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Evaluating the Effectiveness of a Fall Risk Screening Tool Implemented in an Electronic Medical Record System


Published on: 09.11.2018
Associated with: October/December 2018, Volume 33, Issue 4;

Mr. Yokota and his team investigated the effect of using a fall risk screening tool in an EMR by using data for 25 039 patients in 24 general wards at a large health system in Tokyo. The probability of the occurrence of falls decreased after the tool was implemented, but using the tool did not reduce the actual occurrence of falls. The author summarizes the findings in the video and describes the full study in the article.

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Strategies have been identified to establish patient-centered care and improve patient engagement with care. However, the relationship of patient/ family engagement to reduction of harm is not well understood. Dr Schenk, in her first study, identified an opportunity for reducing risk and harm by more actively engaging patients and families in the effort. In another study her team convened a Patient Safety Advisory Panel to explore potential interventions to increase patient/family engagement with safety. The preferred intervention was Speak Up-My Advocate for Patient Safety. Learn about these studies in the video and implications for engaging patients and families in your own settings of care. Be sure to read both articles.
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Providing appropriate and timely mealtime assistance to hospitalized patients should be part of a multifaceted and multidisciplinary approach to optimizing the patient's nutritional care plan. The combined interventions of staff engagement, redesigning the model of care to reprioritize activities at mealtimes, clarifying nutritional care roles and responsibilities, introducing a protected mealtime and a novel 2-tiered colored tray system, and implementing an awareness and education program have resulted in significant improvements in mealtime assistance. Learn more about this project from the authors in the video and their article.
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This is the first video in our writing for publication series. The purpose of the manuscript and intended readers guide your selection of a journal for submission. Learn about directories of nursing and other journals and sending a query email.
Creator: Marilyn Oermann
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This is the 2nd video in our writing for publication series. Learn about the journal’s Information for Authors and why important, formats for writing different types of manuscripts, and reporting guidelines. The video will prepare you for writing papers about quality improvement and using the SQUIRE guidelines. References and tables/figures also are discussed.
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Nursing home providers face challenges in urinary tract infection assessment and treatment, often prescribing unnecessary antibiotics for asymptomatic bacteriuria. The project tested the effectiveness of the multifaceted Cooper Urinary Tract Infection Program that includes the Cooper tool algorithm, didactic education for providers, and change champions. This Program led to significant improvements in nurse knowledge and reduced rates of urinary tract infections, inappropriate antibiotic treatments, and urinalyses. Learn about this important Program: Dr Cooper presents her Program in this video and describes the study in her article.
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Learn about this interesting study that used a process evaluation methodology. The aim was to examine the effectiveness of implementing same day discharge (SDD) following percutaneous coronary intervention. During implementation, 22 patients were discharged home the same day. It was found, however, that staff did not follow the guideline consistently, with an overall adherence of 77.3%. The study is important as it provides direction for future improvement both in the criteria and implementation process. After watching this video, be sure to read the article.
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Incomplete or inaccurate triage examination in an emergency department can result in delays, which could compromise patient outcomes. Dr. Johnson discusses the outcomes of her study on triage interruptions and how they affect the triage process. A significant difference was seen in triage duration between interrupted and uninterrupted interviews. Understanding the impact of interruptions on patient outcomes allows nurses and other health care providers to develop interventions to mitigate the impact.
Creator:
Duration:
Mr. Yokota and his team investigated the effect of using a fall risk screening tool in an EMR by using data for 25 039 patients in 24 general wards at a large health system in Tokyo. The probability of the occurrence of falls decreased after the tool was implemented, but using the tool did not reduce the actual occurrence of falls. The author summarizes the findings in the video and describes the full study in the article.
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This study explored the trajectory of patients who remained on a general unit after medical emergency team activation. Of those who had a second activation within 24 hours, 80% occurred within 12 hours of the baseline activation. Chest pain and recent ICU discharge were associated with having a second activation. The authors share their study and discuss implications of interest to nurses across settings. Watch the video and be sure to read the full article.
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The demand for acute care clinical sites, along with the need to prepare CNLs for a role in health promotion, disease prevention, and population health management, created an opportunity for these authors to expand the CNL role outside of the acute care setting. The goal was to allow CNL students to develop competencies in improving patient and population health. Learn how they developed and implemented the course: after watching the video, read the full article. Be sure to access the supplemental content on strategies for clinical site development for CNL in primary care.
