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Nurses help to ensure patient safety, which includes preventing falls and fall related injuries. Nurses help ensure patient safety, including prevention of falls and fall related injuries. Fall-related injuries are a serious health issue for the aged population (Centers for Disease Control and Prevention [CDC],2007). In 1995, the American Nurses Association (ANA) Board of Directors commissioned the development of nursing quality indicators that link nursing care and patient outcomes. Health care organizations rely on incident reports for counting the frequency of falls and collecting fall-related data. Many facilities (VA and non-VA) use an incident report form for falls, specifically designed to collect data based on evidence about factors contributing to fall occurrences (Elkins et al., 2004).
When analyzing effectiveness of fall prevention programs, rates of both fall incidence and severity of injury should be included.
This fall rate accounts for changes in patient census so that fall rates can be adjusted for census and then compared across clinical units.
Injury analysis by severity levels enables clinical and administrative staff to profile both vulnerability of their patients and effectiveness of patient safety programs. Increases in the length of time between major injuries are another indicator of the effectiveness of fall reduction programs. In addition to tracking injury and injury severity rates, another performance indicator is the number of days between major injuries. Clinicians, administrators, and risk managers collaborate to set realistic target goals for reducing rates of falls and fall-related injuries through implementation of patient safety interventions.
The National Database of Nursing Quality Indicators® (NDNQI) enables comparison of fall rates and other nurse sensitive indicators for enrolled acute care organizations (American Nurses Association, 2004-2006). Visual presentation of falls data is an effective method for summarizing and presenting outcomes and trends over time. The control chart provides visual cues that help the viewer understand how the data relate to the process and outcomes of patient care.
For example, the control chart in Figure 2 displays the monthly fall rate on one unit in the facility where a pilot fall prevention program was established.
During this time the average fall rate dropped to 4.49 falls per 1000 -BDOC on the pilot unit, creating a new center line for the average fall rate. These charts provide nursing staff with visual displays of data indicating the results of nursing and interdisciplinary care. During the assessment phase, monthly fall rate data are entered into the control chart, performance continues to be monitored, and the chart is annotated to determine when the initiatives are introduced relative to trends (within and outside of the control limits). Following is an exemplar of development and implementation of a fall prevention program, using control charts to evaluate its effectiveness and share the outcomes with staff. Prior to the fall prevention program, a comprehensive, coordinated approach to fall prevention did not exist with each unit working in isolation on its fall prevention program. To address these problems, a Process Action Team (PAT) was formed and conducted a comprehensive data analysis to assess the current nature and scope of falls occurring on the long term care units. The falls workgroup was immediately established under the direction of the PAT, and developed a strategic plan to implement and evaluate the impact of the above actions. Progress made during each phase of deployment and system change was celebrated through a recognition program.
Lastly, a key intervention was implemented to address communication gaps in the information collected about a fall and reporting the fall occurrence among disciplines. As a result of this sheet, anyone on the unit can visually see a patient who fell, and where the staff are in the communication process about the fall occurrence and revising the plan of care to prevent a repeat fall.
When using control charts to evaluate the effectiveness of a particular program, the team may want to develop two separate charts for each phase of a process, each with its own mean and upper and lower limits plotted. The team achieved its patient safety goals by reducing the residents' fall rate and severity of fall-related injury.
After this site's participation, the staff's interventions ultimately led to decreased falls and related injuries. When this site first enrolled in the National VHA Falls Quality Improvement Project, quality managers displayed fall rates and injury rates using line graphs, reporting statistics for individual units and for the entire veterans' home. Thus, communication systems were put in place for signage to identify patients at risk for falls, shift reports to communicate patient risk status, and revised charts with more detailed analysis of falls and fall-injury rates.
Committed to communication, the quality manager reported the G-Chart data are shared at weekly team meetings. Protecting patients from falls and fall-related injuries requires shared responsibility among health care providers, administrators, and risk managers.
