Outcome measures enable healthcare organizations to identify gaps or clinical issues that must be improved to boost the quality and safety of care or enhance the delivery of healthcare. Thus, outcome measures or quality indicators guide the implementation of evidence-based practices (EBP) in clinical settings. Quality improvement (QI) specialists collaborate with interprofessional team members, in particular, nurse researchers, to identify underlying issues or gaps in clinical practices by comparing the organization’s outcome measures in a particular practice with its target score or established benchmark. A significant difference between the outcome measure and results necessitates the implementation of QI projects. Additionally, the change project team evaluates the availability of various resources or opportunities required for successful implementation of the EB change project during need assessment. However, the required resources significantly depend on the implementation of the EB project. The executive leadership and the top management support the implementation of EBP projects within the organization by providing required resources, including financial, technology, and human resources. Nonetheless, stakeholders’ support significantly depends on the effectiveness of the proposed change project in improving a specific patient outcome measure and related issues. This report presents outcome measures, issues, and opportunities related to high rates of patient falls in the healthcare organization’s PACU.
Organizational Processes, Functions, and Behaviors in High-Performing Health Care Organizations
High-performing healthcare organizations strive to excel in providing quality, efficient, and cost-effective medical care to achieve optimal patient outcomes. This goal is only achieved by enhancing the effectiveness of organizational processes, functions, and behaviors. Therefore, a high-performing healthcare organization must align its activities and procedures with its objectives and goals to achieve the desired quality of care and health outcomes. Effective leadership is considered the most essential functional element in these organizations. In high-performing healthcare organizations, leaders set clear vision, communicate directions with staff members regularly and frequently, and develop a continuous improvement culture (Al-Habib, 2020). These leaders also manage change effectively to ensure that achieved outcomes are sustainable in the constantly evolving healthcare industry. Moreover, leaders ensure effective management of the organization’s resources, including financial resources, physical assets, and human resources. Efficient allocation of resources and effective usage improve the quality of patient care in high-performing healthcare organizations.
Furthermore, high-performing healthcare organizations value processes. These organizations have adopted effective systems to enhance the care process from admission to discharge. These healthcare systems enhance patient assessment, physical examination, diagnosis, treatment initiation and management, and follow-up care (Brkic et al., 2021). High-performing healthcare organizations have adopted effective processes to enhance the management of patient flow via the healthcare system. Additionally, systems are used to manage staff workflows, ensuring that all healthcare professionals are working effectively and efficiently.
Finally, high-performing healthcare organizations consider adopting health behaviors. Staff members prioritize patient needs and are committed to the provision of high-quality patient care. In high-performing practice settings, healthcare providers are willing to go the extra mile to meet patient needs. Furthermore, staff are willing to collaborate with other interprofessional team members throughout the care process, enabling them to generate new ideas (Dellafiore et al., 2019). These collaborative efforts enable healthcare providers to make informed clinical decisions, achieving the desired outcome measures.
The Impact of Organizational Processes, Functions, and Behaviors on Outcome Measures Associated with Postoperative Patient Falls
Outcome measures of interest are related to patient fall rates, such as increased treatment costs. A gap analysis indicated a significantly high prevalence of postoperative patient falls in the PACU. The increased rate of patient falls in this unit is associated with organizational processes, functions, and behaviors. First, the healthcare organization’s management has contributed to the increased fall rates through its functions. The management has failed to ensure adequate resource allocation in the PACU despite the comprehensive and critical nature of care services provided to postoperative patients in this department. Consequently, interprofessional healthcare providers working in the unit are unable to meet all patient’s needs, exposing them to adverse health issues related to patient falls. For instance, inadequate nurse staffing in the PACU compromises nurses’ hourly rounding. As a result, staff fail to identify patients at a high risk of falling, resulting in the high cost of treating fall-related health complications.
Moreover, the organization has not reduced fall risk in the PACU through modification of its processes. For instance, the management has not invested in monitoring devices and alarm systems in the PACU despite patients receiving medical care in this unit being highly vulnerable to falls (Safavi et al., 2019). Thus, postoperative patients are exposed to a high treatment cost due to fall-related expenses. Lastly, healthcare professionals’ behaviors have significantly contributed to high fall-related treatment costs among postoperative patients admitted to the PACU. In this department, critical care nurses and other interprofessional team members have not embraced the culture of patient quality and safety. Hence, they are reluctant to monitor postoperative patients closely, exposing them to fall-related high treatment expenses.
