence-based practice. The use of post-fall huddles results in positive perceptions of teamwork support for reducing fall risk and a culture of safety (Jones, et al., 2019). Huddles are a team-based approach to reporting, adapting, and learning (Jones et al., 2019).
  • The post-fall huddles enable analyses of falls. Analyzing falls and implementing injury reduction strategies reduces fall-related harm (Zubkoff, et al., 2016).

 

The interventions were fully implemented by the end of March 2024.

 

Clinical nurses’ implementation of the evidence-based change of incorporating post-fall forms and huddles, in alignment with the PPM, led to an improvement in an outcome, with decreased falls in the CHI SVHS 4E Medical Surgical Unit.

 

References

Jones, K. J., Crowe, J., Allen, J. A., Skinner, A. M., High, R., Kennel, V., & Reiter-Palmon, R. (2019). The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: A quasi-experimental evaluation of a patient safety demonstration project. BMC Health Services Research, 19(1). https://doi.org/10.1186/s12913-019-4453-y

 

Zubkoff, L., Neily, J., Quigley, P., Soncrant, C., Young-Xu, Y., Boar, S., & Mills, P. D. (2016). Virtual breakthrough series, part 2: Improving fall prevention practices in the Veterans Health Administration. The Joint Commission Journal on Quality and Patient Safety, 42(11). https://doi.org/10.1016/s1553-7250(16)42092-1

 

Outcome

(Evidence EP1EOa-2, CHI St. Vincent Hot Springs 4 East Falls Rate Graph)