Patient falls are correlated with an increase in negative outcomes including patient mortality, and yet there is evidence that falls and mortality have been increasing in recent decades (Johnson et al., 2011). The importance of data evaluation and interpretation to the continuous improvement of patient quality and safety cannot be underestimated, as it provides the evidence needed to determine the extent of the problem and the risk factors as well as whether positive change is occurring. The purpose of this paper is to outline how data can be used by nurse leadership to transform the organizational context while reducing the risk with regard to patient falls, thereby leading to better outcomes and increased quality of care.
Improving the outcomes with regard to the patient fall rate requires using the developed benchmarks as a basis for assessment, and this requires capture and analysis of data. First and foremost, the data must be accurate, as the clues to quality improvement will be found in the details of the data. If the data is not based on accurate information then the quality improvement plan may be based on fallacies.
Most falls in the data captured regarding patient falls in a telemetry unit note that it is the hours between 3am and 11am where there is the greatest risk. In fact, over sixty percent (61.7%) of falls occur during this time. A similar risk is posed by weekends, as the period between 7pm on a Friday and 7am on Monday represents over half (55.3%) of all falls. Clearly there is the greatest risk for falls for patients in the morning and on weekends. In fact, just the falls on weekend mornings, that is Saturday between 3am and 11am, account for over one quarter (27.7%) of all falls during the week. The period from Monday at 7am to 11pm on weekdays, on the other hand, accounts for less than thirty percent (29.8%) of falls.
Clearly there is a need to review what is different with regard to those time periods, including nurse scheduling, patient activities and other factors that may be influencing the rate of falls. It may be that it is more difficult during these times for patients to find assistance when trying to go to the bathroom, or it may be that nurses and other workers are more distracted during this time. By understanding the statistical increase in risk for falls during this time, observation and monitoring can provide insights which lead to systematic actions which reduce the fall rate for patients, leading to better outcomes including decreased mortality.
Quality Improvement Plan
The Code of Ethics for Nurses provides guidance for nurse leadership regarding how to approach quality improvement. Provision 3, for example, makes clear that the health and outcomes for a patient come first and foremost, even above compliance with policies or processes (Fowler et al., 2008). Quality improvement should not stray from this moral requirement.
A quality improvement plan would include reviewing the causes of patient falls with a view to risk reduction, development of a social marketing plan to raise awareness of staff, patients and families regarding how they can improve the outcomes by preventing patient falls, research to determine new methods of risk reduction and mitigation by translating evidence into practice and a monitoring plan to capture and assess ongoing data regarding patient falls in order to evaluate whether there had been improvement. This would be a cooperative effort with the objective of identifying from multiple perspectives the perceived reasons why falls increase during this time.
Healthcare administrators and nurse leaders must be able to leverage collaboration and cooperation, and to that end a chief characteristic of the successful leader is the ability to motivate all stakeholders (Goh et al., 2013).
Ideally this includes the cultivation of a patient safety culture, and this would require communicating to staff the increased risk of falls between 3am and 11am as well as the increased risk of falls on the weekend.
Further, Provision 7 of the code requires that nurses commit themselves to quality improvement of their own skills and competencies, and this would include the ability to analyze data in order to improve patient outcomes as well as the translation of evidence into practice (Fowler et al., 2008). To that end, a nurse can learn new methodologies and techniques for data analysis, including the plan-do-check-act approach, Lean Six Sigma analysis, root cause analysis, and failure mode effects (Seidl & Newhouse, 2012). Increasing proficiency does not indicate simply taking a class or workshop, but rather using and practicing these methods until they become second nature. Nurse leaders can improve the level of safety through improvement efforts based on data evaluation techniques, but in order to capture the data and interpret it the nurse leader must engage staff, patients and other stakeholders (Fagan, 2012). It is in motivating the participation of all that the main leadership component lies.
The role of the leader in evaluating data in order to lead quality improvement initiatives is to set targets, determine areas for improvement, monitor progress and communicate this information to other stakeholders in a motivational way. Quality improvement for patients begins with ensuring quality data and it is implemented through quality leadership. For the leader who wishes to succeed in a quality improvement initiative in the area of improvement patient outcomes relating to falls in a telemetry unit they must engage all stakeholders in the reduction of the fall rates. This would include a targeted intervention which begins with trying to determine why falls increase during the weekend at in the mornings but it would also include insights regarding falls at any time of day. These insights, as well as research of other regarding similar situations, will help to determine approaches which will result in a reduction then monitoring the implementation to such initiatives to see if they are successful in reducing the fall rate of patients.
- Fagan, M. (2012). Techniques to improve patient safety in hospitals: What nurse administrators need to know. The Journal of Nursing Administration, 42(9),426–430.
- Fowler, M. D., & American Nurses Association. (2008). Guide to the code of ethics for nurses: Interpretation and application. Silver Spring, MD: American Nurses Association Silver Springs, MD: Nursesbooks.org
- Goh, S., Chan, C., & Kuziemsky, C. (2013). Teamwork, organizational learning, patient safety and job outcomes. International Journal of Health Care Quality Assurance, 26(5), 420–432.
- Johnson, J., Veneziano, T., Green, J., Howarth, E., Malast, T., Mastro, K., Moran, A., Mulligan, L., & Smith, A. (2011). Breaking the fall. The Journal of Nursing Administration, 41(5), 538–545.
- Seidl, K. & Newhouse, R. (2012). The intersection of evidence-based practice with 5 quality improvement methodologies. The Journal of Nursing Administration, 42(6), 299–304.