replies

T heresa Weinschrot 

 Julita Soliszko  

LEXIS

KHUSHBOO

Sepsis

Aiza Butt, Hector Cortes, Theresa Weinschrott

Purdue University Northwest

Meghan McGonigal-Kenney, PHD, RN

NUR 45200 Quality and Safety for Professional Nursing Practice

September 4, 2022

Background of the problem
Definition:
Sepsis is an inflammatory response to infection that can lead to organ failure. When the inflammatory response becomes generalized it can cause tissue hypoxia ultimately leading to dysfunction of organs and death (Gyawali et al.,2019).
According to Taeb et al. (2017), “Sepsis is associated with high morbidity and mortality, with estimates of more than $20 billion in annual U.S. healthcare expenditures.The incidence of severe sepsis in the United States is estimated to be about 300 cases per 100,000 population” (p. 296).

PICO Question:
In emergency department patients, can using the sepsis bundle help identify sepsis earlier when compared to the current sepsis protocol on this unit in order to decrease mortality rate?
Problem: Sepsis rates have risen over 20% in the past year in our facility.
Goal: Improving the speed and accuracy of sepsis detection to decrease sepsis rates and lower mortality.
Search Strategy:
The search strategy involves using PICO question and PICO template, using broad search terms initially, and then narrowed down to specific terms, scholarly article nursing databases, evidence based studies, national statistics, unit based data metrics.

Analysis of Current Condition
Sepsis rates at our facility have risen over 20% during the past year. We decided that the best way to reduce our sepsis rate was to place a sepsis alert system into our emergency department. Our current process is as follows. A patient comes into the ED (either by foot or by ambulance). We perform a basic assessment and triage the person. If the patient’s temperature is 101 or less, we place them in a regular ED room and screen them for COVID. They are seen by the physician in the order in which they arrived and based on their acuity. The doctor will then order labs to be drawn. Usually, we draw a chemistry profile (12 labs), a complete blood count, a sputum, and a urinalysis. The results take about 1-2 hours to come back. Unless we are looking for the lab results, we do not see them.
If the WBC comes back over 12, we start them on a broad-spectrum antibiotic until we know what specific antibiotic will work. This usually takes about 24-48 hours to determine. By that time the patient is usually in a hospital room.
We want to know if there is a better way to identify sepsis patients quickly and if there is a faster way to start treatment. We would love an evidence-based protocol we can follow.

Evidence

The evidence was found using key terms and Boolean Operators such as “sepsis” AND “bundle” AND “emergency room”. This was narrowed down to “sepsis patients” OR “emergency room” AND bundle OR protocol AND treatment OR diagnosis. We narrowed down the articles to the most recent research in the last 5 years. We used different databases such as CINAHL, Pubmed or Google search. We also paid attention to the type of evidence that was used in the articles to find the most reliable article.
The evidence suggests that using a sepsis bundle protocol has increased sepsis recognition, prompting earlier treatment resulting in decrease in mortality rates of emergency room patients with sepsis.

Sepsis Data
Our unit: blue Comparison unit 1: orange Comparison unit 2: grey

AAnaAAAAAA
Table and graph with narrative (use data from assigned problem)
Flowchart comparing current process versus what evidence says should be done with narrative identifying missed opportunities (indicators).

Analysis of Current Condition: What is Currently Being Done

Patient arrives in ED

Triage assessment with vitals: Temperature 101 or less?

Yes

Admit to ED room and COVID screen

Seen by physician in order of arrival and acuity

Labs drawn:
CBC/CMP
Sputum Sample
Urinalysis
Wait 1-2 hours
for results
WBC count >12?

Yes

Start on broad spectrum antibiotics:
Wait 24-48 hours to determine which specific antibiotic might work

Analysis of Current Condition: What Needs to be Done

Patient arrives in ED

Sepsis Red Flag Assessment: Systolic BP< or= 90? HR>130?
RR>25?
O2 sats< or =92? Yes Admit to ED room Administer oxygen as needed to keep sats>94%
COVID screen
Pt to be seen by physician in order of acuity
Labs drawn: CBC/CMP/ LACTATE

Yes

Is Lactate > or = 2?

START SEPSIS SIX PATHWAY
Keep 02 sats>94%
Collect Blood Cultures
Administer IV antibiotics: Always verify Allergies First!!
Administer IV fluids: if Lactate > or= 2: 500 mL STAT
Check serial lactates
Measure urine output: urinary catheter if indicated

Cause Analysis
Possible causes that may be contributing to the problem of delayed sepsis recognition and treatment on our unit have been identified here. Our unit is currently not measuring serial lactates, which we have identified as a key component to diagnosing sepsis in a timely manner. It is one of the key components to the sepsis six bundle (Rhee et al., 2016).