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Creator:
Duration: 6:29
Strategies have been identified to establish patient-centered care and improve patient engagement with care. However, the relationship of patient/ family engagement to reduction of harm is not well understood. Dr Schenk, in her first study, identified an opportunity for reducing risk and harm by more actively engaging patients and families in the effort. In another study her team convened a Patient Safety Advisory Panel to explore potential interventions to increase patient/family engagement with safety. The preferred intervention was Speak Up-My Advocate for Patient Safety. Learn about these studies in the video and implications for engaging patients and families in your own settings of care. Be sure to read both articles.
Creator:
Duration: 3:34
Providing appropriate and timely mealtime assistance to hospitalized patients should be part of a multifaceted and multidisciplinary approach to optimizing the patient's nutritional care plan. The combined interventions of staff engagement, redesigning the model of care to reprioritize activities at mealtimes, clarifying nutritional care roles and responsibilities, introducing a protected mealtime and a novel 2-tiered colored tray system, and implementing an awareness and education program have resulted in significant improvements in mealtime assistance. Learn more about this project from the authors in the video and their article.
Creator: Marilyn Oermann
Duration:
This is the first video in our writing for publication series. The purpose of the manuscript and intended readers guide your selection of a journal for submission. Learn about directories of nursing and other journals and sending a query email.
Creator: Marilyn Oermann
Duration:
This is the 2nd video in our writing for publication series. Learn about the journal’s Information for Authors and why important, formats for writing different types of manuscripts, and reporting guidelines. The video will prepare you for writing papers about quality improvement and using the SQUIRE guidelines. References and tables/figures also are discussed.
Creator: Marilyn Oermann
Duration:
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Creator:
Duration:
Nursing home providers face challenges in urinary tract infection assessment and treatment, often prescribing unnecessary antibiotics for asymptomatic bacteriuria. The project tested the effectiveness of the multifaceted Cooper Urinary Tract Infection Program that includes the Cooper tool algorithm, didactic education for providers, and change champions. This Program led to significant improvements in nurse knowledge and reduced rates of urinary tract infections, inappropriate antibiotic treatments, and urinalyses. Learn about this important Program: Dr Cooper presents her Program in this video and describes the study in her article.
Creator:
Duration:
Learn about this interesting study that used a process evaluation methodology. The aim was to examine the effectiveness of implementing same day discharge (SDD) following percutaneous coronary intervention. During implementation, 22 patients were discharged home the same day. It was found, however, that staff did not follow the guideline consistently, with an overall adherence of 77.3%. The study is important as it provides direction for future improvement both in the criteria and implementation process. After watching this video, be sure to read the article.
Creator:
Duration:
A goal in many health systems is to improve heart failure (HF) core measure (CM) scores. Learn how an interdisciplinary team analyzed the processes in their setting, implemented an accurate reporting system, redesigned the process for identifying patients with HF, and changed the EHR. There was a decrease in readmissions from 12% to 8%, and HF CM compliance score increased from 88% to 100%. increased from 88% to 98%. Watch the video and then be sure to read the full article (for CE)
Creator:
Duration:
Incomplete or inaccurate triage examination in an emergency department can result in delays, which could compromise patient outcomes. Dr. Johnson discusses the outcomes of her study on triage interruptions and how they affect the triage process. A significant difference was seen in triage duration between interrupted and uninterrupted interviews. Understanding the impact of interruptions on patient outcomes allows nurses and other health care providers to develop interventions to mitigate the impact.
Creator:
Duration:
Achieving optimal compliance for bar code medication administration (BCMA) in mature medication use systems is challenging due to the iterative system refinements over time. The author describes a nursing leadership initiative to increase BCMA compliance, measured as a composite across all hospital units. Compliance increased from 95% to 98%, but most importantly, through this initiative, leadership discovered unanticipated benefits and unintended consequences. The methodology used provides valuable insight into effective strategies for BCMA optimization with applicability for other QI initiatives. After watching the video, learn more about the initiative in the article.
Creator:
Duration:
Learn more about this study of 1933 RNs in 24 hospitals with shared leadership and the nurses’ perceptions of their decisional involvement. The author explains the study and its implications for nurses. Be sure to read the article for details about this important study and how you can use the findings in your own health care setting.
