RESEARCH LITERATURE REVIEW•Four meta-analysis (19 studies) universally found multicomponent fall prevention programs, including use of a fall-risk assessment tool, patient and staff education, and post fall evaluations, reduce risk for falls by as much as 30% (Miake-Lye et al., 2013).

• Four randomized controlled trials (n= 6,478) found a 31% decrease in falls when multifactorial interventions were implemented. Fall incidents were compared before and after interventions, rate ratio = 0.69, 95% CI (Miake-Lye et al., 2013).

•Trepanier and Hilsenick (2014) found that precautionary care including a falls safety champion reduced the occurrence of injurious falls by 58.3% (n=36). Corresponding cost savings was an estimated $776,064.

•A quality improvement initiative conducted on eight nursing units and four hospitals using a multifactorial bundle which included a falls safety champion. Pre-initiative falls = 146 and post-initiative falls = 110 with estimated savings of $450,000 annually (Spiva & Hart, 2012).

CHANGE PROCESS

Use of a Falls Safety Champion to Reduce the Prevalence of Falls in Acute Care Settings

PACE University, College of Health Professions, Lienhard School of NursingPICO: For geriatric patients ages 65 and older with a score greater than or equal to 45 on the Morse Fall Scale, can the implementation of a unit based nurse falls safety champion on a medical surgical unit in an urban hospital serving active duty and retired military personnel, in comparison with existing fall measures, reduce the prevalence of falls within this population?

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2•The desired outcome is a reduction in the number of falls for geriatric patients in the experimental group as compared to the control group.

•The incidence of falls on the medical surgical unit will be monitored over the course of 1,000 patient days.

•MFS scores will be calculated by nurses at the time of admission to the floor and reports on the number of hospital falls will be conducted on a monthly basis.

•Authors propose statistical analysis involving rate ratios to determine the effectiveness of the FSS. Researchers will use a rate ratio and 95% confidence interval (CI) to compare the rate of falls (e.g. falls per personyear) between experimental and control groups.

REFERENCESAgency for Healthcare Research and Quality (2012). Prevention of falls (acute care). Health care protocol.

Retrieved from http://www.guideline.gov/content.aspx?id=36906&search=morseLevel of Evidence: Evidence-based Practice Guideline

Agency for Healthcare Research and Quality (2013). Tool 3H: Morse fall scale for identifying fall risk factors.

Retrieved from http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtktool3h.htmlBouldin, E. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters, T. M., Liu, M., . . . Shorr, R. I. (2013). Falls

among adult patients hospitalized in the united states: Prevalence and trends. Journal of PatientSafety, 9(1), 13–17. doi:10.1097/PTS.0b013e3182699b64Level of Evidence: Systematic Review

Centers for Disease Control and Prevention (CDC). (2015, September). Costs of falls among older adults.Retrieved from http://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html

Centers for Medicare & Medicaid Services (CMS). (2015, August). Hospital-acquired conditions. Retrieved

from https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitalacqcond/hospital-acquired_conditions.htmlDegelau, J., Belz, M., Bungum, L., Flavin, P. L., Harper, C., Leys, K., . . . Webb, B. (2012).

Prevention of falls (acute care). Health care protocol. Agency for Healthcare and Research Quality (AHRQ). Bloomington (MN): Institute for Clinical Systems Improvement (ICSI): Retrieved from http://www.guideline.gov/content.aspx?id=36906&search=morse+fall+scale

Level of Evidence: Evidence-based Practice Guideline Kruse, K. (2015). The ROI of employee engagement: Engagement springs from growth, recognition and

trust. Aspen Publishers, Inc. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=edsgao&AN=edsgcl.408510805&site=eds-live&scope=site

Level of Evidence: Evidence from Systematic Reviews of Descriptive and Qualitative StudiesMiake-Lye, I. M., Hempel, S., Ganz, D. A., & Shekelle, P. G. (2013). Inpatient fall prevention programs as a patient Safety strategy: A systematic review. Ann Intern Med., 158, 390-396.