Action Plan

Indicator
Evidence
Measurement
Goal
Implementation

Serial lactate measurement
Measuring lactate levels has been shown to prompt aggressive early treatment of sepsis
(Bakker, 2017).
Charts will be audited to check for lactate results..Data will be collected on the number of patients diagnosed with sepsis who had a lactate drawn within the first hour of ER arrival (numerator) out of the total number of septic patients (denominator).
100 percent of septic patients will have had their first lactate level drawn within one hour of admission
ER clinical staff will be educated on the importance of serial lactate measurements in order to identify/treat sepsis promptly.

Administer IV fluids within 2 hours
A MAP that is is less than 60 mmhg can result in lack of perfusion to organs causing organ failure (Taeb et al., 2017).
The data collected will be blood pressure measurements every 30 minutes to ensure that organs remain perfused. MAP should be greater than 60 mmhg. # of blood pressures taken Q 15 mins/ # of blood pressures taken
100% of septic patients will maintain a MAP greater than 60 mmhg
ER staff will take routine vitals every 15 mins for suspected sepsis patients.

Action Plan (Continued)

Indicator
Evidence
Measurement
Goal
Implementation

Multidisciplinary support for septic patients
According to Taeb et al. (2017), “A multidisciplinary approach to assessment and management of septic patients is recommended. Nursing, nutrition support, respiratory therapy support, and pharmacy are critical to achieving good outcomes” (p. 304).
# of patients that receive multidisciplinary support/ # of total septic patients. Overall patient comfort level will be measured by a patient satisfaction survey.
100% septic patients will verbalize improved quality care/life.
100% of septic patients will receive multidisciplinary support.
Nursing, respiratory, physician, CNA, staff will receive education on multidisciplinary support to improve compliance of comfort care for septic patients.

If sepsis is suspected, call sepsis code and start a time sensitive bundle. Evaluate the patient, initiate sepsis screen, early management bundle and sepsis order set.
It’s been noted that delays in sepsis recognition and treatment leads to higher mortality rates (Gunsolus, Sweeney, Liesenfeld & Ledeboer, 2019).
Number of sepsis code called (numerator)/Number of sepsis patients (denominator).
Sepsis code will be called 100% of the time when the patient is suspected of sepsis.
Use of a sepsis checklist to initiate septic bundle.

If non responsive to Fluids, begin vasopressors within 4 hours
A MAP that is is less than 60 mmhg can result in lack of perfusion to organs causing organ failure (Taeb et al., 2017).
The data collected will be blood pressure measurements every 30 minutes to ensure that organs remain perfused. MAP should be greater than 60 mmhg. # of pts non responsive to fluids/Total # of septic pts on fluids
100% of septic patients will maintain a MAP greater than 60 mmhg
ER staff will take routine vitals every 15 mins for suspected sepsis patients and response to fluids

Reference Page

Bakker, J. (2017). Lactate is the target for early resuscitation in sepsis. Revista Brasileira de Terapia Intensiva, 29(2), 124-127. https://doi.org/
10.5935/0103-507X.20170021

Gunsolus, I. L., Sweeney, T. E., Liesenfeld, O., & Ledeboer, N. A. (2019). Diagnosing and Managing Sepsis by Probing the Host Response to Infection: Advances, Opportunities, and Challenges. Journal of clinical microbiology, 57(7), e00425-19.
https://doi.org/10.1128/JCM.00425-19

Gyawali, B., Ramakrishna, K., & Dharnoon, A. (2019). Sepsis: The evolution in definition, pathophysiology, and management. Sage Open Medicine, 7, 2050312119835043.
https://doi.org/10.1177/2050312119835043.

Igiebor, O., Nakeshbandi, M., Mehta, N., Ozaki, R., Lucchesi, M., Daley, M., Salifu, M. O., & McFarlane, S. I. (2020). Impact of Sepsis Intervention Protocol (SIP) on Adherence to Three-hour and Six-hour Bundles and Mortality Outcomes in the Emergency Department. International journal of clinical research & trials, 5(2), 149. https://doi.org/10.15344/2456-8007/2020/149
Rhee, C., Murphy, M., Li. L., Platt, R., & Klompas, M. (2016). Lactate testing in suspected sepsis: Trends and predictors of failure to measure levels. Critical Care Medicine, 43(8), 1669-1676. https://doi.org/
10.1097/CCM.0000000000001087

Taeb, A. M., Hooper, M. H., & Marik, P. E. (2017). Sepsis: Current definition, pathophysiology, diagnosis, and management. Nutrition in Clinical Practice, 32(3), 296–308. https://doi.org/10.1177/0884533617695243.