The Quality and Safety Outcomes and Related Measures Relevant to Postoperative Patient Falls
In the PACU, the increased prevalence of postoperative patient falls mainly emerges from hitches on the medical facility’s quality and safety measures. Therefore, quality and safety outcomes are relevant in the collection and interpretation of data about postoperative patient falls in the PACU. Various safety and quality tools should be used effectively in measuring the outcomes related to various quality outcome indicators, including healthcare processes, organizational structure, patient perceptions, and systems. The PACU should implement an effective and proper system to capture data about patient fall frequency. The unit’s management will utilize data derived from the outcomes to curb postoperative patient falls in the department. In the PACU, patient falls mostly arise from jeopardized movements due to anesthesia-related sedation. Thus, applying proper quality and safety measures in this department would effectively reduce patient falls and the high treatment costs related to them.
The PACU department must provide all postoperative patients with safety companions to minimize patient falls in this unit (Close the gap). The companion would assist the patient in moving around or leaving the bed or the chair, preventing strain or struggle experienced by postoperative patients when sitting, standing, or walking (Ünver et al., 2024). Additionally, PACU staff should detect a high fall risk among postoperative patients with leg or hand injuries. The fall risk is even higher among postoperative patients with other comorbidities, including hypotension, heart disease, and dementia, due to poor vision, dizziness, and other impairments. Further safety measures, including close-care administration and safety rounds, are recommended to reduce fall risk in postoperative patients.
Performance Opportunities and Issues related to Organizational Operations and their Effect on Safety and Quality Outcomes
Performance opportunities or issues are attributed to the organization’s activities associated with patient falls-related safety and quality outcomes. Successful management of patient falls in the PACU requires effective leadership, resource allocation, and proper management. These factors will contribute to a significant decline in fall risk in the PACU. The healthcare organization is responsible for promoting the quality and safety of patient care by creating a conducive environment and eliminating health hazards. Thus, the PACU management should ensure that patients’ beds are relatively low to promote safety. Additionally, ambulation facilities should be readily accessible to reduce fall risk. The floor should be kept dry with adequate lighting to reduce fall risk. Moreover, the PACU management should ensure adequate nurse staffing to maintain the recommended patient–to–caregiver ratio. Consequently, nurses will provide patients with a high fall risk with walk assistance and conduct hourly rounds to address patients’ needs and reduce fall risk. However, some postoperative patients might be against the idea of being allocated a walk assistance. In such cases, staff should maintain boundaries as a way of adhering to their professional standards and ethical code of conduct. Failure to provide postoperative patients with walking assistance or monitor them closely would expose them to fall-related injuries or fractures in their legs or hands.
A Strategy That Would Enhance the Measuring of Patient Care and Disseminating Knowledge to the Staff
Healthcare organizations should adopt an initiative that would reduce postoperative falls through a change model. The unit management should also collaborate with QI specialists in measuring all significant aspects of patient care. The knowledge derived from outcome measures will be disseminated to the staff members to inform them about the need for interprofessional collaboration in bridging the gap in practice. A change model should be incorporated into the implementation of the change intervention to guide the project team throughout the implementation process. Lewis’s change model would be applied in implementing change intervention to reduce patient falls in the PACU. This change model is recommended since it creates the need for change in the clinical facility, resulting in stakeholders’ support (Harrison et al., 2021). Secondly, the model would enable the PACU to move towards achieving the desired organizational behavior that would result in fall reduction. Lastly, the model would facilitate the full adoption of the new behavior in the PACU, making the reduction in postoperative falls sustainable. Therefore, the Lewis model would contribute to the achievement of desired patient fall rates in the PACU.
Conclusion
Outcome measures create opportunities for quality and safety improvement in clinical settings. The outcome data and effective communication facilitate interprofessional collaboration during the implementation of a change project. Interprofessional team members would collaborate with QI specialists in implementing a fall prevention program in the PACU. The rate of postoperative patients would reduce significantly in this unit, improving the quality and safety of patient care. The project team members should disseminate knowledge to PACU staff members to gain their support throughout the implementation process. Incorporating the Lewis change model would ensure the successful adoption and sustainability of the new patient fall prevention program.
References
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Ünver, S., Yildirim, M., Akbal, S., & Sever, S. (2024). Challenges experienced by cardiac intensive care nurses during first out‐of‐bed patient mobilization after open‐heart surgery: A descriptive phenomenological qualitative study. Journal of Advanced Nursing, 3 (4): 1-7. https://doi.org/10.1111/jan.16091
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