The Nursing Home Care Unit, a 160 bed nursing home, highlights implementation and ongoing assessment phases. Figures 1-5 reflect non-identifiable aggregate data only and are used courtesy of the VAMC at Bath, New York. Patricia Quigley, PhD, MPH, ARNP, CRRN, FAAN, is currently Deputy Director of the VISN 8 Patient Safety Center of Inquiry at the Tampa VA, and assists with oversight for the Clinical Falls Team. Julia Neily, RN, MS, MPH works for the Veterans Health Administration (VHA) National Center for Patient Safety, Field Office in White River Junction, Vermont.
Mary E Watson, MSN, APRN.BC has been employed at the Central Arkansas Veterans Healthcare System for 19 years. Department of Veterans Affairs, Veterans Health Administration (VHA) National Center for Patient Safety. The Aspen Vista MultiPost Collar is the latest addition to Aspen’s award-winning Vista Cervical Collars. Pivoting occipital panels feature a circular design that cradles the head and provide increased support.
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Almost 13 million young adults aged 20-29 years did not have health insurance coverage in 2008 (30%). Almost three-quarters of young adults aged 20-29 years had a doctor visit in the past year, 87% of women and 60% of men. Almost 1 in 10 young adults aged 20-29 years had two or more emergency room visits in the past 12 months. Overall, 10% of young adults aged 20-29 years needed medical care but did not get it due to cost in the past 12 months. Twelve percent of young adults aged 20-29 years needed prescription medication but did not get it due to cost in the past 12 months. Young men aged 20-29 years were 36% more likely than young women of that age to be uninsured. Young adults aged 20-29 years without insurance were less likely to have a usual source of medical care (44%) than were those with private insurance (80%) or Medicaid (84%).
Young adults aged 20-29 years without insurance were four times as likely (21%) as those with private insurance (5%) and two times as likely as those with Medicaid (9%) to have unmet medical need. Uninsured young women aged 20-29 (33%) were almost twice as likely as uninsured young men of that age (18%) to have had unmet prescription medication need in the past 12 months. Health insurance status is a primary indicator of access to medical care in the United States.
Among young adults aged 20-29 years, men were 36% more likely than women to be uninsured (35% compared with 26%).
Those without insurance were less likely to have a usual source of medical care (44%) than were those with private insurance (80%) or Medicaid (84%).
Overall, young women aged 20-29 years were more likely to have a usual source of medical care than young men. Young women with private coverage (91%) were more likely than young men with private coverage (70%) to have a usual source of medical care. Among uninsured young adults, women (50%) were more likely than men (39%) to have a usual source of medical care.
Young adults aged 20-29 years without insurance were less likely to have a doctor visit in the past year (54%) than were those with private insurance (81%) or Medicaid (84%).
Approximately 9 out of 10 young women aged 20-29 years with private insurance had a doctor visit in the past year compared with 7 out of 10 young men.
Among young adults with Medicaid coverage, more young women (94%) had a doctor visit in the past year compared with young men (59%).
Uninsured young women were 75% more likely than uninsured young men to have had a doctor visit in the past year. Young women were twice as likely to have had two or more emergency room visits in the past 12 months (12%) as young men (6%). Among young adults with Medicaid, women (27%) were three times as likely as men (9%) to have had two or more emergency room visits in the past 12 months. Uninsured young women were more likely to have unmet medical need (24%) than uninsured young men (19%).
Young adults aged 20-29 years without insurance were more likely to have had unmet prescription medication need in the past 12 months (24%) than those with either private insurance (6%) or Medicaid (12%).
Young women aged 20-29 years were more likely to have unmet prescription medication need in the past 12 months (15%) than were young men (9%). Uninsured young women (33%) were almost twice as likely as uninsured young men (18%) to have had unmet prescription medication need in the past 12 months.
Approximately 13 million young adults aged 20-29 years did not have health insurance coverage in 2008 (30%).
Health insurance coverage: Health insurance is broadly defined to include both public and private payors who cover medical expenditures incurred by a defined population in a variety of settings.