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SURGICAL SITE INFECTION PREVENTION

Shannon Pienkowski

Julita Soliszko

Sally Tecpanecatl

BACKGROUND
A hospital is working on reducing surgical cite infections (SSI) for knee and hip replacement patients. The SSI rate for knee replacements last year was 11.2% and the SSI rate for hip replacements was 16.3%. They want to reduce the numbers to zero.

The process is as follows: The patient is scheduled for surgery, they are required to attend a 2-hour educational session pre-operatively, they are informed the night before of the time to be at the hospital and to take a shower on the day of surgery but no not scrub at the surgical site.

On the day of: the patient is placed onto a pre-op bed, given information about the surgery, is visited by the surgeon and the anesthesiologist, and asked to sign a consent form.

Surgical Site Infection Prevention

BACKGROUND CONT.
During surgery, the surgeon cleanses the site and creates a sterile field. After closing the site, a dressing is placed on the surgical site and the patient is later informed not to change the dressing for one week.

The patient is given a new dressing to replace the old one.

The patient is allowed to shower but has to keep the surgical site dry by using plastic wrap and tape.

All patients are sent home with instructions about what to watch for and when to call the physician or come to the emergency room (e.g., temperature over 100 degrees, redness or soreness at the site, cold leg).
Surgical Site Infection Prevention
3

DOES THE USE OF A SURGICAL SITE INFECTION BUNDLE HELP PREVENT OR REDUCE SURGICAL SITE INFECTIONS IN PATIENTS RECEIVING TOTAL HIP OR KNEE REPLACEMENTS?
“
”
4
PICO question

ANALYSIS OF PROBLEM
On the PNWOSC unit there are many surgical site infections compared to other units.

SSI RATES

Surgical Site Infection Prevention
6

FISHBONE DIAGRAM
7
Surgical Site Infection Prevention

ACTION PLAN TO PREVENT SSI
Surgical Site Infection Prevention
8

INDICATORS
Surgical Site Infection Prevention
9

2-hour educational session

A 10-question quiz will be administered to the patients regarding the information learned from the session

WHO: RN in charge of the class and administering the quiz

WHAT: Assess the need to educate patients on surgical site infection prevention and what signs and symptoms to look for

WHERE: In the preoperative surgical unit or classroom

WHY: To help reduce the risk of developing a surgical site infection

WHEN: The day of taking the quiz, the patients will be educated on what they missed

HOW: Reviewing the quiz

Showering or bathing with skin antiseptics can help reduce SSIs (Tsai and Caterson, 2014).

Pt acknowledging the risk and benefits of not showering using skin antiseptics.

WHO: The nurses in charge of making phone calls the day before surgery.

WHAT:
Make sure the patient knows the education (why) behind the reason to shower.

WHERE: At home before arriving to the hospital the day of surgery.

WHY: To reduce the risk of surgical site infection.

WHEN: The day of the scheduled surgery.

HOW: Making a note in the patient’s EMR stating verbatim whether they were or were not compliant with the antiseptic shower.

INDICATORS CONT.
Surgical Site Infection
10

Administration of prophylactic antibiotics (Aginga, 2022)

Administering the antibiotics approx. 120 minutes before the incision is made and considering the half-life of the antibiotic can reduce the risk of SSI (Tsai and Caterson, 2014.

WHO: Unit Nurse Manager

WHAT: Implement a protocol to administer antibiotics, depending on their half-life, prior to the time of the incision.

WHERE: In the preoperative surgical unit and inpatient surgical unit

WHY: To help reduce the risk of developing a surgical site infection

WHEN: Within 30 days

HOW: Auditing charts

Pre-operative surgical site scrub and technique

Surgeons use appropriate technique for pre-operative surgical site scrub

WHO: Surgeons

WHAT:
Scrubs the surgical incision site in accordance with the hospital protocols

WHERE: In the OR

WHY: To reduce the risk of surgical site infection postopeatively

WHEN: Within 30 days of protocol implementation

HOW: Auditing charts

AREAS OF FOCUS

11
PATIENT EDUCATION
Educate patients from the moment they decide that it is time for a hip or knee replacement
Educate them on the importance of preventing infection beginning with the shower at home to the day of discharge
Make sure the patients are able to attend any educational session regarding their surgery

