NURS2006 - CPI Project: Integrative Education to Reduce Hospital Falls

This clinical practice improvement (CPI) project aims to reduce falls in a hospital setting by 30% within six months through integrative education and training for bedside nurses. It emphasizes the relevance of clinical governance, particularly clinical performance, risk management, professional development, and patient involvement. The project addresses the significant problem of hospital falls, citing statistics on hospitalization and mortality rates associated with falls. Key stakeholders include the nursing workforce, nurse managers, consumer representatives, and safety risk coordinators. The project utilizes the PDSA (Plan-Do-Study-Act) cycle as its CPI tool, detailing the planning, implementation, study, and action phases. Interventions include interactive educational sessions on fall prevention policies, risk assessment using the Morse Fall Scale, and the use of fall signage. The project evaluates its success by measuring the reduction in fall rates and monitoring compliance with fall prevention guidelines. The ultimate goal is to improve patient safety and reduce the physical and emotional impact of falls in the healthcare environment.

Running head: CPI PROJECT ON FALLS IN HOSPITAL
CPI project on falls in hospital
Name of the student:
Name of the university:
Author note:

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CPI PROJECT ON FALLS IN HOSPITAL
NURS2006 ASSIGNMENT 5
Clinical Practice Improvement Project Report
Student Name, FAN and ID:
Project Title:
The implementation of integrative education and training on fall prevention on the bedside
nurses to reduce false.
Project Aim:
To explore the effectiveness of educational and training activities to reduce rate of falls in
the facility by 30% within the next 6 months involving the bedside nursing workforce.
Relevance of Clinical Governance to your project
Clinical governance is one of the most effective practice frameworks that can be used in
the health care scenario to enhance the clinical safety of the care services that are being
provided to patients and maintain the continuous improvement of the overall care services
(Vordenberg et al. 2018). This systematic framework holds the each and every care
provider accountable and responsible for the safety and efficacy of the care activities they
are engaging in. This project has aimed to reduce the rate of falls in the health care facility
by improving the awareness and knowledge of the bedside nurses regarding the fall
prevention policies and practices, the project relates to a number of pillars of the clinical
governance (Van Zwanenberg and Edwards 2018).
There are 7 pillars of clinical governance, which relates to different interconnected aspects
of improvement of the clinical care services. The seven pillars of clinical governance in
practice, they are clinical performance and evaluation, clinical risk management, patient

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experience and involvement or consumer value, resource effectiveness, communication,
strategic effectiveness, and professional development and management. Among the seven
pillars, there are four pillars or principles of clinical governance which relates intricately
with the care services that are being provided to the health care professionals. First and
foremost, the first pillar of clinical effectiveness and performance is associated with the
implementing evidence based practice to ensure providing safe and effective care services
to the patients (Vordenberg et al. 2018). This project aims to build on the knowledge and
expertise among the nurses regarding fall prevention in the facility with respect to
interventions that are derived from the best practice evidence available. Along with that, it
has to be mentioned that health care associated falls are linked with many adversities and
can even lead to fatal consequences for the critical care units. Hence, falls and the related
injuries are a very important clinical risk which this project is aiming to address (Vlaeyen
et al. 2017).
Similarly the pillar of professional development and management is the pillar which
addresses the need for education and training among the existing staff. In this case as well,
the intervention being proposed in this case refers to the training and educating the nurses
regarding the fall prevention policies and practices, hence, the project is addressing the
third pillar effectively as well. Lastly, the fourth and final pillar that the project is
addressing is the consumer voice. Elaborating further, the project will involve the
interventions that are going to be implemented in the health care facility will also
incorporate the consumer representatives to ensure their perception, wishes and grievances
is taken into consideration regarding the implementation of the interventions (Van
Zwanenberg and Edwards 2018). Hence, overall, it can be easily stated that the project that
has been designed follows these 4 essential pillars of clinical governance effectively.
Evidence that the issue / problem is worth solving:

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Among the different health risks that cause a massive influx in thee mortality rates of the
older adults or critically ill patients, falls account for a major portion of the clinical risk
(Coppedge, Conner and Se 2016). The impact of a fall is multifactorial, the falls that the
patients in the health acre facility not just leads to injuries, pain and suffering, but it also
affects the emotional and psychosocial wellbeing of the patients altering the sense of safety
and security while staying in the facility (Dykes et al. 2017). Hence, the impact of falls
encompasses both physical and emotional wellbeing of the patients, and undoubtedly it is
one of the greatest public health priorities for the health care professionals worldwide.
Discussing the prevalence and predominance of falls in the health care environment, falls
has become a major contributor to the mortality and morbidity in the health care
environment (Vlaeyen et al. 2015). Considering the data from the South Australia, in the
year of 2017, the rate of hospitalization admission due to fall and related injuries had been
22576 people and among the alarming number of people, 400 had been dead due to fall
related injuries (Aihw.gov.au 2018). As derived from the statistical data that had been
gathered, there had been 34000 incidents of fall that had occurred in the health care facility
which complicated the disease, enhanced the number of days of hospice care and also
added to the cost of hospital based care. Hence, the fall and fall related injuries has become
a grave concern, especially for the elderly patients and critically ill patients with mobility
restrictions. Hence, the topic of concern for this project is relevant, and addresses one of
the most impactful aspects associated with patient safety in the health care environment
after health care associated infections (Matarese et al. 2015).
Key Stakeholder:

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Nursing workforce:
The first internal stakeholder that is needed to be discussed in the context of fall prevention
is the nurses elderly and critical care unit. Nurses are the primary point of contact for the
patients and they carry out the most of the patient care as well. Hence, the most important
stakeholder for this case will be nurses of the elderly or critical care units.
Nurse manager:
The nurse manager will be the leader of the intervention program, and will be supervising
the entire program completion. The compliance of the selected staff and smooth operation
of the educational intervention sessions will be monitored by the nurse manager.
Consumer voice:
The consumer voice will be the representative of the patients and their family members and
will be sharing their set of recommendations and suggestions along with any grievances or
wishes.
Safety risk coordinator:
The safety risk coordinator will monitor that the educational intervention is not affecting
the patient safety in the ward selected and whether the care services or programs are going
smoothly.
CPI Tool:
CPI stands for clinical practice improvement which is a systematic project framework
which can be easily employed to the care scenario to improve the current status of the care
services or to minimize the incidence of any clinical risk (Taylor et al. 2014). Elaborating
more, the CPI project can be defined as the framework that is utilized in planning,
implementing and evaluating any change that has been introduced to the health care
scenario. The CPI project format helps in introducing a format of continuous improvement
cycle which is maintained throughout and can be integrated in the care practices of the
facility on a large scale basis. The CPI project requires the implementation of any CPI tool

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which will help in the implementation of the project that has been designed. The CPI tool
helps in the designing and successfully implementing the change into the target group
successfully. In this case thee chosen CPI tool for this project is the PDSA cycle. PDSA
cycle stands for Plan-do-study-act cycle which is also one of the most renowned change
implementation tools used in the health care environment. There are various benefits to
using this cycle. First and foremost, the most important aspect for a pilot project is timely
completion and minimal resource usage. In this case as well, the project will involve only
30 bedside nurses practicing in either elderly care units or critical care units. Hence, using
the PDSA cycle will ensure that the project is completed in a timely manner utilizing as
minimal resource as possible. Along with that, as mentioned by Rodda et al. (2017), the
utilization of the PDSA cycle as a change implementation tool, also helps in better staff
management, optimal resource utilization and also facilitating better teamwork approach to
achieve better outcomes in the project. Hence, we have chosen the PDSA cycle as the
choice of CPI tool for the project.
The PDSA cycle has four interconnected elements:
Plan:
The first phase of the PDSA cycle is planning and will take the first and second month of
the project. The preliminary step will be preparatory and will involve extensive research to
gather data from the research that has been published in the past. The research will
incorporate the incidences of falls, the contributing factors to falls, the innovative
techniques for fall prevention, and the knowledge and awareness in the nurses regarding
these techniques. Based on the research training and educational content will be prepared,
which will contain both recent fall prevention policies and fall prevention practices such as
fall prevention bundles, use of Morse fall scale, fall signage, and patient/family fall