Private insurance: Private insurance is indicated when respondents report that they were covered by private health insurance through an employer, union, or individual purchase. Medicaid: Medicaid is indicated when respondents report that they were covered by Medicaid. Uninsured: Uninsured status is indicated when respondents report that they did not have coverage under private health insurance, Medicare, Medicaid, CHIP, another state sponsored health plan, other government sponsored programs, or a military health plan (TRICARE, VA, or CHAMP-VA). Doctor or other health care professional contact: This may include a contact while a person is in the hospital as well as a contact from a home visit, but not a contact made to arrange appointments. Emergency room visit: This includes all emergency room visits even those that resulted in a hospital admission. Unmet need: A person was considered to have unmet need if he or she did not get medical care due to cost or did not get a prescription drug due to cost in the past 12 months. Usual source of care: Usual source of care was measured by asking the respondent, a€?Is there a place that you USUALLY go when you are sick or need advice about your health?a€? Persons who report the emergency department as their usual source of care are defined as having no usual source of care in this report. NHIS is designed to yield a sample representative of the civilian noninstitutionalized population of the United States, and this analysis uses weights to produce national estimates.
Most access and utilization measures in this report are based on the 12 months prior to interview, with the exception of a usual source of care. All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated. The aging Veteran population, like the general population, is at risk for falls and fall related injuries whether at home, in hospitals or in long term care facilities.
Nurses make a major contribution to patient safety by assessing fall risk and designing patient-specific fall prevention interventions that reduce risk and prevent falls and fall-related injury.

Patient injury rate, noted to be most often caused by falls, was promoted as a nurse sensitive indicator, a measure of quality that links patient outcomes with availability and quality of professional nursing services (ANA, 1995). When a fall occurs in a health care organization, an incident report is completed to record the occurrence and circumstances surrounding a fall. For example, these data might include time of day, location, activity, orthostasis, and incontinence. Each rate is needed to monitor the effectiveness of fall prevention interventions for a specific population in a specific clinical setting.
For example, if 80% of patients who sustain lateral falls fracture their hips, one would suspect a large prevalence of osteoporosis. Once systems are developed for fall rate tracking and internal comparison, organizations can both identify trends and compare rates to those from national databases. The Uniform Data System for Medical RehabilitationSM (UDSMR) for acute rehabilitation has a quality improvement program to analyze and report inpatients by demographic profile (age, gender, diagnosis) who fall once or more than once during their length of stay.
Control charts are a specific kind of run chart intended to assess the amount of variation within a specified measurement range referred to as upper and lower limits of performance and quality control (Wheeler, 2000).
An interdisciplinary fall quality improvement team participated in individualized patient fall prevention care planning and fall-rate reporting. Next, new upper and lower control limits were calculated that reduced the amount of variation around the mean.
All parties, nursing staff, administration and risk management, monitor for the desired effects for improved patient safety.
For example, using the graph may reveal that a high fall rate in a particular month was related a higher census of patients with stroke on the unit. The program was developed for three long term care units representing 160 beds in a rural 400-bed Veterans Administration Medical Center that provides acute medicine, psychiatry, intermediate medicine, and long term care.
Nursing staff assessed patients' risk for falling with a "home grown" risk scale, the incident reporting system was cumbersome and lengthy, and periodic audits suggested that falls were under reported.
The team members analyzed medical record data related to the location, severity, time of day, and frequency of falls, and identified residents with multiple falls. For implementation and evaluation, the workgroup used the Plan–Do-Study-Act (PDSA) cycle of planned change (Langley, Nolan, Nolan, Norman & Provost, 1996). Additionally, interdisciplinary environmental rounds were implemented for patient safety and fall prevention. Thus, the workgroup's successes were an integral part of the medical center’s staff recognition program. Since these fall related information are integral part of the fall prevention program, a unit-based fall data and communication tracking sheet (Figure 4) was developed to monitor fall specific data, and is available to all providers directly responsible for the care of the residents. This sheet visually displays fall occurrences for nurses and physicians on a unit, and any staff member can easily view the unit’s most recent falls. The first control chart (Figure 2) depicts the "implementation" phase of the previous mentioned key interventions and initiatives where the PDSA cycles were developed and the "ongoing assessment" phase in which analysis and evaluation occurs on the pilot unit. This accomplishment is even more significant because it was achieved while concurrently eliminating use of restraints as a fall prevention measure (Figure 1). This exemplar is included to demonstrate how units can expand data analysis of fall prevention programs beyond fall rates.
