Dissemination of Results

Complete your abstract when your project is complete

2. Identify what you plan to do with your findings and actually do it.

A. Publish

B. Place information in nursing lounge; name and email left for staff/patient should they want to discuss findings

C. Complete a package for the stakeholders, which includes brochure, PPT, pre-test/post-test, to be used at the later time

Fall Risks Reduction
Workshop in a
Nursing Home
NAME
COURSE
DATE
ABSTRACT
Patient falls are common in nursing homes and a threat to patients’
safety and quality of care. This project aimed to determine whether
an evidence-based educational workshop on preventing resident falls
in nursing homes could increase knowledge in nursing staff and
consequently reduce the rates of falls. A pre-test was conducted to
determine the nurses’ level of knowledge prior to the intervention.
After the workshop, a post-test questionnaire was also conducted to
determine differences. The data was analyzed on Microsoft Excel
using a t-test statistical approach. The mean of nurses’ knowledge
improved from 10.4 to 15 and mode changed from 10 to 15. A pvalue of 0.000038 indicated a statistically significant difference
hence increase in knowledge. The project shows the effectiveness of
workshops to improve nurses’ knowledge and consequently reduce
fall rates in nursing homes.
INTRODUCTION
• A fall is any event in which a person involuntarily comes to rest
on the floor or a lower surface with considerable force. In
healthcare, falls are unwanted and a major safety risk.
• Past research has shown that falls are the leading cause of injury
among older adults and can be minimized through the
implementation of evidence-based practice (EBP) interventions
(Florence et al., 2018). Falls and fall-related injuries among older
adults in long-term care facilities can result in decreased ability to
maintain baseline independence, a need for constant assistance or
supervision, and a decline in quality of life.
• With increasing age and a decline in their medical condition,
older adults are more likely to remain in the hospital longer
after sustaining a fall-related injury (WHO, 2017). Falls are
not only a major contributor to functional decline among older
adults but can also lead to increased healthcare costs and
increased economic burden.
BACKGROUND
• The project will be implemented in a nursing home. The
nursing home hosts 25 residents and is located in New
Jersey.
• Nursing homes in New Jersey have high rates of patient
falls leading to increased rate of disability and poor quality
of life (New Jersey Department of Health, 2020).
• In the specific nursing home, the rates of resident falls had
increased by 30% in the previous year leading up to the
quality improvement project.
• This led to poor safety and health outcomes in the
nursing home which should be addressed through
preventive interventions.
PROBLEM STATEMENT
•The lack of knowledge on fall prevention in the nursing home has
led to high rates of falls and hence lower safety of residents.
•Nurses have an ethical responsibility to solve this health hazard.
•The problem of focus for this project is that the rates of falls in the
nursing home indicate inadequate patients’ safety and lack of
knowledge and skills to reduce falls.
•This project aimed to increase staff knowledge on risk reductions
for falls.
PURPOSE STATEMENT
•This project seeks to develop an effective educational tool for fall
risks reduction in the nursing home.
•The purpose of this project is to improve the safety of residents at
the nursing home through enhanced staff knowledge on fall safety.
•An evidence-based educational workshop was developed to
educate staff.
OBJECTIVES
• This project had three main objectives:
1. The first objective was to develop an evidence-based fall
prevention workshop to educate nurses on fall prevention
in the nursing home.
2. Secondly, the project sought to develop PowerPoint
presentation with the key issues considered in the
education process.
3. Third, it was meant to develop a brochure to augment the
workshop processes.
ASSESSMENT METHODS
• Pre-test and post-test questionnaire
• ADDIE worksheet to evaluate content validity
• PowerPoint presentation
• Educational brochure
METHODOLOGY
•Planning phase: the objectives and processes were established: increasing nurses’ knowledge on fall rates
reduction.
•Do: The pre-test questionnaire administered. The questionnaire contained 17 closed ended questions. Then,
a workshop augmented by the slides presentation and brochure was carried out.
