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NDNQI Falls; Falls with Injuries

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Vaughn Roberts

on 28 October 2013

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Transcript of NDNQI Falls; Falls with Injuries

NDNQI Falls; Falls with Injuries
Created by: Bobby Phillips, Alyssa Tucker, and Philip Roberts
The National Database of Nursing Quality Indicators: Falls
Risk Factors
Goal: To ensure knowledge of various aspects of falls, including: NDNQI, interventions, prevention methods, costs, etc.

Target Audience: Nursing students pursuing a career in high quality patient-centered care.

Date of Production: October 24, 2013

Definition
"An unplanned descent to the floor (or extension of the floor, e.g., trash can or other equipment) with or without injury. All types of falls are included, whether they result from physiological reasons or environmental reasons."



Patient-Related (Intrinsic)
Impaired Gait
Age
Hx of Falls
Impaired Cognition
Impaired Vision
Weakness (especially legs)
Hypotension
Urinary frequency, urgency, and/or incontinence
Acute Event (eg. MI, PE)
Pharmacological
Polypharmacy
Sedative/Hypnotic
Cardiovascular
Environmental (Extrinsic)
Furniture on Wheels
Cluttered Pathways
Poor Lighting
Slippery/Wet Floors
Height of Furniture
Obstructive view of patient from nurse's station.
Medical Devices
Poorly Fitted Clothing
Lack of Ambulatory Aids
( Mion, 2012)
(Mion, 2012)
Fall Prevention
Implications
Minimize Risks
Assist with Ambulation (bathroom, walking)
Consider Physical Therapy to improve gait
Ambulatory Aid
Non-Skid, Fall risk Socks
Do not leave unattended in bathroom or halls
Request pharmacist/physician to review meds.
(Mion, 2012)
Support Stockings (min. orthostatic hypotension)
Avoid Restraints
Adequate Lighting
Bed in lowest position
Pathways free of clutter/spills
Consistent assessment of mental status and fall risk
Fall risk band
Fall Risk Assessment
Patient Health Implications
Healthcare Costs Associated with Falls
Morse Fall Risk Scale
-0-125 point scale
-Low, moderate, high risk classifications
-Scoring basis:
-Fall Hx
-Diagnosis
-Ambulation status (cane/walker/etc.)
-IV fluid therapy
-Gait assessment
-Mental Status
(Swartzell, Fulton, & Friesth, 2013)
STRATIFY
-0-5 point scale
-2 or more points = "high risk"
-Scoring basis:
-Hx of falls
-Mental status
-Visual impairment
-Continence/frequency
-Ambulation status
(Swartzell, Fulton, & Friesth, 2013)

Hendrich II Fall Risk Model (HIIFRM)
-0-16 point scale
-5 points or more = "high risk"
-Scoring Basis:
-Confusion/Disorientation/Impulsivity
-Symptomatic Depression
-Dizziness/Vertigo
-Male gender
-Anti-epileptics
-Benzodiazepines
-Ambulation (Get Up & Go)
Swartzell, Fulton, & Friesth, 2013)
(Choi, Lawler, Boenecke, Ponatoski, & Zimring, 2011)
NDNQI Goals
Data collection and comparison for quality improvement purposes in hospitals.
Analyze data to show the relationship between nursing staff and patient outcomes.
(NDNQI, 2013)
(NDNQI, 2013)
NDNQI Data Collection
-Standardized definitions for reliability and validity.
-Unit based.
-Quarterly reporting.
-Data collection, compilation, analyzation.
-Quarterly reports posted to NDNQI website.
-Identifies problem areas.