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teaching contract (Pfortmueller, Lindner and Exadaktylos 2014). The training will be given
by head intensive care nurses, nurse managers and leaders along with lead
physiotherapists.
Do: The next phase is actual implementation of the intervention which will take up 5
months of the total allotted time of the project. In this case, the intervention will be
designed in a twice a month pattern. The 30 bedside nurses from two wards, aged care
ward and intensive care ward, randomly. The training will be provided after shifts so that
the patient care is not affected in any manner. Each session will be of 45 minutes and after
each activity the nurses will be given informative pamphlets for future reference. A
demonstrative workshop of using Morse fall scale and fall signage will be conducted every
two months during the project to help the nurses get a clear idea regarding the fall
prevention.
Study:
The outcome measurement will be done by calculating the rate of falls in the units and
comparing it with the rate before commencement of the CPI project. The nurse manager
will also monitor the compliance rate of the nurses that have participated in the training to
the different fall prevention guideline on the patients. The patient perception and feedback
will also be shared by the consumer representative at the end of the project.
Act:
The last stage of the project will be action which will be based on the data that has been
gathered and the analysts will check whether the fall rate in the selected wards has reduced
as expected from the aims and objectives of the assignment. Based on the data, the verdict
will be decided that this pilot project should be replicated on a large scale or ceased.

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Summary of proposed interventions:
The most important intervention to be provided to the bedside nurses that has been selected
from both the wards will be the education and training on the fall prevention bundle. The
educational session will be an interactive presentation, and the content of the presentation
will be fall prevention policies, why and how falls occur, its impact, fall prevention
techniques, fall risk assessment using Morse fall scale, usage of fall signage and other
interventions.
The participants will also be given informative pamphlets to keep a track of everything that
is being taught to them so that they can keep using these resources to rekindle their
knowledge in the future.
The next step of the intervention will be integrative tests or open question answer sessions
to analyse the extent of improved understanding which will be conducted after each two
months of intervention session. The participant nurses will be given the opportunity to
improve the gaps left behind after the test results in a form of one to one doubt clearance
sessions.
Lastly, the education and training committee will also arrange two demonstrative seminar
workshops where each participants will be given the opportunity to practice whatever is
being taught to the nurses and apply the theoretical knowledge. The demonstrative
workshop will be supervised by the nurse manager and the head RN. This sessions will be
simulation activities allowing the nurses to implement their learnings in the controlled and
supervised environment.
Barriers to implementation and sustaining change:
There will be many challenges that the project will encounter while implementing the
project in the facility. First and foremost, staffing issue will be the most fundamental
challenge. Due to the alarming nurse to patient ratio in the aged and critical care units, the
project might require additional staffing or it might jeopardize the patient care (Rodda et al.

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2017).
The next most important challenge will be limited resource such as time, money and
training resources. The lack of willing trainers to educate the participant nurses can also be
a notable challenge
Along with that, the last challenge disinterest among the selected nurse and resistance to
change implementation due to emotional and physical exhaustion, burnout and extra of
aged and critical care units.
Other possible barriers to successful accomplishment of the project includes Change
champions, feedback, comparative data, and lack of flexible organizational culture in the
facility (Rodda et al. 2017).
Evaluation of the project:
The project will be evaluated using a variety of parameters to ensure that the intervention
solution being proposed is relevant and optimized. The most notable parameters will be
audits, such as chart audits and evaluation audits which will measure the rate of fall
incidents in the unit every month and compare the data with the fall rates in the previous
months. At the end of the 6 months, the collective data will be pooled and gathered to
arrive at the exact rate of reduction after the completion of the project. If the collected data
addresses all of the best practice criteria successfully such as stakeholder involvement,
timely completion, clinical governance, risk minimization, and relevance and authenticity,
the project will be considered successful and worth being replicated on a large scale.

