PICOT question for a chosen clinical problem.
Among adult inpatients on a med-surgical unit (P), how does the implementation of a fall prevention protocol (I) compared to current practice (C) impact the rate of falls (O) over three months (T)?
A line drawing depicting a person performing leg exercises by extending their legs out in front while holding weights has been included. This graphic illustrates exercises to improve strength and mobility that could help address falls in post-op orthopedic patients.
Falls are a significant issue impacting patients recovering from orthopedic surgery on this unit. Delbaere et al. (2021) found that 30% of postoperative orthopedic patients experienced at least one fall during their inpatient stay, with half resulting in injury. Post-surgical impairments like new pain, weakness, or mobility limitations increased fall risk. However, the researchers also demonstrated that regaining movement and strength through targeted lower body exercises was correlated with reduced falls and faster functional recovery times (Delbaere et al., 2021). Implementing a prevention strategy combining evidenced safety protocols with individualized strengthening exercises tailored for muscular deficits can minimize fall risk and support discharge goals in this population, according to the literature.
Action plan
The recommended practice change is implementing a standardized fall risk screening and individualized intervention plan for each patient. Nurses will complete a validated assessment tool at admission, during transitions of care, and daily, considering factors like mobility, vision, medication use, and cognitive status. From this, physiotherapists will design targeted exercises, and nurses will implement non-pharmacological strategies such as rounded footwear, scheduled bathroom visits, and customized patient education (Randell et al., 2023).
The timeline involves a six-month pilot project commencing in July after staff training. Two medical units will begin screenings and plan implementation in August to allow for the identification and addressing of challenges. The initiative will expand unit by unit each month to achieve full hospital adoption by December. Monthly compliance checks and fall rates will track success.
Essential tools needed include the screening tool integrated into the electronic documentation system and alert triggers (Wayne, 2023). Exercise equipment, visual reminders in rooms, and compliance monitoring through rounding and huddles will also support consistency. Education module access, both online and on units, ensures all staff learn the evidence and their roles.
Stakeholders, opportunities for innovation, and potential barriers
The stakeholders impacted by this practice change include patients, nurses, nursing assistants, physical therapists, physicians, hospital administrators, and quality leaders. A significant opportunity lies in creating a streamlined fall risk screening tool integrated within the existing electronic health record system (Wayne, 2023). This would allow for a simplified assessment process with automated documentation and compliance tracking. However, several barriers may challenge implementation efforts. Lack of dedicated time could negatively impact staff engagement with the new protocol due to busy clinical demands. Ensuring prescribers consistently order indicated prevention strategies presents another difficulty. Resource constraints may also arise if needs for additional supplies emerge from initial screenings. Addressing these issues thoroughly during the planning phase will help facilitate successful adoption across units throughout the project. Regular feedback from all groups can then guide further refinement.
Overcoming Barriers:
Strategies to address potential barriers include offering just-in-time education and video modules that can be accessed virtually on department tablets or computers for staff without dedicated time for in-services. This allows self-directed learning around individual schedules. Meeting with hospital administrators to submit a proposal for planned equipment purchases as part of regular capital replacement planning would be required to procure additional supplies over time. To enhance patient compliance, prescribing providers and nursing staff will need to communicate fall risks and goals of fall prevention as part of discharge planning conversations (D’Souza et al., 2022). Conducting leadership rounding will allow real-time identification of and problem-solving support for units facing challenges with implementation.
Outcome criteria proposal
The proposed outcome criteria for evaluating the effectiveness of the fall prevention protocol include monthly measurement of fall rates per 1000 patient days, percentage of patients receiving daily risk assessments as documented, and number/severity of falls resulting in injury.
Outcomes will be measured through monthly audits of fall data and compliance with risk screening recordings in the health records. Monitoring these metrics will demonstrate the impact on fall and injury incidence experienced by patients.
The selected outcomes align with the Quadruple Aim goals. Reduced falls and injuries improve patient experience through safer care while lowering costs associated with injury treatment. Regularly collecting compliance data ensures that best practice guidelines are followed consistently.
After six months of evaluating the outcomes, the results have the potential to guide necessary updates to further optimize fall prevention processes. For example, particularly successful components could be strengthened, while ineffectual elements may warrant replacement based on findings. Insights may also support dissemination of the protocol to other clinical areas or inform revisions to organizational policies and standards of care. More broadly, documenting the project outcomes contributes to shaping evidence-based practice and quality improvement in patient fall reduction.