Creator:
Duration:
Learn about this QI initiative to improve oropharyngeal dysphagia screening and reduce aspiration pneumonia rates on inpatient hospital medical units. Guided by a Plan-Do-Study-Act methodology, an interdisciplinary health team developed and implemented a systematic process for oropharyngeal dysphagia screening and management. As a result, use of the screening protocol increased, timely initiation of speech language pathology consultations increased, and aspiration pneumonia rates decreased. After watching this video, be sure to read the article.
Creator:
Duration: 2:33
The purpose of this project was to determine whether patients with COPD receiving in-home visits by a nurse practitioner (NP) in a program called Community Cares had fewer hospital encounters such as ED visits, observation stays, and inpatient admissions. With in-home NP visits, inpatient encounters decreased by 71%; ED visits decreased by 68%; and there was an 84% reduction in 30-day readmissions. Learn more about this program (from a patient and NPs). Don’t miss this video and then read the article.
Creator:
Duration: 3:54
Two major cost concerns related to joint replacement surgery are patient length of stay (LOS) and 30-day hospital readmission rates. Dr Ashcraft describes a QI project to evaluate the impact of a joint replacement program on patient readmissions and hospital LOS. A total of 1425 patients older than 50 years participated. At the end of the project period, readmission rates decreased from 6.19% to 2.8%, and average LOS decreased from 5.87 days to 2.7 days. After watching the video be sure to read the article. The authors share strategies for adopting this program in your own setting.
Creator:
Duration: 2:49
This study explored the trajectory of patients who remained on a general unit after medical emergency team activation. Of those who had a second activation within 24 hours, 80% occurred within 12 hours of the baseline activation. Chest pain and recent ICU discharge were associated with having a second activation. The authors share their study and discuss implications of interest to nurses across settings. Watch the video and be sure to read the full article.
Creator:
Duration: 2:55
The demand for acute care clinical sites, along with the need to prepare CNLs for a role in health promotion, disease prevention, and population health management, created an opportunity for these authors to expand the CNL role outside of the acute care setting. The goal was to allow CNL students to develop competencies in improving patient and population health. Learn how they developed and implemented the course: after watching the video, read the full article. Be sure to access the supplemental content on strategies for clinical site development for CNL in primary care.
Creator:
Duration: 4:14
As part of an outcome improvement initiative in an intermediate ICU at the Health Sciences Centre, Winnipeg, Manitoba, Canada, patients participated in an innovation on the effects of collaborative goal setting and activity tracking through a visual display of the goals achieved. Patients had a high degree of engagement in setting their goals. Displaying patients’ progress had an effect on their quality of life and self-efficacy. Learn more about this project in the video and article: this is a project you can easily implement in your settings, and the authors explain how to do it.
Creator:
Duration: 3:11
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Clinical nurse leaders (CNLs) improve care at the microsystem level. Learn about the use of the CNL role in an academic medical center for evaluating pressure ulcer reporting – watch this video and be sure to read the article. The authors used the Plan-Do-Study-Act cycle as the methodology for the study. The CNL assessment of pressure ulcers resulted in a 21% to 50% decrease in the number of hospital-acquired pressure ulcers reported in a 3-month time period. The CNL role has potential for improving the validity and reliability of pressure ulcer reporting.
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Duration: 4:40
The QSEN RN-BSN Task Force developed recommendation for a systems-based practice competency. Recommendations are to integrate systems-based practice into both education and practice settings. Watch the video and read the article to learn more about this proposed QSEN competency.
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Duration: 4:03
Limited research has been conducted on how nurses perceive “quality nursing care.” The authors conducted focus groups to identify nurses' perceptions of quality care at a Midwestern academic medical center. Transcripts of the focus group sessions were analyzed using thematic analysis techniques, and 11 themes emerged: Leadership, Staffing, Resources, Timeliness, Effective Communication/Collaboration, Professionalism, Relationship-Based Care, Environment/Culture, Simplicity, Outcomes, and Patient Experience. Learn how nurses define quality care: watch the video and read the article.
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Duration: 3:15
Many readers are interested in transitional care. This video and article provide the information you need. The authors describe their project to reduce readmissions through the establishment of a pilot program using the C-TraC program, which is a phone-based, protocol-driven, low-cost, nurse-led, transitional care model. The goal was to connect with the patients telephonically up to 30 days postdischarge to mitigate current confusion regarding the discharge plan and identify potential medication discrepancies. Learn about this effective transitional care model.