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References:
Aihw.gov.au. 2018. Australia's health 2018, Falls resulting in patient harm in hospitals -
Australian Institute of Health and Welfare. [online] Available at:
https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/indicators-
of-australias-health/falls-resulting-in-patient-harm-in-hospitals [Accessed 22 Nov. 2018].
Chan, W.C., Yeung, J.W.F., Wong, C.S.M., Lam, L.C.W., Chung, K.F., Luk, J.K.H., Lee,
J.S.W. and Law, A.C.K., 2015. Efficacy of physical exercise in preventing falls in older
adults with cognitive impairment: a systematic review and meta-analysis. Journal of the
American Medical Directors Association, 16(2), pp.149-154.
Cheng, P., Tan, L., Ning, P., Li, L., Gao, Y., Wu, Y., Schwebel, D., Chu, H., Yin, H. and Hu,
G., 2018. Comparative effectiveness of published interventions for elderly fall prevention: a
systematic review and network meta-analysis. International journal of environmental
research and public health, 15(3), p.498.
Coppedge, N., Conner, K. and Se, S.F., 2016. Using a standardized fall prevention tool
decreases fall rates. Nursing2018, 46(3), pp.64-67.
Dykes, P.C., Duckworth, M., Cunningham, S., Dubois, S., Driscoll, M., Feliciano, Z.,
Ferrazzi, M., Fevrin, F.E., Lyons, S., Lindros, M.E. and Monahan, A., 2017. Pilot Testing
Fall TIPS (Tailoring Interventions for Patient Safety): a Patient-Centered Fall Prevention
Toolkit. The Joint Commission Journal on Quality and Patient Safety, 43(8), pp.403-413.
Goodwin, V.A., Abbott, R.A., Whear, R., Bethel, A., Ukoumunne, O.C., Thompson-Coon, J.
and Stein, K., 2014. Multiple component interventions for preventing falls and fall-related
injuries among older people: systematic review and meta-analysis. BMC geriatrics, 14(1),
p.15.

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Healthdirect.gov.au. (2018). Falls. [online] Available at:
https://www.healthdirect.gov.au/falls [Accessed 22 Nov. 2018].
Matarese, M., Ivziku, D., Bartolozzi, F., Piredda, M. and De Marinis, M.G., 2015. Systematic
review of fall risk screening tools for older patients in acute hospitals. Journal of advanced
nursing, 71(6), pp.1198-1209.
Pfortmueller, C.A., Lindner, G. and Exadaktylos, A.K., 2014. Reducing fall risk in the
elderly: risk factors and fall prevention, a systematic review. Minerva Med, 105(4), pp.275-
81.
Rodda, S.N., Hing, N., Hodgins, D.C., Cheetham, A., Dickins, M. and Lubman, D.I., 2017.
Change strategies and associated implementation challenges: An analysis of online
counselling sessions. Journal of gambling studies, 33(3), pp.955-973.
Sahealth.sa.gov.au. (2018). Safety and quality programs:: SA Health. [online] Available at:
https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/
clinical+resources/safety+and+quality/safety+and+quality+programs [Accessed 22 Nov.
2018].
Taylor, M.J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D. and Reed, J.E., 2014.
Systematic review of the application of the plan–do–study–act method to improve quality in
healthcare. BMJ Qual Saf, 23(4), pp.290-298.
Tricco, A.C., Thomas, S.M., Veroniki, A.A., Hamid, J.S., Cogo, E., Strifler, L., Khan, P.A.,
Robson, R., Sibley, K.M., MacDonald, H. and Riva, J.J., 2017. Comparisons of interventions
for preventing falls in older adults: a systematic review and meta-analysis. Jama, 318(17),
pp.1687-1699.

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Van Zwanenberg, T. and Edwards, C., 2018. Clinical governance in primary care. In Clinical
Governance in Primary Care (pp. 17-30). CRC Press.
Vlaeyen, E., Coussement, J., Leysens, G., Van der Elst, E., Delbaere, K., Cambier, D.,
Denhaerynck, K., Goemaere, S., Wertelaers, A., Dobbels, F. and Dejaeger, E., 2015.
Characteristics and effectiveness of fall prevention programs in nursing homes: A systematic
review and meta‐analysis of randomized controlled trials. Journal of the American Geriatrics
Society, 63(2), pp.211-221.
Vlaeyen, E., Stas, J., Leysens, G., Van der Elst, E., Janssens, E., Dejaeger, E., Dobbels, F.
and Milisen, K., 2017. Implementation of fall prevention in residential care facilities: A
systematic review of barriers and facilitators. International journal of nursing studies, 70,
pp.110-121.
Vordenberg, S.E., Smith, M.A., Diez, H.L., Remington, T.L. and Bostwick, J.R., 2018. Using
the Plan-Do-Study-Act (PDSA) Model for Continuous Quality Improvement of an
Established Simulated Patient Program. INNOVATIONS in pharmacy, 9(2), pp.19-19.