# data[].attributes.body
Data collected from the unit prior to the project implementation showed the neurology patient fall rate as being 5.177 : 1,000 patient days. In the month prior to project implementation, the unit experienced a total of 15 falls in one month, which increased their monthly fall rate to 13.181 : 1,000 patient days.

# data[].attributes.body
Yost, D. L., & Baur, K. (2021). Reduction of Falls: An Acute Care Neurology Unit Quality Improvement Plan. MEDSURG Nursing, 30(2), 122–126.

# data[].attributes.body
Inconsistencies in nursing assessments of patient fall risks and specific interventions.

# data[].attributes.body
An acute care neurology unit at a Stroke Center was experiencing an increased trend in patient falls. Fall risk assessment tools were overly complex and led to inadequate interventions for fall prevention.

# data[].attributes.body
The expected outcome was to decrease falls in the project unit by 25% within a 3 month time period.

# data[].attributes.body
In previous studies, it has been discovered that certain medications identified as inappropriate for patients of an older age can often be overlooked, which in turn can result in falls. This particular project focuses more on patients with neurological diagnoses. According to research, 50% of stroke patients are at risk of falling, 80% will have issues with their balance, and 60%-70% tend to have a fall within 1 year's time of their stroke diagnosis.

# data[].attributes.body
Prior to the quality improvement, the organization already had evidence-based processes in place. Four different tools were used for fall risk assessments. Unnecessary complexity of the assessment methods and the lack of clarity that allowed staff to identify at-risk patients, all led to inadequate fall prevention interventions. Also, inadequate teaching for staff, patients, and family members contributed to a lack of knowledge on fall prevention. Other factors related to fall events were identified, such as nurse-to-patient ratios, patient assignments relative to room location and nurses stations, patient acuity levels, and time of day.

# data[].attributes.body
The executive nurse administrator led a team that consisted of unit leaders, unlicensed staff, nursing clinical information systems analysts, patient transporters, physical therapists, and of course, nurses. Over the course of time, team members collaboratively worked on a process to develop fall risk assessment tools and interventions that were tailored to individualize, patient-specific risks. The interdisciplinary team gave great feedback that allowed for the formatting of the EMR to eventually be revised in a more user-friendly way. The facility compliance officer & the director of quality improvement directed a literature search, which resulted in the discovery of tools and interventions that could be implemented and correlated to the new policy.

# data[].attributes.body
Data was collected, compared, integrated and entered into SPSS, an analytical software used for data analysis. Over time, common elements between observed data & documented data were tracked and trended in Excel charts. Modified Morse Scale and Nursing Delirium Screening scale were both used in order to identify patient fall risks, as well as assess for and apply indicated interventions for delirium. T and U charts, also, were used for trending unit fall rates/events.

# data[].attributes.body
The CDC's Framework for Program Evaluation was used to evaluate the project for program details, data collection, analysis/interpretation of outcomes. The Stetler Evidence Based Practice (2001) model was what guided measurement of the project progress in the direction of the targeted outcomes.

# data[].attributes.body
In order to help standardize the improvement process with the organization's mission, vision, and values, as well as to promote innovative quality care, leaders stayed engaged and fluidly interacted with staff. Frequent reminders of the importance of fall prevention and interventions were given by a designated person on their unit. During shift huddles, it was encouraged for staff to discuss the improvement process. A visual aid called Fall TIPS, was approved and placed at the patient bedside and staff education was provided.

# data[].attributes.body
The QI research was a mix of qualitative and quantitative. Quantitative parts of this were the data that could be numerically analyzed and quantified into hard facts, as well as the use of charts and statistical programs. The observation of the focus group (neurology unit) allowed for detailed gathering from a smaller group. The target for the project was to reduce the fall rate by 25% for the unit but was not achieved. The fall rate was only reduced by 8%, which took the unit fall rate from 5.177 to 4.79 per 1,000 patient days. The number of falls was reduced by 7; the number of patients with a no-fall event increased from 70%-83%.

# data[].attributes.body
Supportive leaders & increased awareness by staff, as well as consistent use of simplified, standardized tools, and implementing patient-centered fall interventions, the project's outcome was successful. Although the 25% fall reduction target was not met, fall reduction still occurred following the project.

# data[].attributes.body
By implementing the new policy, which consisted of a more user-friendly EMR, assessment tools, staff, and patient/family education, outcomes were met & improved. Not all staff were compliant with the changes, but overall, the analysis showed better assessment documentation, which resulted in fall prevention.

# data[].attributes.body
The plan was to assess the fall percentages for this neurology unit and come up with a system that would decrease the number of falls and more accurately document assessments for patients who were fall risks.

# data[].attributes.body
The QI project adequately implemented a new policy and introduced tools to a unit in order to help reduce patient falls and appropriately document fall risks.

# data[].attributes.body
Data collection tools were developed and used for observational data, as well as retrospective review of nursing documentation pertaining to fall risk assessments and applied interventions. A 42-bed unit designated for medical-surgical and step-down neurology patients was used for this project.

# data[].attributes.body
Stay in connection with fellow staff, continue education on the tools that were developed & implemented in the project, educate new staff, and incorporate fall risk education into the patient's care plan. Also, it will be imperative to accurately document assessments on fall-risk patients in order for everything to work as planned.