In 2001, a nurse manager, Director of Nursing Services, and quality manager from the organization participated in the national VHA multi-facility quality improvement project, designed to reduce falls and fall-related injuries among inpatients. The injury rate was calculated by aggregating all injuries, without differentiation according to severity. According to the Joint Commission International Center for Patient Safety (2006), communication issues were the leading root cause of errors reported between 1995-2004, as well as the sentinel events reported in 2005 (Angood, 2006). Realizing that their long term care veteran population was all high risk for falls, they decided to increase focus on injury prevention, protecting veterans from falls and injury.
The horizontal axis marks each serious injury over a three year period (18 injuries, as indicated on the X axis); the vertical axis displays number of days (0-350 days). Yet, data analysis using only general fall rates lacks specificity needed to profile effectiveness of fall risk reduction programs and injury prevention methods.
This material is the result of work supported with resources and the use of facilities at the VISN 8 Patient Safety Center, Tampa, Fl., and the Field Office of the Veterans Affairs National Center for Patient Safety and the Veterans Affairs Medical Center in White River Junction, Vermont. MD, Co-Director, VA National Quality Scholars Fellowship Program developed original template for this g-chart. She has an adjunct faculty appointment at the University of South Florida, College of Nursing.
She has worked for the VHA for over 21 years and she has a special interest in fall prevention. She has been functioning in the role of Patient Safety Practitioner since 2000 managing the Fall Prevention Program for a 2 division facility with a total of 550 beds.
Wright BSN, RNC (retired) has over 20 years experience in long term care at the Missouri Veterans Home in Mt.
She has functioned as an ICU Nurse, Risk Manager, and presently as the Performance Manager. It adds a whole new level of support and motion restriction with its pivoting occipital panels behind the head.
Historically, in the United States, lack of health insurance coverage has been highest among younger adults (1).
However, young women were more than twice as likely as young men to have Medicaid coverage. Although young men and young women were equally likely to have private health insurance coverage, young women with private coverage were more likely to utilize medical services than young men with the same coverage. This includes persons covered by private health insurance, whether offered through employment or purchased individually, and persons covered by public programs such as Medicare, Medicaid, Childrena€™s Health Insurance Program (CHIP), and other state-sponsored programs.
Private health insurance includes managed care such as health maintenance organizations (HMOs). Individuals were also considered covered by Medicaid if they reported coverage by CHIP, or other state-sponsored plans.
A person was also defined as uninsured if he or she had only Indian Health Service coverage or had only a private plan that paid for one type of service such as accidents or dental care. Other health care professional includes physician assistants, psychologists, nurses, physical therapists, chiropractors, etc. Cohen and Barbara Bloom are with the Centers for Disease Control and Preventiona€™s National Center for Health Statistics, Division of Health Interview Statistics. Access to and utilization of medical care for young adults aged 20-29 years: United States, 2008. Nurses are leading practice innovations to systematically assess patients’ risk for falls and implement population based prevention interventions. Falls have been linked to nurse staffing patterns and thus, some falls are preventable (Potter, Barr, McSweeney, & Sledge 2003). Fractures are the major category of injuries produced by falls with 87% of all fractures in older adults resulting from falls (Magaziner et al., 2000). Reports from the CDC (2005) note that fall-related deaths are higher among men than among women and that the incidence of fall-related injuries in the aging U.S. The ANA asserted nurses' responsibility to assess patients' risk for falls and injury, design and implement risk reduction care plans, and evaluate effectiveness of clinical fall prevention programs.
Repeat fallers may account for a large percentage of falls within a single clinical unit of an organization. If one unit exceeds other units on their monthly fall rates and has higher injury rates, one would target that unit for evaluation and intervention. The Minimum Data Set Resident Assessment Instrument (MDS RAI) (Centers for Medicare and Medicaid, 2006 is required data that certified Medicare or Medicaid facilities must submit to the Centers for Medicare and Medicaid Services (CMS) for certification as a Medicare or Medicaid nursing provider, and for reimbursement.
