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Ask nurses for input when designing form
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Inclusion of all nursing staff members in the development of the falls risk assessment tool for Hernando Pasco Hospice in Hudson, FL, improved acceptance of the program and resulted in decreases in falls in the care centers using the tool, says Cyndi Cortes, RN, CHPN, administrator of the hospice's Marliere Care Center in New Port Richey, FL.
When the performance improvement team began working on reducing falls, there was no clear definition of a fall, no policy outlining interventions, and no focus on the importance of falls reduction among the staff, Cortes says. Reviews of literature helped the team develop a definition and policy guidelines for appropriate interventions, but the team relied upon input from staff members to determine the best assessment tool, she says.
"We used the Morse Fall Scale and required every nursing shift to sign the form indicating use of interventions each day in the first version of our tool," says Jana Donovan, RN, administrator of the Hernando Hospice Care Center in Brooksville, FL. A nursing survey was conducted after the tool was used for two weeks. Nurses were asked if the implementation of the policy and interventions would reduce falls and if writing the level of fall risk in the nurse's notes made them more aware of the risk, she says. "In the first survey, only 7% of nurses replied that the policy and interventions were effective," Donovan says.
Based on staff feedback, the next assessment tool incorporated a combination of elements from the Morse Fall Scale and the Hendrick Scale, says Donovan. The admitting nurse conducted the assessment and wrote the patient's fall risk level on the whiteboard in the room, so that all other staff members would be aware of the risk, she says. Although 31% of nurses replied that the policy and interventions were effective in the second survey, it was noted that the risk level was not always written on the whiteboard, so staff members were not always aware of it, she adds.
The final version of the policy required that the risk level be written in red ink in a specific area of the nurse's notes, so that all other staff members would know where to look, says Donovan. "We also added a reassessment of fall risk level whenever the patient's condition changed," she says.
The staff's reaction to the assessment was that it was "another piece of paper for which they didn't have time," admits Donovan. "As we kept testing tools and asking for their input, then incorporating their suggestions, they saw that the tool was simple and effective," she says. "They bought into the program, because we asked for their ideas." All of the nurses liked being asked to help develop something that would be a part of their responsibility rather than being told that they had to use a specific form, Donovan added.
In addition to initial staff education, and the discussion and input received during the testing period, hospice staff members stay up to date on the progress of the fall reduction program with a storyboard that travels between the participating centers, says Donovan. "It has charts and graphs showing our progress so that staff members can see that the additional assessment and interventions do make a difference."