Mobile Logo in White
Search/Quicklinks

Texas Falling Star Prevention Program

Principal Investigator: Clarissa Silva Herrera, RN, MSN
Co-Principal Investigator/Collaborator: Jerry Asumbrado, Susan Richardson-Alecozay
Organization: UT Health Science Center at San Antonio School of Nursing

Abstract

Problem

The Texas Falling Stars Prevention Program is designed to reduce the rate of falls, reduce the severity injury and contain cost.

Evidence

The team conducted a random 20 inpatient records review on clients between the ages of 18–90; a data analysis on the types of injuries and falls rate; a root cause analysis; an environmental assessment; and a review of the literature. The 20 inpatient records showed 80% of the initial risk assessment and 40% of the daily fall risk assessments were completed. However, hospital wide fall rates were 7.05 for a period of six months which were higher than the national average of 3.6. The data analysis revealed 50% of the falls occurred during the day and 45% occurred in the evening. The root cause analysis showed 68% of the falls occured in patient rooms and 18% in patient bath rooms.

Strategy

The EBP literature review revealed a best practice approach is using multiple interventions. The Hendrich II tool for fall assessment has validity and interrater reliability measuring 100% agreement; electronic version for fall assessment individualizes and facilitates communication; interdisciplinary falls teams, staff and patient education are vital in falls prevention programs.

Practice Change

The Texas Falls Prevention Program components include: implementation of the Hendrich II fall risk model for fall assessment including an optional electronic version; creation of a falls team; education of staff regarding tool and documentation; visual cues; hip protectors; and restructure of variance process.

Evaluation

Patient Satisfaction Surveys, Cost Analysis, Data Analysis and Staff Compliance should be used to provide an objective oriented approach to evaluate the Texas Falling Star Prevention Program.

Recommendations

Acute care hospital facilities and staff need continued reinforcement of fall prevention strategies because of aging environments and staff turnover. Implementation of falls prevention programs using a standardized model is recommended.