Their usefulness in analyzing falls data is enhanced by the ability to annotate the chart with narrative comments on the graph about when and what actions were implemented to reduce patient falls. They can also be used to assess process measures, such as percent of staff trained in fall prevention. A control chart used for fall rates could include the fall rate (number of falls per 1000 bed days of care) plotted by month for the unit.
The center line (dark solid line) is the mean or average of all the data points previously collected and averaged (Carey & Lloyd). Discussions were held monthly and results of continuous monitoring of number of days without a fall were posted on the unit During the fall prevention program implementation phase, the mean fall rate was 9.75 falls per 1000 bed days of care (BDOC), as portrayed by the center line in the chart. By viewing the control chart, staff members of the pilot unit were able to visualize the affect of the initiatives that were implemented. In contrast, the graph may reveal a lower fall rate over months after routine toileting rounds were implemented by the nursing staff; noting the start of the toileting program on the control chart can help analyze changes in fall rates over time.
The nursing staff working in an interdisciplinary team lowered the average fall rate by 54% on the pilot unit (Figure 2) and 27% on all three units combined during the implementation phase (Figure 3). This four-part, action-oriented cycle for improvement enables a group to examine barriers to and facilitators of an intervention and assess its outcome before moving to the next step of an improvement plan. The environmental rounds involved staff members from throughout the facility conducting unit surveys with a goal to reduce environmental hazards and provide lessons learned as a part of staff education. Another key intervention, medication reviews, were initiated to heighten the awareness of side effects that may increase fall risk and are now done routinely for patients with frequent falls.
This new process is considered an administrative intervention to fill gaps in the fall prevention program, and thus can be tracked for impact on the fall prevention program.
Also staff can easily view a resident who experienced multiple falls and track when all elements of the post fall care plan were completed. The team has since used falls data to internally compare ongoing progress in patient safety. As stated in the introduction, fall-related injuries have serious consequences that can include loss of function or death.
Thirty-seven teams from VHA hospitals, Veterans nursing homes and one private facility completed an 8-month facilitated quality improvement project. At this medical center, results of a quarterly root cause analysis examining the root causes about why patients fell, revealed that effective communication (handoff, incident reporting, post fall assessment and data analysis) was a contributing problem. To support this focus, all staff in the long term care facility was educated about fall risks, risks for injury, communication systems and the data reporting methods. As shown in the chart, serious injury #1 occurred about five days after the program started, and serious injury #2 was about three days following #1. A chart with a continuing upward line depicts ongoing increases in injury-free days, a desired outcome.
Administration and quality management wanted to recognize staff for their efforts and successes. The exemplars of data management, analysis, and reporting for systematic analysis of patient, unit and organizational factors illustrated vital components of program evaluation needed for understanding the effectiveness of patient safety programs surrounding falls. The views expressed in the article do not necessarily represent the views of the Department of Veterans Affairs (DVA) or of the United States (US) Government. She lead the facility falls workgroup that successfully participated in the VA's collaborative to reduce falls and injuries due to falls.
Identifying nurse staffing and patient outcome relationships: A guide for change in care delivery. The MultiPost cervical collar employs the same one size, adjustable Vista design to fit every patient thus eliminating collar sizing errors. In 2008, young adults in the United States aged 20-29 years were almost twice as likely (31%) as adults aged 30-64 years (17%) to lack health insurance coverage.

Uninsured young women were more likely than uninsured young men to have unmet medical and prescription medication needs, but also to have had a usual source of medical care, a doctor visit in the past year, and two or more emergency room visits in the past 12 months.
Persons with only Indian Health Service coverage or having only a private plan that paid for one type of service such as accidents or dental care were not considered to be covered by health insurance.
