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Running head: REVISION OF HOSPITAL PLAN-EOC-004

Revision of Hospital Plan-EOC-004 Katherine Astaneh East Tennessee State University Health Policy NURS 5001 Dr. Farrar August 2, 2013

REVISION OF HOSPITAL PLAN-EOC-004 Revision of Hospital Plan-EOC-004

In pursuit of a more feasible safety precautionary measures per our discussion, a meeting with the Safety Committee followed to discuss Article J-i-1 of Plan EOC-004 Safety Implementations/Reviews. During the meeting I have found that over the past five years falls is one of the primary sources of extended stay reasons region wide. Most interventions, (81%), included multiple components (e.g., risk assessments (often not validated), visual risk alerts, patient education, care rounds, bed-exit alarms, and post-fall evaluations)(Hempel et al., 2013, p. 483). The discussion brought to my attention that out of every 1000 patient-days in the hospital 3.4 of these are fall related (Volz & Swaim, 2013, p. 336). Current floor policy seems to be limited to the normative of wristbands, a one time education on admission regarding the usage of call light for assistive help, and the mentionable risk assessment checks marked in the daily assessment check. Before six months ago our patient census was strictly dialysis and the nurses knew the routine and medications. As you know we currently are serving several types of patients on our floor. From cardiovascular and Psych issues to seizure precaution management. The medications being administered contribute to falls by various direct and indirect mechanisms, including sedation, slight to total confusion, vision changes, increased lethargy, inability to ambulate properly and neuromuscular incoordination (Howland, 2009) and we are still attempting to implement the same regulations from the past. The Joint Commission National Patient Safety Goals (NPSGs) mandates that fall reduction programs be implemented in order to address the alarming incidence of patient falls in healthcare systems ("NPSGs," 2013). Our Corporate mission is Bringing Loving Care to Health Care not to bring additional issues that are unwanted and easily protected from with a few minutes daily added to staff routine.

REVISION OF HOSPITAL PLAN-EOC-004 Primarily patient falls occur with a necessity to get to or from the bathroom. The

implementation of education begins upon admittance for the need of a walker/ bedside commode (BSC) in the room for those with urgency to go. The staff is then given the information, taking into account age, diagnosis and physical ability and apply to their personal knowledge to decide if this patient is to be a high fall risk. Bed alarms are to be on at all times and checked each shift, by the shift leader or designate. A log is to be kept daily for evaluating the bed alarm to fall ratio system. Family members of patients are to be reminded that this is not a punishment but a safety measure placed into action for their loved one and are not to be turned off by anyone other than the nurse. The case manager and I have spoken with the Environmental Manager and expressed the need to maintain a minimum of one BSC and one walker for every two rooms on the unit. The manager has agreed this is a necessity that must be maintained on their part to assist with patient centered care (PCC). Secondly, large posters are to be placed on the wall at the foot of the bed in sight of patient and in bathrooms at the pull cord as a reminder to WAIT-Call for Assistance and avoid a fall. According to the National Institute on Aging (NIA), Using high-contrast color combinations, such as black type against a white background (2009, para. 4) with size 18 to 20 font will assist the elderly to see, read, and be reminded we are here to assist them. Environmental services have also agreed to maintain the signs, update placement as needed and validation of signs in each room when cleaning after discharge. Thirdly with each shift assessment nurses are to verify a patients ability to work the call light. The Quality Improvement Committee have determined that some patients are in need of a special call light that is easily triggered instead of the normal push button remote. The issue can trigger a long wait time for assistance, hence leading the patients to attempt to go themselves.

REVISION OF HOSPITAL PLAN-EOC-004 The least humiliating way to obtain this information is during the assessment of motor strength. Call lights are then to be attached to the bed to alert the PCP and nurses when the patient is moving out of bed and alarm is not heard the call light in the hallway will light up. Per our unit policy anyone in the vicinity should adhere to the No Pass Light Zone and assist as needed.

Another task to put into play to avoid falls during ambulation will be the distribution and upkeep of the skid socks. A patient may be in the hospital for several days and will need several pair. Each day the patient is to be offered a nice clean pair that fits according to their diagnosis for comfort. The cutting of socks to accommodate edema is not working. Patients are not leaving them on and then not calling out for assistance for fear of being seen without them and another fall occurs. Match them up, keep them clean, and change daily or as needed. Lastly, as you see attached are new High Fall Risk magnet stickers to post outside the door for transporters, Physical Therapy, Occupational Therapy, and others to see that may intend to get the patient up. This will enhance the patient safety when the nurse is not available to give complete report and serve as a reminder to complete hourly checks for bed alarm engaged, side rails in up position, clutter in floor, etc. Considering Falls are very common in older persons and can result in substantial disability and distress (Yardley & Nyman, 2007, p. 122). I submit for your consideration and approval these changes for the current Plan-EOC-004. Our goal is to be a fall free floor and adhere to company policy.

REVISION OF HOSPITAL PLAN-EOC-004 References Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., ... Ganz, D. A. (2013). Hospital fall preventions: A systematic review of implementation, components, adherence, and effectiveness. The American Geriatrics Society, 61, 483-494. http://dx.doi.org/10.1111/jgs.12169 Howland, R. H. (2009). Prescribing psychotropic medications for elderly patients. Journal of Psychosocial Nursing & Mental Health, 47(11), 17-20. http://dx.doi.org/10.3928/02793695-20090930-06. Joint Commissions National Patient Safety Goal (NPSGs). (2013). Retrieved J uly 29, 2013, from http://www.ahrq.gov/professionals/systems/long-termcare/resources/injuries/fallpxtoolkit/ National Institute on Aging. (2009). http://www.nia.nih.gov Volz, T. M., & Swaim, T. J. (2013). Partnering to prevent falls using a multimodal multidisciplinary team. The Journal Of Nursing Administration, 43(6), 336-341. http://dx.doi.org/10.1097/NNA.0b013e3182942c5a Yardley, L., & Nyman, S. R. (2007). Internet provision of tailored advice on falls prevention activities for older people: a randomized controlled evaluation. Health Promotion International, 22(2), 122-128. http://dx.doi.org/10.1093/heapro/dam007

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