•Check: Evaluation of outcomes. Descriptive statistics of frequency distribution were conducted to
determine knowledge levels before and after implementation. T-test for hypothesis testing.
•Act: After determining the effectiveness of the intervention, a review of the results with stakeholders was
conducted. A reflection on implications on practice was conducted.
EVALUATION OF RESULTS
• The results were analyzed using a t-test in Microsoft Excel. In
the t-test, pre-test scores were compared with the post-test scores
to determine whether there was a significant difference.
• The mean for pre-test was 10.4 and that of the post-test was
15. The mode also changed from 10 to 15.
• The p-value statistic was 0.000038. At a 95% significance level, a
test statistic of less than 0.05 indicates a significant difference.
• Based on these findings, there was significant improvement in
self-rated knowledge of fall risks reduction among the nurses.
SIGNIFICANCE TO PRACTICE
• Based on these findings, the objectives of the project were
met. The workshop was associated with a significant
improvement in nurses’ knowledge of fall risk reduction
in the nursing home.
• The PowerPoint presentation and brochure were effective tools
for the workshop and the project indicated an effective means of
improving safety through staff training.
• A review of the workshop with stakeholders showed that it is
feasible, acceptable, and effective in falls reduction.
• This implies that the workshop should be implemented in
the future to improve patients’ safety and care quality.
CONCLUSION
• The project sought to reduce residents’ fall rates in a
nursing home through improvement in nurses’ knowledge of
fall prevention and reduction.
• The nursing home has been experiencing an increase in
fall rates among older residents.
• The intervention was a workshop used to train nurses on
patient falls and how to reduce them.
• The education tool was effective in improving nurses’
knowledge and this change is anticipated to reduce fall
incidents in the future.
• The success of this project indicates the utility of workshops
in improving nurses’ knowledge in patient risk reduction.
REFERENCES
Florence, C. S., Bergen, G., Atherly, A., Burns, E., Stevens, J., & Drake, C. (2018). Medical costs of fatal and
nonfatal falls in older adults. Journal of the American Geriatrics Society, 66(4), 693-698.
https://doi.org/10.1111/jgs.15304
Hessels, A., Paliwal, M., Weaver, S. H., Siddiqui, D., & Wurmser, T. A. (2019). Impact of patient safety culture
on missed nursing care and adverse patient events. Journal of Nursing Care Quality, 34(4), 287.
https://doi.org/10.1097/NCQ.0000000000000378
New Jersey Department of Health. (2020, Sept. 8). Falls among New Jersey residents, inpatients and Emergency
Department visits, 2019. New Jersey Center for Health Statics.
https://www.state.nj.us/humanservices/doas/documents/Falls%20Among%20Elderly%202019.pdf
REDUCING RESIDENT FALLS IN THE
NURSING HOME
AIDA CINO
THE FALLS PROBLEM
 The nursing home had 30%
increase in falls this last year
 Falls cause injuries such as
broken bones, fractures, &
sprains
OLDER ADULT FALLS
FALLS RISK ASSESSMENT
1. JOHN HOPKINS TOOL
 There are 7 categories: age, fall
history, elimination, medications,
patient care equipment, mobility,
and cognition
 Use the tool by checking boxes
that accurately represent the
client condition
 Minimum of 0 and maximum of
28 points for fall risk assessment.
2. TIMED UP AND GO
 Assessing mobility on timed
walking test
1. Client will wear regular footwear
and sit on a standard arm chair
2. Identify a line 3m or 10 ft. away
3. Instruct client to get up, walk to the
line, and come back to sit in the
chair.
4. If they take 12 seconds or more,
they are at risk of falling
3. MORSE FALL RISK ASSESSMENT
 Rapid assessment method
with 6 items:
 Final scale score determines
level of risk from ‘No risk’ to
‘high risk’
4. ALLEN COGNITIVE SCREEN
 Falls related to cognition
 Allows the provider to evaluate six
cognitive levels and 26 modes of
cognition
 1) Automatic action, 2) postural
actions, 3) manual actions, 4) goaldirected actions, 5) exploratory, and
6) planned actions
 Depending on the level of cognitive
action, the client’s fall risk is
determined
UNIVERSAL FALL PRECAUTIONS
Maintain these for all residents:
1. Environment safety and clients’ comfort
2. Familiarize client with environment
3. Client should use call light
4. Keep environment decluttered
5. Keep bed brakes locked
6. Keep environment well-lit
7. Floor should be clean & dry
8. Provide clients with nonslip footwear
EVIDENCE-BASED INTERVENTIONS
 Hourly rounding- Hourly visits integrating fall risk assessment