In this analysis, health insurance categories are hierarchical, and adults covered by both private insurance and Medicaid were considered to have private insurance. Census Bureau for the National Center for Health Statistics (NCHS), Centers for Disease Control and Prevention. Point estimates and estimates of corresponding variances for this analysis were calculated using SUDAAN software (7) to account for the complex sample design of the NHIS. To determine the effectiveness of programs, data can be analyzed using a variety of statistical measures to determine program impacts. Knowledge of fall prevention program deployment and evaluation using statistical analysis can help nurses design and test effectiveness of fall prevention programs. Fall rates for residents of long-term care facilities are almost three times higher than for residents living in homes, and more frequently result in fracture, laceration, or the need for acute hospital care (Eakman et al., 2002). Thus, we recommend a sub-analysis of the fall data, to determine what percent of the falls are second, third, fourth or more falls. Of the 80 falls, 5 resulted in a minor injury such as an abrasion, hematoma not requiring medical attention, 3 falls resulted in a major injury, such as a hip fracture, and the remainder resulted in no injury . For example, fall rates for acute care units should be compared with those for other acute care units, those for an organization's dementia populations with similar populations, and so on. These data must be recorded, encoded and transmitted to CMS, or the must be completed for all residents The MDS data are collected within 14 days of admission and quarterly, recording if a resident fell during the assessment interval.
This chart helps to put the data display into context for the viewer, such as the staff nurses on the unit, (Wheeler, 2000). The control limits are determined through statistical methods for calculation standard deviations (3 standard deviations) around the mean. Before implementing any new intervention on a large scale, a small scale test of changes enables a workgroup to test one action at a time, and modify the intervention to fit the environment at the unit level. This type of information complements a control chart, because this sheet provides information about the single fall, whereas a control chart uses averaged data about monthly fall rates. The chart also demonstrates acceptable fall rates being sustained over time (46 months), (Figure 5). The first two steps for an injury tracking system are to define types of injuries and stratify severity of injury. This method of reporting and analyzing aggregated data did not allow for evaluation of trends according to injury severity. Therefore their interdisciplinary falls quality improvement team agreed that strategies were needed to improve effective and detailed communication among providers in efforts to improving their fall prevention program (Neily et al., 2003). The largest interval was between serious injuries #13 and #14, a difference of about 330 days. These exemplars have results that are meaningful to patients, clinicians, administrators and policy makers.
Quigley is nationally known for her expertise in rehabilitation, functional outcomes, and fall prevention. She served as Staff Development Coordinator, Infection Control Coordinator and Quality Management Coordinator. Performance of number-between g-type statistical control charts for monitoring adverse events. The inside of the collar is lined with Aspen’s proven cotton-lined pads that enhance skin care by reducing contact points in the rear occipital area that can result in skin breakdown.
As young adults transition into the workforce, they may be dropped from public health coverage at age 19 or from their parentsa€™ policies upon high school or college graduation (2). In this report, coverage is measured at one point in time, which is the day of the NHIS interview. NHIS collects information about the health and health care of the civilian, noninstitutionalized U.S. Therefore, an individuala€™s insurance status may have been different at the time health services were sought or received.
Subcommittee on Federal Workforce, Postal Service, and the District of Columbia Committee on Oversight and Government Reform United States House of Representatives Hearing on a€?Providing Health Insurance to Young Adults Enrolled as Dependents in FEHBP.a€? 2008. Thus, data analysis of fall rates by type of fall and severity of fall related injury can help facilities examine the effectiveness of their interventions and program outcomes.
This article describes exemplars of development and evaluation of fall prevention programs. For example, they have estimated that the number of hip fractures, a serious fall related injury, will rise from 350,000 admissions per year to over 500,000 by 2040 (CDC, 2006a). Because of these efforts, by the next decade, valid and reliable fall risk assessment tools and standardized post fall analysis and rates are available for use in nursing practice.
These repeat fall frequencies are needed in order to determine the effectiveness of interventions to prevent repeat falls.
The standard deviations provide a measure of the average deviation from the mean score, accepting that a certain degree of error would be made if only the mean score was used. Nine months after implementation of most of the planned initiative, the impact of these initiatives was assessed by plotting fall rates ("Assessment" Phase, Figure 2). During the Assessment Phase, the falls workgroup reviewed the control charts at biweekly meetings, providing data reports to staff and local leadership monthly. This is important to standardized coding of injury type and severity for surveillance and analysis because all falls are not equal. Team characteristics were assessed by a survey at each learning session and each team was rated on their overall performance at the end of the project. Through further sub-analysis of injuries by severity, staff could better track efforts toward meeting unit and organizational goals in patient safety. She serves as expert consultant to VA and non-VA healthcare systems regarding fall prevention programs. She co-designed, implemented and directed a successful falls management program and tracking system through participation in the VA Fall Collaborative on reducing falls and injuries related to falls.