Bibliography

  • American Association of Colleges of Nursing [AACN] (2006, May). Clinical nurse leader & health care initiatives.[Electronic version]. Retrieved September 15, 2007 from http://www.aacn.nche.edu/CNL/partnershipresources.htm.
  • American Association of Colleges of Nursing (AACN) (2006, May). End of program competencies & required clinical experiences for the clinical nurse leader. [Electronic version]. Retrieved September 15, 2007 from http://www.aacn.nche.edu/CNL/partnershipresources.htm..
  • Agostini, J. V., Baker, D. I., & Bogardus, S. T. (2007). Prevention of falls in hospitalized and Institutionalized older people. [Electronic version].
  • Alcee, D. (2000). The experience of a community hospital in qualifying and reducing patient falls. [Electronic version]. Journal of Nursing Care Quality, 14, 43–53. Retrieved November 6, 2007 from EBSCO data base.
  • Barnett, K. (2001–2002, January–March). Reducing patient falls project. [Electronic version]. Mid Yorkshire Hospitals NHS Trust, 1–31. Retrieved from EBSCO data base.
  • Center for disease control. (2007). Costs of falls among older adults. [Electronic version].
  • Center for disease control. (2007). CDC fall prevention activities. [Electronic version]. Retrieved November 9, 2007 from http://www.cdc.gov/ncipc/duip/FallsPreventionActivity.htm.
  • Cox, K. & Warren, C. (2004, August). A strategy and action plan for falls and fracture prevention in Buckinghamshire. [Electronic version]. Retrieved October 30, 2007 from http://www.dh.gov.uk/PolicyAndGuidance/
    HealthAndSocial/CareTopic/OlderPeopleM    .
  • Dempsey, J. (2003, July). Falls prevention revisited: a call for a new approach. [Electronic version]. Journal of Clinical Nursing, 13, 479–485. Retrieved November 5, 2007 from EBSCO data base.
  • Eakman, et al. (2002). Fall prevention in long–term care: an in–house interdisciplinary team approach. [Electronic version]. Top Geriatric Rehabilitation, 17, 29–39. Retrieved September, 11, 2007 from EBSCO data base.
  • Englebardt, S. & Nelson, R. (2002). Health care informatics: An interdisciplinary approach. St. Louis, Missouri: Mosby.
  • Gray–Miceli, D. (2007). Fall risk assessment for older adults: The Hendrich II fall risk model. [Electronic version]. The Hartford Institute for Geriatric Nursing. Retrieved September 15, 2007 from http://www.hartfordign.org.
  • Hart–Hughes, S. & Haley, J. A. (2004, May). Balance assessment handbook. [Electronic Version]. Falls toolkit, 1–9. Retrieved October 18, 2007 from veterans library.
  • Hendrich, A. (2006, May–June). Inpatient falls: lessons from the field. [Electronic version]. Patient Safety and Quality Healthcare.
  • Hendrich, A. L., Bender, P. S. & Nyhuls, A. (2003, February). Validation of the Hendrich II fall risk model: a large concurrent case/control study of hospitalized patients. [Electronic version]. Applied Nursing Research, 16, 9–21. Retrieved October 5, 2007 from EBSCO data base.
  • Hofmann, M. T., Bankes, P. F., Javed, A. & Selhat, M. (2003). Decreasing the incidence of falls in the nursing home in a cost–conscious environment: a pilot study. [Electronic version]. Journal of American Medical Director Association, 4, 95–97. Retrieved September, 11, 2007 from EBSCO data base.
  • Hook, M. L. & Winchel, S. (2006, December). Fall–related injuries in acute care: reducing the risk of harm. [Electronic version]. Medical Surgical Nursing, 15, 370–379. Retrieved November 6, 2007 from http://www.medsurgnurse.org.
  • Hospital X. (2004, May). Policy and procedure on falls; quality committee patient safety and quality report; 24 hour patient flow sheet; admission history and assessment; variance report follow–up obtained from quality risk manager.
  • Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st Century, Washington DC: National Academy Press.
  • Joint Commission (2007, July). National patient safety goals. [Electronic version]. Retrieved September 25, 2007 from http://www.jointcommission.org.
  • Joint Commission (2007, July). Sentinel event policy and procedure. [Electronic version].
  • Lancaster, et al. (2007, July). Preventing falls and eliminating injury at ascension health. [Electronic version]. The Joint Commission Journal on Quality and Patient Safety, 33, 367–375. Retrieved November 7, 2007 from EBSCO data base.
  • National Database of Nursing Quality Indicators. (2007, June). Guidelines for data collection and submission on quarterly indicators. [Electronic version]. Retrieved October 29, 2007 from NDNQI national data base.
  • McCarter–Bayer, A., Bayer, F. & Hall, K. (2005, March). Preventing falls in acute care an innovative approach. [Electronic version]. Journal of Gerontological Nursing, 25–32. Retrieved October 10, 2007 from EBSCO data base.
  • McKenzie, J. F., Neiger, B.L., & Smeltzer, J. L. (2005). Planning, implementing, and evaluating health promotion programs. San Francisco, California: Pearson Education Inc.
  • Melnyk, B. M, & Fineout–Overholt, E. (2005). Evidenced–based practice in nursing and healthcare: A guide to best practice.
  • Poe, S. S., Cvach, M. M., Gartrell, D. G., Radzik, B. R., & Joy, T. L. (2004, May). An evidence–based approach to fall risk assessment, prevention, and management: lessons learned. [Electronic version]. Journal of Nursing Care Quality, 20, 107–116. Retrieved October 10, 2007 from EBSCO data base.
  • Stein, L. (1997). The electronic medical record: Promises and threats. [Electronic version]. Web Journal, 2, 1–13. Retrieved November 17, 2007 from http://www.oreilly.com/catalog/wjsum97/excerpt/index.html.
  • Sulla, S. & McMyler, E. (2006, November). Falls prevention at Mayo clinic Rochester a Path to quality care. [Electronic version]. Journal Nursing Care Quality, 22, 138–144. Retrieved October 16, 2007 from EBSCO data base.
  • U.S. Department of Health and Human Services. (1998–2003, September). Evidence report and evidence–based recommendations: falls prevention interventions in the medicare population. [Electronic version]. Retrieved November 6, 2007 from center for Medicare Services website.
  • Veterans Hospital Association. (2004, May). Hip Protectors. [Electronic version]. pp. 91–93.
  • Veterans Hospital Association. (2004, May). NCPS falls Toolkit. [Electronic version]. pp. 3–106.
  • Wilson, P. & Rogers, B. (2006, December). Research on falls prevention and physical activity in older adults and a notice of a new web–based quality system by the agency for healthcare research and quality. [Electronic version]. Home Healthcare Nurse, 24, 632–636. Retrieved October 3, 2007 from http://www.homehealthcarenurseonline.com.
  • Wright, K. M. (2006, July–December). Falling head over heels. Reducing falls in high risk neurosurgical inpatients with the implementation of a ‘High risk falls room’. [Electronic Version]. Retrieved October 4, 2007 from EBSCO data base.