Date of Award

Spring 5-25-2024

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Dr. Lilian Chan, DNP, RN, PCCN-K

Second Advisor

Dr. Veronica Timple, Ph.D, RN, CCRN-K

Abstract

Purpose of Project: This project aims to utilize multimodal standardized patient education as an evidence-based practice intervention to reduce inpatient falls.

Background: In 2022, Kaiser Foundation Hospital (KFH) San Diego had 116 falls. Inpatient falls with injury account for the second-highest Joint Commission (TJC) sentinel event and California Department of Public Health (CDPH) adverse events. These injuries include lacerations, subdural hematoma, subdural hemorrhage, hip fractures, and wrist fractures. The Centers for Medicare and Medicaid Services (CMS) have also stopped reimbursing hospitals for the care provided after patients have sustained a fall with injury.

The project was implemented at KFH-San Diego 5 East Medical-Surgical (MS) Unit. This unit was selected as it had the highest number of inpatient falls and falls with injury in 2022 for the Kaiser San Diego Service Area.

Methods: All patients admitted to KFH-5 East MS from September 2023 to December 2023 will be provided standardized fall prevention patient education based on the patient’s fall risk score (low, moderate, high) by the Registered Nurse (RN). The patient’s education will be given in a multimodal format, which includes the following:

  • Printed material/handout detailing what it means to be at risk for falls, fall risk score, and fall prevention strategies based on their fall risk.
  • Video explaining fall risk and fall prevention strategies.

The 5 East MS RNs received education on implementing multimodal patient education and how to document education in the electronic medical record (EMR). A documentation guideline was developed and disseminated to the 5 East RNs to ensure a reinforced understanding of the fall prevention education provided to patients. Collaboration with staff, educators, information technology, and leaders in quality and nursing was essential to the success of project implementation. Metrics were tracked over three months of intervention.

Results: The benchmark selected for this project includes a 25% improvement in patient falls in 5 East MS and falls with injury. Another benchmark selected for this project was to ensure that 50% of the patients in 5 East MS received multimodal standardized patient education on their fall risk score and fall prevention strategies, as evidenced by a generated report that patients viewed the fall prevention video and documentation in the EMR that the patient received the patient fall prevention education printed material.

The number of patient falls for 5 East MS decreased by 19%. In 2022, the number of patient falls was 16; in 2023, it was 13. However, the number of falls remained the same during the project's implementation compared to the same months in 2022. In both years, from September 28 to December 28, the number of patient falls was 5.

The number of patients with falls and injuries for 5 East MS decreased by 40%. In 2022, there were five falls with injury, and in 2023, there were 2. During the implementation of the project, there were 0 falls with injury. By December 2023, at least 50% of patients received multimodal patient education.

Evaluation: Utilizing multimodal standardized patient education has reduced inpatient falls with injury. Considerations for further implementation include auto-population of evidence that patients viewed the fall prevention video to be available for staff in the EMR. Another consideration is having the fall prevention video in languages other than English or Spanish. Staff who were part of the implementation recommended posting the printed material in the patients' rooms as another way to visualize the education.

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