Measuring quality improvement in healthcare: A guide to statistical process control applications.
The low wages or temporary jobs typically available to young adults upon graduation often come with limited or no health benefits.
Most estimates shown in this report meet the NCHS standard of reliability (relative standard error less than or equal to 30%).
Examples of actual fall prevention programs and their approaches to measurement are showcased in this article. These estimates are probably under-representative of actual fall rates because not all falls are reported.
Adoption of the ANA recommendations encourages organizations to analyze effectiveness of fall prevention programs that are unit-specific and population-based. For example, one clinical unit may report that 90% of their falls were single falls; yet, a second clinical unit with the same patient population as unit one reports 40% single falls and 60% repeat falls (40% of falls were second falls and 20% were third falls). Points that fall outside the control limits are likely to be reflective of a significant change in the fall rates. In addition to monitoring fall rates, the falls workgroup also tracked minor and major fall-related injuries as part of their patient safety and quality improvement program. More detailed information about this national quality improvement project has been published (Mills, Waldron, Quigley, Stalhandske & Weeks, 2003). As showcased in the prior exemplars, quality managers, nurse managers, and staff are integrating charts and graphs, familiar to researchers, into program evaluation at the point of care.
Young adulthood is a high-risk period for unintended pregnancy, sexually transmitted diseases, substance abuse, and injuries (3).
Interviews are conducted in respondentsa€™ homes, but follow-ups to complete interviews may be conducted over the telephone.
Estimates with a relative standard error more than 30% but less than or equal to 50% are preceded by an asterisk (*). The recommendations suggest that clinical, administrative and risk management staff conduct in depth data analysis and provide unit-specific feedback to staff regarding fall rates and fall related injury rates.
This sub-analysis offers clinicians, administrators and risk managers important information for strategic interdisciplinary planning and corrective action.
Therefore, facilities should track types of injuries (such as lacerations, fractures, and bleeds) and severity of injuries (none, minor, major, or death). The exemplars demonstrate effective means for tracking additional outcomes in fall prevention programs.
Leveraging nurse-related dashboard benchmarks to expedite performance improvement and document excellence.
Pregnancy rates are highest among women aged 20-29 years, which is directly related to the need for health care services (4).
Questions about health insurance coverage and did not get medical care due to cost are asked of family respondents in the family component of the survey.
Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. Following these practices has resulted in the emergence of best practices for patient safety related to reduced falls and fall-related injuries, as showcased in this article’s exemplars. Disruption of health insurance coverage can introduce barriers to health care and leave young adults vulnerable to high out-of-pocket expenses in the event of a serious illness or injury (5). Terms such as a€?higher thana€? and a€?less thana€? indicate statistically significant differences. These exemplars describe actual fall programs across settings, along with strategies to showcase data at the unit level and compare fall program outcomes over time. Rich, RN, MA, CT (October 17, 2011)Improving Quality and Patient Safety by Retaining Nursing ExpertiseKaren S. In 2008, information was collected on a total of 9,874 persons aged 20-29 years from the family core component and 3,609 persons aged 20-29 years from the sample adult component of the survey. Terms such as a€?similara€? and a€?no differencea€? indicate that the statistics being compared were not significantly different.
For example, a minor injury would be an abrasion, bruise, or small surface laceration not requiring medical action, whereas a major injury would be one that requires medical action, such as a hip fracture, head trauma, or arm fracture (VHA, 2001). Lack of comment regarding the difference between any two statistics does not necessarily suggest that the difference was tested and found to be not significant. One classification system for injury severity has not been adopted nationally by non-VHA facilities; as a result, one should include the classification system used in analysis when reporting fall related injury data. The following exemplar describes one VHA facility’s approach to reporting fall-related injury data, and the success they have made in reducing severe injuries.
Mitchell, PhD, RN, FAAN (September 30, 2003)Contributions of the Professional, Public, and Private Sectors in Promoting Patient Safety Evelyn D.

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