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Duration: 2:41
Medication errors are a source of serious patient harm. A unique approach, Socio-Technical Probabilistic Risk Assessment, was used to analyze medication errors in this pediatric setting. Three steps were identified that should be taken with every intravenous medication or fluid administration. Nurses check for the 3Cs: Connections, Clamps, and Confirming pump settings. Preliminary analysis revealed a 22% reduction in errors. This video is prepared with a pediatric theme!
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Duration: 2:58
Rapid response team (RRT) adoption and implementation are associated with improved quality of care of patients who experience an unanticipated medical emergency. The sustainability of RRTs is vital to achieve long-term benefits of these teams for patients, staff, and hospitals. The author describes a study that examined the relationship between sustainability elements and RRT sustainability in hospitals with RRTs. Watch the video and be sure to read the article.
Creator:
Duration: 7:26
Recent changes in the Surgical Care Improvement Project guideline require blood glucose values be less than 180 mg/dL 18 to 24 hours after anesthesia end time after cardiac surgery. The authors studied 2 groups of patients: the first group of patients was transitioned off IV insulin on postoperative day 1, 24 hours after anesthesia end time, whereas the second group was transitioned off IV insulin on the second day, 48 hours after anesthesia end time. The results showed no statistical differences in outcomes between groups. Watch this video and read the article to learn about the study and evidence they gathered from it.
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Duration: 3:07
The purpose of this QI project was to determine the feasibility of using provider-led participatory visual methods to scrutinize 4 hospital units' infection prevention and control practices. Methods included provider-led photo walkabouts, photo elicitation sessions, and postimprovement photo walkabouts. Nurses readily engaged in using the methods to examine and improve their units' practices and reorganize their work environment.
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Duration: 6:12
Among hospitalized patients, malnutrition is prevalent yet often overlooked and undertreated. The author implemented a QI program that integrated early nutritional care into the nursing workflow. Nurses screened for malnutrition risk at patient admission and then immediately ordered oral nutritional supplements for those at risk. Supplements were given as regular medications. Pressure ulcer incidence, length of stay, 30-day readmissions, and costs of care were reduced. Watch this video and read the entire article for free: the article is open access so readers can learn about this important QI initiative.
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Duration: 16:32
A multicomponent intervention was attempted in a pediatric emergency department to increase reporting of workplace aggression committed by patients and visitors. Overall reporting decreased from 53% to 47% (p = .06). Reasons for reporting were severity of incident and being asked to report. However, many incidents were not reported. Watch the video and be sure to read the article.
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Duration: 3:18
Dr. Rahn examined the relationships between nursing teamwork and NDNQI outcomes including pressure ulcers, falls, and catheter-associated urinary tract infections, and she found some significant relationships. Improving teamwork in medical-surgical acute care units can transform care and impact the occurrence of preventable adverse outcomes. Watch this video and read the article to understand the importance of teamwork on your unit.
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Duration: 7:29
The authors examined whether an integrated nursing handover system (structured content and an electronic tool within the patient clinical information system with bedside delivery) would improve the quality of information delivered at nursing handover and reduce adverse patient outcomes. They demonstrated improvements in the transfer of critical patient information and reductions in nursing clinical management incidents. Watch this video and read the article to learn more about this important project.
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Duration: 7:42
Ensuring optimal care coordination requires a clear understanding of how clinician activities and continuity during transitions affect patient-centered care and quality outcomes. Dr. Radwin describes an expanded theoretical framework to better understand care coordination. She provides a clear explanation of concepts. Watch the video and read her article to understand the framework and how you can use it to guide care coordination in your own setting.
Creator:
Duration: 7:21
The Race is led by Clinical Nurse Specialists in partnership with nurse leaders to engage frontline staff in QI. Staff adopts evidence-based practice changes and actively engages in friendly competition to improve selected quality metrics. Data from compliance audits and automated outcome metric reports are used to identify top performing units. The Race project provides a focus for frontline staff by helping to correlate the impact on outcomes of providing quality patient care through best practices. The authors explain the project in this video and their article.