Level of Evidence: Systematic ReviewOrtman, J. M., Velkoff, V. A., & Hogan, H. (2014). An aging nation: The older population in the United States. Current population reports. Retrieved from: https://www.census.gov/prod/2014pubs/p25-1140.pdfSpiva, L. & Hart, P. (2012). Evidence-based intervention for preventing falls in acute care hospitals. Retrieved from http://new.medline.com/media/mkt/pdf/White-Paper-Evidence-Based-Interventions-for- Preventing-Falls-Acute- Care-Hospitals.pdf

Level of Evidence: Evidence from Single Descriptive or Qualitative StudiesTrepanier, S. & Hilsenbeck, J. (2014). A hospital system approach at decreasing falls with injuries and cost. Nursing Economics, 32(3), 135-41. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25137810

Level of Evidence: Controlled Trails without RandomizationYu, S. Y., Ko, I. S., Lee, S. M., Park, Y. W., & Lee, C. (2011). A unit-coordinator system: An effective method of reducing inappropriate hospital stays. International Nursing Review, 58(1), 96-102. doi:10.1111/j.1466-7657.2010.00850.x

Level of Evidence: Randomized Control Trial 

• Target sample population is geriatric patients ages 65 and older on a medical surgical unit with a Morse Fall Scale score ≥45.

• The control group of the target population will be assessed for fall risk using the MFS and experience usual precautionary care regarding fall prevention.

• The experimental group of the sample population will receive the same assessment and precautionary care. However, their multifactorial intervention will include the addition of a Falls Safety Champion nurse.

• Evaluation of this intervention will be conducted to determine if this measure can enhance the bundle intervention currently in place.

• Authors propose the implementation of a falls safety champion to enhance the multifactorial intervention already in place in an urban hospital serving active duty and retired military personnel.

• Following approval by the the nursing education department and nursing administration, this intervention will be introduced to the staff through a three part inservice and volunteers for the role will be sought after.

• The FSC nurse should be selected based on merit and experience. Yu et al. (2011) states, the selected falls champion should demonstrate continued dedication and commitment to its cause.

• To attract candidates to the falls safety champion role the nursing educator and nursing administration can use the following incentives:

1) Establish the falls safety champion as a symbol of excellence in service and patient care. 2) Gold pin identification. 3) Recognize selected champion in

organization newsletter and website. 4) $2.00 pay differential for the selected RN.

BACKGROUND PROPOSED PRACTICE CHANGE

Beny BabuSuraiya Chowdhury

Kaitlyn CurranSteven Jacques

Kelvin MasilananiClaudine Pearson

MAJOR RECOMMENDATIONS

• A falls safety champion is a unique component of multifactorial interventions used to reduce the incidence of falls in acute care settings (Agency for Healthcare Research and Quality, 2012).

• Prevalence: In hospitals, the prevalence of falls ranges from 1.3-8.9 falls per 1,000 patient days. Over 700,000 patients are hospitalized annually because of fall related injuries, most often due to a head injury or hip fracture (Centers for Disease Control and Prevention, 2015).

• Morbidity/Mortality: Fall related injuries in clients ≥65 are often linked to alterations in mental status, impaired gait, need for ambulatory aids, and polypharmacy. Mortality rates associated with falls in the acute care settings are less than one percent (approximately 11,000 fatal falls/year).

• Costs: Falls add $34 billion dollars to health care costs each year (CDC, 2015)

• Nursing implications: The population of adults age ≥65 is expected to grow from 43.1 million to 83.7 million by 2020 (Ortman et al., 2014); hence the number of falls/ fall-related expenses is projected to increase as well. Nurses are at the forefront of patient care and must work to reduce the number of falls seen in acute care settings.

SEARCH STRATEGY• Databases used included:1) PubMed 2) CINAHL3) Proquest4) Cochrane Library5) CDC6) AHRQKeywords: Falls safety champion, expert unitcoordinator, fall risks, older adult, morse fall scale,

accidental falls, hospital fall prevention.Delimitations: publication date of 2010 and after;

studies where a personal care assistant was selected as a safety champion were not used.

Studies identified: 12 articles- two systematic reviews, two evidence-based practice guidelines, and one randomized controlled trial were chosen based on amount of evidence supporting intervention

EVALUATION

EBP recommendations Relation to PICO Question/ PIP

A registered nurse should be designated as the unit falls safety champion (FSC) (Spiva & Hart, 2012).

Screen only nurses for the position of a falls safety champion and select an RN for each unit based on merit and excellent standards of care.

Use the Morse Fall Scale (MFS) to assess possible fall risk factors including impaired gait, need for ambulatory aids etc. (Agency for Healthcare Research and Quality, 2013)

Identify geriatric patients at risk for falls as those with a score ≥45 on the MFS.

The role of the FSC is to facilitate communication among the IDT and lead post-fall huddles to assess what aspects lead to the fall and what can be learned from the incident (Degelau et al., 2012) The falls champion advocates for patient safety by educating patients and staff about the principles of fall prevention while reinforcing hospital policy (Deglau et al., 2012). Enhancing communication and education regarding fall prevention lowers the number of hospital falls.

Implement the nurse unit champion as part of a bundle intervention to reduce the incidence of falls in acute care settings