Quality improvement on fall during the hospital stay

CAP Draft Instructions

Students submit two drafts of their CAP paper during the term. The student’s clinical instructor reviews the drafts and provides feedback. Each draft earns a maximum of 5 points. Consult the “CAP Instructions and Rubric” document for guidance on content.

1st draft contains:

· Introduction

· Literature review of the topic/issue

The first draft includes proper APA-styled citations for the articles referenced. It does NOT need to include an APA-styled title page; however, this is a requirement for the final paper.

2nd draft contains:

· Literature review of the solution/interventions

· Implementation/intervention

The second draft includes proper APA-styled citations for the articles referenced.

Instructor Feedback

· These drafts are an opportunity for the instructor to tell the student if they are on the right track for content, writing, and formatting.

· The drafts are not an opportunity to receive detailed corrections on content and APA style.

Students are encouraged to seek writing/APA assistance from the APA Publication Manual, ResU’s lib guides, the Online Writing Lab (OWL) at Purdue, or through the TutorMe resource found on the landing page of Brightspace.

Grading criteria

CAP drafts will be assessed using the following criteria. Late submissions will lose up to 10% for every day submitted past the due date.

4-5 points: very good/good

Draft follows all instructions; includes the required content contained in the CAP rubric. Writing is cohesive. Draft may have one or two deficiencies in completeness, content, writing mechanics, or APA format.

3 points: average

Draft follows most instructions; includes most of the required content contained in the CAP rubric. Writing may need improvement. Draft has three or four deficiencies in content, writing mechanics, or APA format.

1-2 points: deficient

Assignment is submitted but does not follow directions, lacks content, and/or is incomplete.

0 points: Nothing submitted

CAP Instructions and Rubric

Description
:  The Clinical Application Project (CAP) is an opportunity for the BSN student to identify an issue, topic, or challenge that is relevant to their Role Transition clinical placement. The student will examine the research related to their topic and investigate the literature regarding a potential solution for, or intervention to improve, the issue. The student then creates a final project, intervention, or solution to their identified topic. They will present their work in a professional paper and electronic poster which will be presented via video.

Step-by-step directions
: 

1. Identify a problem, issue, concern, or area for improvement relevant to your clinical setting. Consult with your RN preceptor and ResU clinical faculty regarding your topic. Your clinical faculty must approve the topic before work is initiated.

2. Educate yourself about the importance of your topic to nursing and your particular clinical placement. Whenever possible, you will want to include facts, statistics etc. relevant to your

3. Critically analyze the literature related to the area of concern.

4. Identify possible solutions to the selected area of concern, based on the evidence in the literature.

5. Review each for its strengths, weaknesses, and feasibility.

6. Select one solution.

7. Engage in the necessary work for this quality improvement project (e.g., develop a new form and identify approvals required for its use). Although students may not have enough time to actually implement their entire project or quality improvement activity, the final work product should clearly outline the plan for implementation, including a timeline. Students will provide evidence of their work by submitting the product of their (e.g., educational program outline, instructional pamphlet, nursing form, pocket resource, new policy, patient or family focused education, etc.)

The student will create an electronic poster which visually represents the clinical application project. The e-poster displays similar components as the paper, but in a very concise and visually pleasing design. Further guidelines and instructions for the e-poster are included in the document entitled “e-Poster Creation”.

The final paper and electronic poster are graded according to the specifics contained in the following grading rubric. Due to the pandemic, e-poster presentations will not take place on campus. Instead, students will present via video and upload to Brightspace.