Creator:
Duration:
The authors examined the differences between medical-surgical patients who had a Rapid Response Team Intervention (RRTI) and those who did not. There were 5 significant differences between these 2 groups of patients. Watch this video and read the article to learn more about the effectiveness of the Rapid Response Team in this hospital.
Creator:
Duration: 5:48
Many fall prevention strategies exist with some degree of effectiveness. Watch this video and read the article to learn about a staff-driven QI initiative to develop a video in partnership with patients and families to prevent falls when hospitalized. Since the video's release, the fall rate has decreased by 29.4%.
Creator: Sabrina Orique and Christopher Patty
Duration: 5:08
Watch this video and read the article to learn more about the nature and causes of missed nursing care and how it relates to unit-level nurse workload. This study was conducted in California, which legally mandates nurse staffing ratios. There were no significant relationships between patient turnover and missed nursing care.
Creator: Erica Lewis
Duration: 4:51
Registered nurse (RN) “second victims” are RNs who are harmed from their involvement in medical errors. This study found a relationship between RN involvement in preventable adverse events and 2 domains of burnout: emotional exhaustion (P = .009) and depersonalization (P = .030). Support to RNs involved in preventable adverse events was inversely related to RN emotional exhaustion (P < .001) and depersonalization (P = .003) and positively related to personal accomplishment (P = .002).
Creator: Jan Bahle
Duration: 3:12
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Creator: Sandra Oliver-McNeil
Duration: 5:12
Ten hospitals participated in a multisystem collaborative to reduce heart failure readmissions. The overall 30-day readmission rate was reduced more in the collaborating hospitals than the non-collaborating (29.32 to 27.66% vs. 27.66 to 26.03%, p=.008). Regional collaboration between health care systems within a QI project was associated with reduced 30-day readmission.
Creator: Christopher Patty
Duration: 4:30
Using methods nearly identical to those in large national studies, the authors examined the incidence and typology of medication-related injury in their community hospital. This practice innovation provided the hospital with its first systematic assessment of medication-related injury.
Creator: Pam Cosper
Duration: 3:00
Multiple interventions were used to reduce restraint use in 4 acute care hospitals within a single health system: multidisciplinary rounds on restrained patients, increased availability of restraint alternatives, development of unit-based restraint champions, and education of staff. The health care system has maintained a quarterly restraint prevalence rate of less than 2.26% with 1 variant.
Creator: Danielle Miller
Duration: 7:54
A follow-up telephone call within 72 hours of discharge reduced the readmission rate. Learn how to do this in your own setting.
Creator: Paula Restrepo
Duration: 2:52
Deep vein thrombosis (DVT) remains a source of adverse outcomes in surgical patients. Nurses created a guideline for using non-invasive mechanical modalities for prophylaxis. Read more about this project.
Creator: Meredith Borak
Duration: 5:35
Early defibrillation is critical for patients with in-hospital cardiac arrest. This video and article describe how a team at The University of Chicago Medicine increased the rate of early defibrillation by nurse first responders in noncritical care areas.
Creator: Michelle Kimrey
Duration: 4:04
Learn how this team used team training to reduce falls. The intervention group improved on all measures except teamwork perception. A 60% fall reduction rate was reported in the intervention group. Read more about this study.
Creator: Sue Rees, RN, VP for Development, Nursing & Patient Care Services at University of Wisconsin Hospital & Clinics
Duration: 5:01
This interdisciplinary team reduced the number of catheter-associated urinary tract infections in their health system. Learn more about the 4 strategies they used and how they implemented the project system wide.
Creator: Dr. Maria M. Cvach. Video developed by Peter Cardamone
Duration: 3:00
Dr. Maria M. Cvach tested an alarm escalation algorithm for communicating cardiac monitor alarms to pagers. This innovation led to a significant decrease in mean frequency and duration of high-priority monitor alarms and improved nurses' perception of alarm response time. Read more about this study.
Creator: Dr. Timothy Morgenthaler; video developed by Joel Streed, Mayo Clinic (Streed.Joel@mayo.edu)
Duration: 4:39
The authors used a healthcare failure mode and effects analysis (HFMEA) to analyze the expressed breast milk feeding process in their NICU. This approach identified latent risks and provided semi-quantitative estimates of the effectiveness of recommendations. Findings demonstrated nursing interruptions and multitasking requirements contributed to risk. Read more about this study and HFMEA