Quadruple Aim Impact:
Implementing a fall prevention protocol directly impacts all aspects of the Quadruple Aim through reduced fall rates, leading to better patient outcomes and experience, decreased costs from shortened hospital stays and injury treatment, and increased staff satisfaction from participating in quality improvement efforts (Morris et al., 2022). Conducting outcome evaluation through metrics like fall rate, staff compliance, and injury data will measure the impact. This data can then guide further practice changes to continue enhancing quality and safety and reducing hospital-acquired conditions, with a focus on value-based reimbursement. Lessons learned can also influence facility-wide fall prevention strategies to benefit the whole health system.
Search Strategy:
I searched CINAHL, PubMed, and Cochrane databases from January 2020 to March 2024 using the key terms “fall prevention,” “fall protocol,” “inpatient fall*,” and “multifactorial fall intervention.” These indexes were selected as they index nursing and medical literature. The search was limited to peer-reviewed articles in the English language. Reference lists of relevant articles were also reviewed to identify additional studies not found in the database search. In total, six articles were identified that discussed interventions to reduce inpatient falls in acute care settings.
Resources:
The literature consistently shows that comprehensive fall risk assessments and multifactorial interventions that target modifiable risk factors are most effective at reducing fall rates. Studies directly comparing single interventions like wristbands or footwear to multifactorial protocols found that multifactorial approaches significantly reduced fall rates (Wayne, 2023). For example, a systematic review and meta-analysis found that multifactorial interventions reduced fall rates by 13-30% compared to usual care. This proposed action plan incorporates conducting comprehensive risk assessments and targeting modifiable risk factors, supported by high-quality systematic reviews and meta-analyses.
Action Plan Feasibility:
The timeline of phasing education and implementation over six weeks is feasible as it allows staff to be trained staggered during everyday workflows to address time constraints. Conducting education and rollout of the new fall protocol in phases, such as starting on one unit and progressively rolling out to other units, will help identify and address any challenges early on before full implementation. The use of existing equipment, such as non-slip footwear and wristbands, and aligning the protocol with standards of care enhances realistic adoption into everyday practices (Wayne, 2023). Compliance can be promoted through regular follow-up by unit leaders and engaging staff to problem-solve identified barriers as a team.
In conclusion, falls among postoperative orthopedic patients present a significant safety challenge and barrier to recovery on the unit. While surgery often contributes to new impairments, elevating fall risk, regaining adequate strength and mobility is equally essential for functional outcomes and discharge planning. The evidence supporting a multifaceted prevention strategy combining standardized precautions with individualized therapeutic exercises provides a framework for a much-needed practice change. Implementing a formal fall protocol that addresses patients’ postoperative rehabilitation needs holds promise to impact both incident rates of falls and patient satisfaction positively. Ongoing evaluation of outcomes is necessary to ensure the solution proves genuinely effective for this vulnerable population. With stakeholder engagement and attention to barriers, this evidence-based project is hoped to lead to optimized fall safety precautions and recovery progress for orthopedic surgical patients.
References
Delbaere, K., Valenzuela, T., Lord, S. R., Clemson, L., Zijlstra, G. R., Close, J. C., … & Van Schooten, K. S. (2021). E-health StandingTall balance exercise for fall prevention in older people: results of a two year randomized controlled trial. bmj, 373. https://www.bmj.com/content/373/bmj.n740.short
Randell, R., McVey, L., Zaman, H., Wright, J., Cheong, V-Lin., Dowding, D., Gardner, P., Hardiker, N., Healey, F., Lynch, A., & Alvarado, N. (2023). Designing health IT to support falls prevention in hospitals: Findings from a realist review. AMIA … Annual Symposium Proceedings. AMIA Symposium, 2022, 902–911. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10148347/
Wayne, G. (2023). Risk for Falls – Nursing Diagnosis & Care Plan. Nurseslabs. https://nurseslabs.com/risk-for-falls/
Turner, K., Bjarnadottir, R., Jo, A., Repique, R. J. R., Thomas, J., Green, J. F., & Staggs, V. S. (2020). Patient Falls and Injuries in U.S. Psychiatric Care: Incidence and Trends. Psychiatric Services, 71(9), 899–905. https://doi.org/10.1176/appi.ps.202000004
D’Souza, A. N., Said, C. M., Leggett, N. E., Tomkins, M. S., Kay, J. E., & Granger, C. L. (2022). Assessment tools and factors used to predict discharge from acute general medical wards: a systematic review. Disability and Rehabilitation, 44(14), 3373-3387. https://journals.sagepub.com/doi/abs/10.1177/00178969211032711
Morris, M. E., Webster, K., Jones, C., Hill, A. M., Haines, T., McPhail, S., … & Cameron, I. (2022). Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing, 51(5), afac077. https://doi.org/10.1093/ageing/afac077
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