Date of Award

Spring 5-23-2020

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Sharon Boothe-Kepple, PhD, MSN, FNP-C, PHN (Chickasaw)

Abstract

Background and Evidence Problem: As the population ages, there is an increase in the incidents of falls. Falls are the predominant cause of both nonfatal and fatal injuries among adults aged 65 years and older (Bergen et al., 2016). Extensive research has been conducted in fall prevention in hospitals, skilled nursing, and rehabilitation units. End-of-life care in a hospice setting presents a greater challenge in risk identification and prevention of falls. A local hospice had 457 falls between July 2018 to mid-March 2019 with a lack of consistent, detailed, fall education and documentation.

Evidence-Based Practice Intervention: Utilizing the American Geriatrics Society/British Geriatrics Society Fall Prevention Guidelines (American Geriatrics Society, 2011) and the Center of Disease Control and Prevention’s Stopping Elderly Accidents, Deaths, & Injuries (STEADI) Initiative [Stevens & Phelan, 2013], the project leader created and implemented an evidence-based, multifactorial, multidisciplinary fall prevention program within the hospice setting. The anticipated measurable impact is to reduce fall rates and increase nursing fall prevention documentation in hospice care. During the course of this project, hospice teams adopted a higher standard of fall assessment, documentation, and intervention tactics. The effectiveness and cost benefit analysis may serve as a model for other hospice facilities and may be considered for registered nurse (RN) and licensed vocational nurse (LVN) curricula, continuing education, and hospice certification.

PICO: Among hospice patients greater than 60 years of age living in the home/hospice setting, does implementing a multidisciplinary and multifactorial fall prevention program, compared to current fall risk interventions, result in reduced rate of falls by 30% and increased nurse knowledge and documentation intervention compliance by 90% in 3 months?

Project Process: Three 1-hour, in-person educational presentations were completed for the pilot teams. Additional one-on-one sessions and a recorded presentation documented compliance. A validated pre- and post-test served as a final confirmation of the pilot teams’ fall prevention knowledge, techniques, and required documentation. The final stage of the project was comprised of a 90-day follow-up fall-rate report and audit of nursing fall-documentation compliance.

Outcomes Achieved: The fall rate during the study period was reduced by 31.8%. The pre- and post-test results did not appear to be statistically significant. Initial analysis of documentation improvement was minimal during this first phase of the pilot program.

Conclusions and Implications for Nursing Practice: Research indicates 30 million older adults (65 years of age and older) fall each year resulting in approximately 30,000 deaths (Bergen et al., 2016; Centers for Disease Control and Prevention, 2019). Hospice patients are particularly vulnerable due to comorbid conditions. Falls of elderly patients result in substantial medical costs, premature death, and preventable pain and suffering. Many of these falls can be averted. Fall prevention is essential and can best be accomplished utilizing a multifactorial and multidisciplinary approach to assess fall risk and to implement evidence-based preventive strategies (Eckstrom et al., 2016; McKenzie et al., 2017).

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