SURGICAL SITE INFECTION PREVENTION
Adjust protocols accordingly
Continue to use the best available evidence for guidance regarding administration of antiobiotics
Educate staff on the prevention of surgical site infection

REFERENCES
12
Aginga, C. (2022). Surgical site infection: Preoperative evaluation and preventative measures [PDF]. The JBI
EBP Database. https://ovidsp-dc2-ovid-com.pnw.idm.oclc.org/ovid-b/ovidweb.cgi?
&S=EICLFPLPOGEBPPGAIPMJBGLENLKCAA00&Link+Set=S.sh.41%7c3%7csl_190

Tsai, D.M., Caterson, E.J. Current preventive measures for health-care associated surgical site infections: a review. Patient Saf Surg 8, 42 (2014). https://doi.org/10.1186/s13037-014-0042-5

Surgical Site Infection Prevention

THANK YOU
Shannon Pienkowski
Julita Soliszko
Sally Tecpanecatl

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Sepsis

Lexi Gibrick, Anna Wojtowicz, Brayan Aguirre

Background of problem:

Sepsis is a medical emergency that describes the body’s systemic immunological response to an infectious process that can lead to end-stage organ dysfunction and death
Sepsis is the 3rd leading cause of death in the United States
More than 30 million people are affected by sepsis every year worldwide
Early detection of sepsis with timely, appropriate interventions increases the likelihood of survival for patients with sepsis

PICO: For adult patients in the Emergency Department, do sepsis alerts and screening tools, as compared to no early detection tools, reduce the mortality rates of patients?

Background of problem

Who is at high risk?
Adults 65 and older
Chronic health conditions
Weakened immune system
Sepsis survivors
Recent hospitalization
Signs and symptoms
High heart rate
Fever and/or shivering
Shortness of breath
Confusion
Pain
Feeling of impending doom

Analysis of Problem:
Sepsis Data

Month
Our Unit
Comparison Unit – 1
Comparison Unit – 2

January
1
1
0

February
1
1
0

March
4
3
1

April
7
0
0

May
5
0
2

June
12
1
0

July
13
0
0

August
16
0
1

September
18
0
0

October
8
0
0

November
9
3
7

December
10
1
0

Our Unit:
Mean – 8.67
Median – 8.5
Range – 17

Comparison Unit – 1:
Mean – 0.83
Median – 0.5
Range – 3

Comparison Unit – 2:
Mean – 0.92
Median – 0
Range – 7

Number of Cases

Analysis of problem
Current practice at our facility:

If the patient’s temp is 101 or less, they are placed in regular ER rooms and tested for Covid-19

Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor.

Patient arrives into our ED (via walk in/ ambulance)
Basic assessment and triage is completed

They are seen by the physician in the order in which they arrived and based on their acuity. The doctor will then order labs to be drawn.
(CMP, CBC, sputum, UA) *1-2 hours for results*
Lorem ipsum dolor sit amet, consectetur adipiscing elit, sed do eiusmod tempor. Ipsum dolor sit amet elit, sed do eiusmod tempor.

Evidence based practice:
If WBC’s are over 12, patient receives wide spectrum antibiotic until we know what antibiotic will work.
* this usually takes 24-48 hours to determine. By then patients are already in their hospital room. *

If patient meets Sepsis criteria, sepsis alert is activated by EHR.
Sepsis trained nurse finishes assessment and determines if sepsis alert is required. *Notfies MD*
*

Patient arrives to ED (via walk in/ ambulance)
Assessment and triage completed with assistance of sepsis screening tool.

EHR prompts RN/MD to input sepsis order set.
Sepsis order set: CBC, CMP, Lactate, CRP, PT/PTT, Blood cultures X2, UA, Urine culture, EKG, 1L bolus, Antibiotic

Lab results are prioritized for sepsis patients and transferred over to EHR. Pharmacy acknowledges antibiotic use and fluids based on weight.
*This leads to faster intervention and doctor able to focus more on finding source of infection.*

Sepsis mortality increase

Improved/overcame sepsis

Analysis of problem

Action Plan
Establish an alert system for high risk/potential septic patients into the EHR
EHR able to detect abnormal V/S indicating risk or potential septic patients.
EHR able to detect abnormal lab values significant for sepsis
EHR creates hard stops for user when sepsis criteria is met forcing user to use critical thinking on identifying sepsis.
EHR recognizes sepsis and allows user to input sepsis order set: (CBC, CMP, Lactate, CRP, PT/PTT, Blood cultures X2, UA, Urine culture, EKG, 1L bolus, Antibiotic)

Action Plan
Educate all Emergency room nurses on identifying and treating septic patients
WHEN DO WE EDUCATE?

