Date of Award

Fall 2019

Project Type

Clinical Doctorate

College or School

UNHM

Department

Nursing

Program or Major

Doctorate of Nursing Practice

Degree Name

Other

First Advisor

Joanne Samuels

Second Advisor

Kelly Krout

Abstract

BACKGROUND: Patient falls are a serious safety concern in the hospital setting throughout the country. Falls are one of the most challenging patient safety events to prevent, as there are many contributing factors with toileting activities producing the highest incidence. Fall prevention bundles are used to minimize and reduce these such events although multifaceted. The project was conducted with an academic medical center on an acute inpatient medical-surgical unit primarily housing burn wound patients. Nursing leaders and front-line nursing staff participated.

METHODS: Literature review to determine the gap in knowledge of interventions to prevent acute inpatient falls was completed. Concepts from purposeful rounding were used to identify a single intervention surrounding safe toileting activities. Staff actively self-reported via audit tool supervised patient toileting activities. Leadership support to develop increased engagement and satisfaction with the intervention was present.

INTERVENTION: Purposeful toileting rounds utilizing acquired knowledge and skills to encourage patient’s participation in safe patient toileting activities. A daily shift self-reporting nursing staff auditing tool was deployed and utilized to track staff participation in supervised toileting bringing awareness to safe patient toileting. Lippitt’s and Lewin’s change theories were used to drive change with in the nursing unit and staff adoption of this workflow.

RESULTS: The post intervention staff survey demonstrated staff engagement and improvement in supervised safe toileting patient activities. Staff results showed 23% overall improvement in satisfaction with time spent with patients, a 24% improvement in not feeling satisfied with unsupervised patient toileting, 31% combined positive satisfaction with providing privacy with toileting and 62% combined rating for satisfaction with safe toileting activities on the unit. Nurse pre- survey satisfaction scores of very dissatisfied were eliminated in the appropriate questions and increased in the one question regarding leaving patients unsupervised. The primary goal to reduce or eliminate falls was achieved with staff engagement. There were no patient falls during the project and continued without falls post implementation.

CONCLUSION: The deployment of a single focused fall prevention intervention can successfully prevent patient falls with engagement and support of front-line nursing staff.

Keywords: toileting, patient falls, fall prevention

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