Patient falls are still the most common adverse event taking place in the healthcare settings that sometimes result in injuries and even mortality. Approximately 800.000 patients fall every year (CDC, 2015). A fall may cause lacerations, fractures or internal bleeding, leading to higher healthcare costs and decreased patient satisfaction. According to CDC around one-third of all falls can be prevented.
One of the major objectives of the nursing profession consists in improving the care quality and patient safety. In order to deliver professional care of high quality, a nurse has to poses certain leadership traits, enabling one to work independently, communicate efficiently, collaborate with colleagues, coach the subordinates, being aware of one’s own strengths and weaknesses and providing ongoing useful and visible feedback. The ability to collect, analyze and interpret information is crucial for a leader, enabling one to develop an efficient problem solving approach in order to manage the medical errors that may occur in the healthcare settings. The purpose of this paper is to analyze how efficient data analysis and interpretation can help a leader to improve safety and quality of patient care.
According to the data provided by the case study, the older adults constitute the majority of the telemetry unit patents. Falls in the elderly persons happen more often than falls in younger patients, while being likely to result in serious injuries, such as wrist or hip fractures (Saccomano & Ferrara, 2015). The normal aging changes, such as poor hearing or eyesight increase the likeliness of falling. Older adults who experience difficulty walking or a poor balance fall more often than others. This problem is linked to a sedentary lifestyle, lack of exercise, arthritis, or other conditions and their management. 12% of the patients have secondary diagnoses of disorientation or confusion. Elderly people often suffer from “sundown syndrome” that makes them experience confusion late in the evening (Saccomano & Ferrara, 2015). The data shows that most of the falls occurred during the night or late evening hours, which can be partially explained by the above mentioned condition.
According to the given data, the majority of the unit patients are women who tend to be more susceptible to falls then men due to certain factors. Women are at increased risk of developing osteoarthritis because of the hormonal changes, poor nutrition and sedentary lifestyle that makes them more likely to fall then men. Data shows as well that the majority of falls occurred between 11pm and 7am, with the highest number of falls between 3am and 7am on Sunday. This may be linked to the fact that one of the full time nursing assistants was moved from the night shift to the evening shift.
A 2004 study conducted by the Agency for Healthcare Research and Quality has found a correlation between hospital staffing and patient safety outcomes (Donaldson, et al., 2005). Shortage of personnel and heavy workload affect the time that an assistant or a nurse can allocate to various tasks. With a heavy workload nurses don’t have enough time to perform all tasks directed at ensuring patient safety which in it turn may lead to patient falls and other consequences.
The vast majority of the patients take diuretic medicines. The recent evidence show that the risk of falling in elderly patients who take diuretics is double when compared to those who do not take this medicine or are prescribed with its low dosage (Berry et al., 2012). Thus, taking loop diuretics could partially explain the high rates of patient falls in the unit.
In order to improve fall rates and enhance patient safety on the unit several changes have to be implemented. Attending to patients’ safety, needs and comfort is able to prevent adverse events like falls, unrelieved pain or pressure ulcers, and contribute to satisfaction of the patients with nursing care. Hourly rounding should be organized in the unit in order to facilitate the workflow and improve outcomes by giving the nurses time as they proactively anticipate and attend to the needs of the patients. According to a study conducted by Blakley and coleagues, hourly rounding contributes to greater patient safety and decreases the number of falls. It also enables nurses to perform complete assessments of the patient health status and medication response.
Installing personal call light alarms is needed for those patients who experience confusion and need a constant supervision. These alerts report nurses that a patient is moving or trying to get up, which is very important in order to prevent fall related injuries (Shorr et al., 2012).
Redistribution of the personnel has to be conducted in the unit. According to the data provided be the case study, the least number of falls occurred between 11am and 7pm. Thus, it is necessary to move a nursing assistant from this shift to the night shift in order to provide sufficient number of staff caring for the patients during the night hours.
There exists evidence that an efficient leader in a team of the healthcare professionals can improve patient outcomes (Wong, et al., 2013). Acting as a leader means being direct, motivating other employees when needed and positively influencing patient outcomes, while moving them toward a goal. Introducing a change in the healthcare settings (such as starting hourly rounding or installing and immediately reacting to an alarm system signal) may face certain resistance of the personnel. A nurse leader has to be aware of the strategies of resistance management and efficient communication.
Organizational qualities of a nurse leader include skills of efficient time, human resources, and change management. One has to be able to communicate one’s vision of the change, and continuous learning to the personnel. The skills of strategic planning and analysis are al well crucial for a leader. A nurse manager has to be able to evaluate internal data, draw conclusions, analyze the change strategy and create a plan of its implementation (Heuston & Wolf, 2011).
The number of patient falls in the telemetry unit during the 4 month period has been unacceptably high. The main factors responsible for these incidents are: the specific nature of patient conditions and medications they take, sex and age of the patients, the lack of personnel during the night shifts. The following changes could be introduced in order to improve patient safety in the unit: introducing hourly rounding, installing personal call alarms for patients who need constant surveillance, and redistributing the personnel according to the needs of the unit.
Changing culture is an important element when introducing these changes. The opinion that falls in elderly people are normal should be forgotten. Falls may be very dangerous for the patients, resulting in lacerations, fractures or internal bleeding, leading to decreased patient satisfaction and increased costs. Thus, preventing falls is extremely important in order to improve patient safety and quality of care.