Quality Indicators
-Nursing hours per patient day
-Catheter associated UTIs
-Hospital acquired pressure ulcers
-VAP
-Annual nursing survey
-Voluntary nursing turnover
-Falls
-Falls with injuries
Bed/Chair Monitoring Systems
Integrated Connection Systems
(NDNQI, 2013)
(NDNQI, 2013)

>1 million falls each year
Highest rates (2012):
-Neuroscience floors (6.12-8.83 falls/1,000 pt days)
-Medical floors (3.48-6.12 falls/1,000 pt days)


(Mion, 2012)
Parkview Hospital Falls - YTD
Multifaceted approach that connects patient to caregiver using a variety of technological systems.
(Falen, Unruh, & Segal, 2011)
Technology and Fall Prevention
“Current fall prevention strategies have a significant but small effect on fall rates despite the use of complex, multidisciplinary interventions.”
Randallia - 2.7 falls/1,000 pt days
-Constant care - 2.5 falls/1,000 pt days
-Med/Surg & OB - 0 falls this year
PRMC - 1.2 falls/1,000 pt days
-7 Medical - 1.5 falls/1,000 pt days
-Ped/PICU - 0.3 falls/1,000 pt days

(Dibardino, Cohen, & Didwania, 2012)
According to one study, over 50% of all falls and falls with injuries occurred when the patient was getting out of or back into bed.
(Tzeng, Yin, Anderson & Prakash, 2012)
(NDNQI, 2013)
The best fall prevention strategies incorporate Collaborative interdisciplinary practice, Active leadership, Technology Support, Communication, and Hospital-wide culture change.
NDNQI Fall Injury Definitions
(Bonuel, Manjos, Lockett, & Gray-Becknell, 2011)
None - no obvious s/sx - negative CT/x-ray
Minor - dressing applied, wound cleaned, ice/elevation needed
Moderate - resulted in splinting, wound closure, muscle/joint strain
Major - resulted in surgery, casting, traction, neuro consult, internal injuries, blood products required for pts with coagulopathy
Death - resulting from fall NOT from physiological event causing the fall
(NDNQI, 2013)
Hourly Rounding
The Four (or five) P's Approach
Pain - "Are you having any pain?"
Potty - "Do you need to use the restroom"
Position - "Are you comfortable?"
Possessions - Observe and "Do you have everything you need?"
Psychological - Assess orientation
(Berg, Sailors, Reimer, O'Brien, & Ward-Smith, 2011)
A,B,C,D,E Approach
A-Activity What is the patient doing?
B-Bathroom Bathroom needs
C-Comfort Comfort needs
D-Dietary Is the patient hungry?
E-Environment Possessions in reach, decluttered floor, adequate lighting, etc
(Berg, Sailors, Reimer, O'Brien, & Ward-Smith, 2011)
"Hospital falls remain one of the leading causes of patient injuries in the hospital and are a contributor to patient deaths"
(Falen, Unruh, & Segal, 2011)
Adverse fall events (AFEs) are estimated to be anywhere from 2.2-17.1 falls per 1000 patient days.
(Coussement, De Paepe, Schwendimann, Denhaerynck, Dejaeger, & Milisen, 2008)
"Approximately 2%-12% of all patients have at least one fall during their hospital stay"
(Falen, Unruh, & Segal, 2011)
Up to 50% of falls result in minor injuries and up to 10% result in major injuries.
Minor Injuries
Minor lacerations
Bruising
Redness
Mild Pain
Major Injuries
Moderate to severe lacerations
Bone Fractures
Head Injury (eg. subdural hematoma
Change in Mental Status
Joint immobility
Severe Bruising and Pain
(Falen, Unruh, & Segal, 2011)
(Voyer, Verreault, Mengue, Azizah, 2007)
(Voyer, Verreault, Mengue, & Azizah, 2007)
For adults age 65 years or older, a fall resulting in a major injury will increase the risk of death by 50% in the following year.
(Falen, Unruh, & Segal, 2011)
Fall Rates
(Parkview, 2013)

References
-Falls result in increased length of stay.

-The Medicare HAC policy fines hospitals and denies reimbursement for care associated with HACs.

-"Hospital care associated with adverse events and temporary harm events cost Medicare an estimated $324 million in October 2008."

-Shock absorbing floors to prevent injuries, but does it increase the number of falls?
(Morello et al., 2013)
(Levinson, 2010)
(Levinson, 2010)
(Latimer et al., 2013)
(Zecevic et al., 2012)
Full transcript