Education at new hire orientation
Repeat yearly education for all staff
Refresher courses at ED skills day (bi-yearly w/ sim)
Refresher course with triage training
HOW DO WE EDUCATE?

Assess for readiness and identify barriers
Conduct educational sessions
Develop and organize quality monitoring systems
Distribute educational materials (signs/symptoms)
Provide centrally located references for all staff
Repetition on identification
WHEN DO WE TREAT?
Immediately

Action Plan
Improve the communication system for faster collaboration on sepsis alerts
Faster communication between nurse to MD notification
Faster lab results for sepsis alerts
Faster communication to pharmacy for faster IV antibiotic administration

Action Plan

Who
What
Where
Why
When
How

Nurses
Activate Sepsis Alert System
Emergency Department
To reduce mortality rate in septic patients
Immediately, as soon as warranted.
Work with ED team on early recognition, and rapid/ aggressive treatment

Goal: 100% of all septic patients will have the sepsis alert system activated in the Emergency Department.

Benchmark: Data will be collected every 6 months to assess if all septic patients have had the sepsis timer activated in the Emergency department.

References
Gyawall, B. (2019). Sepsis: the evolution in definition, pathophysiology, and management. Pubmed. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429642/#:~:text=Sepsis%20is%20a%20medical%20emergency,stage%20organ%20dysfunction%20and%20death.
Hou, C., & Kraemear, M. (2016). Statewide sepsis initiative. Ohio Hospital Association. https://ohiohospitals.org/OHA/media/OHA-Media/Documents/Patient%20Safety%20and%20Quality/Sepsis/Webinars/16-Sepsis-Initiatives-Kennedy-Health-System-in-Stratford-NJ
Jeffery, A. D., Mutsch, K. S., & Knapp, L. (2014). Knowledge and Recognition of SIRS And Sepsis among Pediatric Nurses. Pediatric Nursing, 40(6), 271–278.
Symptoms. Sepsis Alliance. (2021). Retrieved September 11, 2022, from https://www.sepsis.org/sepsis-basics/symptoms/
Tuberc, R. (2019). Sepsis: early recognition and optimized treatment. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6304323/

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Falls Prevention

………………………………………………………………………………..

Tay Dove-Zoladz, Khushbu Patel, Laurie Hayes

Purdue University Northwest

College of Nursing

NUR 45200

Hi, This presentation is done by Tay, Khushbu, and Laurie. And our topic is falls prevention.

BACKGROUND
What are falls?
An unplanned descent to the floor with or without injury to the patient.

According to the agency for healthcare research and quality also known as AHRQ, defines falls as an unplanned descent to the floor with or without injury to the patient.

WHO states that falls are the second leading cause of unintentional injury deaths worldwide. In our case study,The interventions for fall prevention that were in place were not enough and the staff was not compliant with the implementation. This lead to an increase number of fall rates in the past year.

Depth & Breadth
700,000-1,000,000 falls annually
250,000 lead to fractures
11,000 deaths
$50 billion spent -non fatal fall injuries
$754 million- fatal falls

In general, experiencing falls after a surgery or in the hospital can be detrimental. WHO states that falls are linked to higher mortality rates, longer hospital stays, and increased healthcare costs.

AHRQ reports there are 700,000 to 1,000,000 hospital falls each year

Out of those falls, 250,000 falls lead to injuries and about 11,000 deaths occur. About 15% of falls cause bone fractures and injuries to the brain.

After these falls, there can be severe consequences faced by the patients and hospitals. In the past year, $50 billion was spent on nonfatal FALLS and $754 million on fatal falls. What is more important is that most fall cases are preventable and measures can be taken to prevent them from occurring. We will be talking more about this later in the slides.

Causes
Can be multifactorial

Consequences

Can be for both patients and organization
Higher mortality rates
Longer hospital stays
Increased healthcare costs
Financial burdens
Legal consequences
Injuries (physical and emotional trauma)

To understand why the falls, occur and to prevent them, it is crucial to identify the potential causes. There can be many factors that can lead to falls. After these falls occur, the consequences that the patients and the organization have to suffer can be severe.
For the patients, it leads to longer hospital stays, financial burden that comes with increased costs, and they may also go through emotional and physical trauma.
For the organization and staff involved, they may have to go through legal consequences and increased costs as well.