CAP Instructions and Rubric

Grading criteria for PAPER	Points	Comments
Introduction · Introduces topic and provides overview of the issue (2 pts MILITARY MEDICINE, 185, S2:28, 2020 Implementation of a Multicomponent Fall Prevention Program: Contracting With Patients for Fall Safety CPT Arrah L. Bargmann, BSN, RN* ; Maj Stacey M. Brundrett, MSN, RN, AGCNS-BC* ABSTRACT INTRODUCTION Falls during hospitalizations can increase the length and cost of a hospital stay. Review of patient safety reports on a 26-bed medical-surgical telemetry unit revealed that the number of falls went from 6 in 2015 to 12 in 2016. The reports identified a knowledge gap in the patient population and nursing staff related to high fall risk interventions. A literature review suggests that patient-staff safety agreements, in combination with proper implementation of Clinical Practice Guidelines, can successfully increase education and adherence to fall prevention measures and reduce the number of inpatient falls. MATERIALS AND METHODS The objective of this evidence-based practice project was to determine if the implementation of a patient fall safety agreement in combination with an existing evidence-based fall prevention bundle reduces the number of falls. Based on the literature review, the unit developed a multicomponent fall prevention program that emphasizes staff and patient education. The program consists of (1) assessment of the patient’s fall risk using the Johns Hopkins Fall Assessment Tool, (2) daily patient education on factors contributing to the patient’s fall risk during the shift assessment, (3) an educational handout on fall risk factors maintained at the bedside, (4) ensuring compliance with implementation of previously existing fall prevention measures, and (5) a patient fall safety agreement. RESULTS During the first 4 months, the fall rate decreased by 55% and staff compliance with interventions for high fall risk patients increased to 89%. To achieve added compliance, the unit implemented an incentive program, which resulted in the increased adherence to the fall risk interventions. The unit experienced 87 and 88 consecutive fall-free days, which was the longest consecutive days since May 2015. This project has reached sustainment and the unit continues to see a low fall rate, well below the national average for medical-surgical units. CONCLUSION One of the largest obstacles to this project was staff and leadership turnover. However, the project found that patient fall safety agreements facilitate a dialogue among staff and patients as well as encourage patients to take ownership of their own care. They improve the safety of patients and create a collaborative environment for nurses to conduct safe, quality patient care. INTRODUCTION Falls during hospitalizations are a safety concern, resulting in added healthcare costs, increased length of stay, and increased disability rates to name a few. According to the Agency *Brooke Army Medical Center, 3551 Roger Brooke Dr, JBSA-Fort Sam Houston, TX 7 Age and Ageing 2019; 48: 337–346 doi: 10.1093/ageing/afy219 Published electronically 5 February 2019 © The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: [email protected] Quality improvement strategies to prevent falls in older adults: a systematic review and network meta-analysis ANDREA C. TRICCO1,2, SONIA M. THOMAS1, ARETI ANGELIKI VERONIKI1, JEMILA S. HAMID1, ELISE COGO1, LISA STRIFLER1,3, PAUL A. KHAN1, KATHRYN M. SIBLEY4,5, REID ROBSON1, HEATHER MACDONALD1, JOHN J. RIVA6,7, KEDNAPA THAVORN1,8, CHARLOTTE WILSON1, JAYNA HOLROYD-LEDUC9, GILLIAN D. KERR1, FABIO FELDMAN10, SUMIT R. MAJUMDAR11✠, SUSAN B. JAGLAL12, WING HUI1, SHARON E. STRAUS1,13 1Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON Canada M5B 1T8 2Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, Canada M5T 3M7 3Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON, Canada M5T 3M6 4Toronto Rehabilitation Institute, University Health Network, 550 University Avenue, 11th floor, Toronto, ON, Canada M5G 2A2 5Department of Community Health Sciences, University of Manitoba, 379–753 McDermot Ave, Winnipeg, MB, Canada R3E 0W3 6Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 6th Floor, Hamilton, ON, Canada L8P 1H6 7Department of Health Research Methods, Evidence and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1 8Clinical Epidemiology Program, The Ottawa Hospital Research Institute, 501 Smyth Road, PO Box 201B, Ottawa, ON, Canada K1H 8L6 9Departments of Medicine and Community Health Sciences, University of Calgary, 1403 29th Street NW, Calgary, AB, Canada T2N 2T9 10Patient Safety & Injury Prevention, Fraser Health, 13450—102nd Avenue, Surrey, BC, Canada V3T 0H1 11Department of Medicine, University of Alberta, 5-134 Clinical Sciences Building, 11350—83rd Avenue, Edmonton, AB, Canada T6G 2G3 12Department of Physical Therapy, University of Toronto, 160-500 University Ave, Toronto, ON, Canada M5G 1V7 13Department of Geriatric Medicine, University of Toronto, 27 King’s College Circle, Toronto, ON, Canada M5S 1A1 Address correspondence to: Andrea C. Tricco, Scientist, Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital 209 Victoria Street, East Building, Toronto, Ontario, M5B 1W8, Canada. Tel: 416-864-6060; Fax: 416-864- 5805. Email: 408 | wileyonlinelibrary.com/journal/ajr Aust. J. Rural Health. 2020;28:408–413.© 2020 National Rural Health Alliance Ltd. 1 | BAC KG R O U N D It is known that falls are a leading cause of mortality and morbidity, especially in the elderly.1 In 2017-2018, there were 64 385 falls that resulted in the need for hospitalisation in NSW, associated with an upward trend over the past dec- ade.2 Australian hospital statistics reported more than 40 000 inpatient falls during 2017-2018 in Australian hospitals that resulted in harm.3 Morello et al4 examined the incidence of inpatient falls across multiple sites in Australia from 2011 to 2013 and identified that 3.6% of hospital admissions involved at least one fall and 1.2% of admissions had at least one fall resulting in injury. One study involving two general rehabilita- tion inpatient wards in the Sydney area had a falls rate of 14%, Received: 30 November 2019 | Revised: 25 April 2020 | Accepted: 18 May 2020 DOI: 10.1111/ajr.12646 Q U A L I T Y I M P R O V E M E N T R E P O R T Reducing falls through the implementation of a multicomponent intervention on a rural mixed rehabilitation ward Colleen Lok Kum Ma MBBS | Rebecca Ann Morrissey FAFRM Department of Rehabilitation & Aged Care, Tamworth Rural Referral Hospital, Tamworth, NSW, Australia Correspondence Colleen Lok Kum Ma, Rehabilitation Unit, Tamworth Rural Referral Hospital, 31 Dean Street, Tamworth, NSW 2340, Australia. Email: [email protected] Abstract Problem: There is an absence of literature to guide staff in how falls can be reduced in a diverse patient population on a mixed acute/subacute rehabilitation unit, espe- cially one with daily fluctuations in acuity that occurs due to frequent changes in its acute/rehabilitation patient ratio. Design: Pre-intervention and post-intervention audits. Setting: The Rehabilitation Unit at Tamworth Rural Referral Hospital in Tamworth, NSW. Key measures for improvement: Improvement in the number of falls and repeat fallers. Strategies for change: A multicomponent intervention involving: (a) in-service education sessions for nursing staff about falls risk-increasing drugs, (b) patient and family education regarding falls risks and prevention strategies, (c) improving documentation of incident reports by using a set template, (d) ensuring that the cor- rect patient mobility status information is handed over between nursing shifts and physiotherapists providing timely and regular updates, (e) the introduction of the ‘traffic light mobility system’ and (f) enhancing the use of existing falls prevention strategies. Effects of change: The total falls reduced in number from 36 falls to 19 with a de- crease in the number of repea Why work with us? 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