 Fall risk assessment to pay more attention to the most at-risk clients
 Resident education and counselling interventions
 Exercise interventions
 Multifactorial intervention programs
RECOMMENDATIONS
What you can do:
 Access the fall risk assessment tools from
relevant websites for day to day use
 Assess risk of falls using the John Hopkins
tool which is a comprehensive risk
assessment tool
 Develop individualized risk reduction
interventions for each client
REFERENCES
Centers for Disease Control and Prevention. (2020, October 8). Older adult fall prevention.
https://www.cdc.gov/falls/index.html
Park, S. H. (2018). Tools for assessing fall risk in the elderly: A systematic review and meta-analysis. Aging
Clinical and Experimental Research, 30(1), 1-16. https://doi.org/10.1007/s40520-017-0749-0
Sherrington, C., Fairhall, N., Wallbank, G., Tiedemann, A., Michaleff, Z. A., Howard, K., & Lamb, S. (2020).
Exercise for preventing falls in older people living in the community: An abridged Cochrane
systematic review. British Journal of Sports Medicine, 54(15), 885-891.
http://dx.doi.org/10.1136/bjsports-2019-101512
Schoberer, D., Breimaier, H. E., Zuschnegg, J., Findling, T., Schaffer, S., & Archan, T. (2022). Fall prevention in
hospitals and nursing homes: Clinical practice guideline. Worldviews on Evidence‐Based Nursing, 19(2),
86-93. https://doi.org/10.1111/wvn.12571
Recommendations
Evidence-Based
Interventions
There is no one sure way of reducing
falls. However, some interventions have
been studied widely:
•
Hourly rounding- Hourly visits
integrating fall risk assessment
•
Fall risk assessment to pay more
attention to the most at-risk clients
•
Resident education and counselling
interventions
•
Exercise interventions
•
Multifactorial intervention
programs
•
Access the fall risk assessment tools
from relevant websites for day to day
use
•
Assess risk of falls using the John
Hopkins tool which is a comprehensive
risk assessment tool
•
Develop individualized risk reduction
interventions for each client
References
Centers for Disease Control and Prevention. (2020,
October 8). Older adult fall prevention.
https://www.cdc.gov/falls/index.html
Park, S. H. (2018). Tools for assessing fall risk in the
elderly: A systematic review and metaanalysis. Aging Clinical and Experimental
Research, 30(1), 1-16.
https://doi.org/10.1007/s40520-017-0749-0
Sherrington, C., Fairhall, N., Wallbank, G.,
Tiedemann, A., Michaleff, Z. A., Howard, K., &
Lamb, S. (2020). Exercise for preventing falls in
older people living in the community: An
abridged Cochrane systematic review. British
Journal of Sports Medicine, 54(15), 885-891.
http://dx.doi.org/10.1136/bjsports-2019101512
Schoberer, D., Breimaier, H. E., Zuschnegg, J.,
Findling, T., Schaffer, S., & Archan, T. (2022).
Fall prevention in hospitals and nursing
homes: Clinical practice guideline. Worldviews
on Evidence‐Based Nursing, 19(2), 86-93.
https://doi.org/10.1111/wvn.12571
REDUCING
FALLS IN THE
NURSING
HOME
Fall Risk Assessment
Tools
1. John Hopkins Fall Risk Assessment
Universal Fall
Precautions
Environment safety and clients’ comfort:
Risk stratification tool
The tool is used for fall risk calculation
with 7 categories: age, fall history,
elimination, medications, patient care
equipment, mobility, and cognition
•
Familiarize client with environment
•
Client should use call light
•
Keep environment decluttered
•
Keep bed brakes locked
•
Keep environment well-lit
•
Floor should be clean & dry
2. Timed up and Go
•
Provide clients with nonslip
footwear
Assessing mobility on timed walking test
Healthcare provider will check boxes
that accurately represent the client
condition.
Minimum of 0 and maximum of 28
points for fall risk assessment.
Client will wear regular footwear and sit
on a standard arm chair
Identify a line 3m or 10 ft. away
Instruct client to get up, walk to the line,
and come back to sit in the chair.
If they take 12 seconds or more, they are
at risk of falling
3. Morse Fall Risk Assessment
Comprehensive fall risks assessment
using a rapid assessment method with 6
items:
Fall history, Secondary diagnosis,
Ambulatory aid, IV/Heparin Lock,
Gait/Transferring, & mental status
Final scale score determines level of risk
from ‘No risk’ to ‘high risk’
4. Allen Cognitive Screen
Falls related to cognition
Allows the provider to evaluate six
cognitive levels and 26 modes of
cognition
Automatic action, postural actions,
manual actions, goal-directed actions,
exploratory, and planned actions are
evaluated
Depending on the level of cognitive
action, the client’s fall risk is determined