CASE STUDY ANALYSIS

Current Measures:
Admission assessment (hx)
Documentation (EMR) Q24hrs
Morse Fall Scale
Yellow Star

Root Cause Analysis identified potential causes for the rise in falls which included:
Policies
Implementation, Accuracy, Documentation
People
RN, CNA, Managers, Family/Visitors
Environment
Workload, Clutter, Lighting
Patient Factors
Post-Surgery Recovery, Medications, Acuity
Equipment
Lack of, Reliable, Training

Month
Our Unit
Comparison Unit
Comparison Unit

Jan
13
1
0

Feb
2
1
1

Mar
12
2
10

Apr
6
1
6

May
4
1
0

June
5
2
0

July
3
1
0

Aug
12
0
1

Sept
6
0
0

Oct
8
0
0

Nov
4
0
1

Dec
10
0
0

Mean
7.08
0.75
1.58

Median
6
1
0

Mode
12,6,4
1,0
0

Case study info

The issue!
Non-compliance with:
Current Measures
Communication

Let’s make a difference!

Multiple interventions
Proper monitoring of compliance.

COMPLIANCE
As we know, being compliant with the protocols and policies in the hospital are important to ensure that all patients are receiving optimal care. Compliance ensures best results, IF they are proper rules in place and if there is a proper way to ensure compliance.. In our case study, it was mentioned that the yellow stars on the doors or the notices were not being changed. The case study also mentions of lack of communication between the staff members.

INTERVENTIONS

ACTION PLAN

Indicator:
What data will be collected:

Fall education and risk prevention.
Interviews for knowledge and education assessment.

Hourly rounding on patients.
Daily audits.

Bed alarms and call bells implementation.
Randomized audits of EMAR and bedside compliance.

Yellow falling star indicator on patient door.
Daily audits.

The Morse Fall Scale completed.
Daily audits.

The indicators chosen to prevent falls on the medical-surgical unit are to educate patients on falls and preventative measures, the implementation of hourly rounding, activation of bed alarms and orientation of the call bell. As well as the application of a yellow star on the patient door to signal fall risk and lastly the completion of fall risk with the use of the morse fall scale. Data will be collected with the use of daily aduits, randomized audits, and interviews.

Plan for Improvement
Upon presenting to the Medical-Surgical unit patient will be educated on falls.

Patient will be assessed of fall rate with Morse Fall Scale.

Patient at high-risk for falls will have bed alarm on, yellow star outside door, and call bell within reach.

Hourly rounding will be completed throughout shift

Upon admission to the Medical-Surgical the patient will be educated on what a fall is defined as and the preventive measures that are implemented to prevent them. The patient will be assessed using The Morse Fall Scale to determine one’s likelihood of a fall. The Nurse will also activate the bed alarm and orient the patient on the call bell such as what it is for, how to use it and when. A falling yellow star will be placed outside patients door to inform staff that patient requires assistance with ambulation or may not be ambulatable. Despite fall risk level all patients are checked on hourly by staff to ensure safety and personal needs are met.

Interventions
Orient the patient to surroundings, including use of call bell.
Educate patient on patient expectations on using call bell.
Place call light within reach.
Answer call light promptly.
Falling star outside the patient’s door.
Activated bed alarm.
Staff rounding every hour.
A fall risk assessment tool used.

Based on a patient’s level of fall risk different interventions need to take place. While other interventions are standard practices. It is standard practice to perform hourly rounding on a patient as well as orientate them to the room and the call bell system. It is also expected of the nurse on each admission to assess the patient’s risk for falls with a scale tool. If patient is moderate to high risk for falls other interventions such as bed alarm and falling star are activated to provide advance safety measures and surveillance.

REFERENCES
Centers for Disease Control and Prevention. (2020, July 9). Cost of older Adult Falls. Centers for Disease Control and Prevention. Retrieved September 8, 2022, from
https://www.cdc.gov/falls/data/fall-cost.html

Preventing Falls in Hospitals. Content (March 2021). Agency for Healthcare Research and Quality, Rockville, MD.
https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html

World Health Organization. (2021, April 26). Falls. World Health Organization. Retrieved September 6, 2022, from
https://www.who.int/news-room/fact-sheets/detail/falls#:~:text=Falls%20are%20the%20second%20leading,greatest%20number%20of%20fatal%20falls.

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Voice Recorder

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Voice Recorder

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Voice Recorder

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