Student Assessment and Fall Evaluation (S.A.F.E. Team): A Collaborative Initiative in an Academic-Service Partnership to Improve Patient Safety

Gosselin, Ann K.

Background: Academic-service partnerships (ASP) are becoming more prevalent in the United States, and while there is no perfect model for this partnership the urgency for health care institutions to establish collaborative relationships for scholarly practice is evident. An ASP is a structural linkage between universities and service entities whose primary goal is to share one vision through collaboration and improving patient care quality with innovative processes or interventions.[1] One such partnership exists at the University of Michigan Heath System where the Clinical Excellence Initiative (CEI) has been implemented since 2009. In the last year three units were chosen within this partnership to pilot an exemplar unit initiative (EUI). An exemplar unit is one that provides an integrated structure for clinical and academic leadership that is mutually beneficial and works towards common goals using quality measures and implementation processes.

Purpose: The purpose of this presentation is to describe and illustrate the innovative processes implemented through fall prevention pilot program on one of the three units chosen for the EUI.

Methods: A leadership team was chosen from the selected EUI that consisted of an embedded faculty member, unit leadership, and clinical nurse specialist. The leadership team met monthly with the guidance of the ASP leadership where it was decided to implement a process that impacted the quality of care and practice on the unit using the undergraduate baccalaureate nursing students as part of the process. Using the current quality data provided by unit leadership, patient falls was identified as a priority quality indicator. Past and current fall prevention practices on the unit were discussed and a logic model for the implementation of a fall prevention pilot was developed based on resources available. A literature search was conducted by a staff nurse with faculty assistance to evaluate the best evidence for a fall prevention program on a medical surgical unit. The current literature suggests that a multimodal individualized patient approach to fall prevention was the most successful way to address inpatient fallers. Oliver et al (2010)[2], identified consistent risk factors for patient fallers to have: experienced a recent fall, muscle weakness, behavioral disturbance, agitation, confusion, urinary incontinence or frequency, drugs, and hypotensive episodes or syncope. Short term and long term goals were identified for pilot program and included: the reduction of the current fall rate on the unit (falls per 1000 days), identification of specific risk factors for the EUI patient population, collaborative development of a multimodal fall prevention plan specifically for the EUI patient population, and development and implementation of an interactive fall prevention process for student learning and promotion of safe collaborative patient care. The Student Assessment and Fall Evaluation (S.A.F.E.) team was developed with staff nurse consultation and nursing leadership approval. Implementation of the S.A.F.E. team included: data collection from the risk pro management system to identify past fallers and possible risk factors, icon sign development and placement for each patient room to clearly and quickly identify a patient’s specific risk factors, nursing student rounding (in addition to nurse rounding) once a week to gather patient stories and identify current patient risk factors, elimination of the immediate environmental risk factors for the patient, promotion of immediate patient protolieting, the provision of in time patient/visitor fall prevention education, and student-charge nurse collaboration to address identified patients at highest risk to fall. Process outcomes measured included: completed patient interviews, compliance to bedside posters, environment of care attention, provision of protolieting, and provision of patient education. The pilot is ongoing and starts each semester with a new group of nursing students; however, the fall data is from the past year (2014) and the student confidence levels are from the past two semesters (8 months total).

Results: The overall fall rate for the EUI unit did not show an immediate reduction from the previous year; however, the overall fall rate for the unit has been on a downward trend. A large increase was noticed in student confidence levels (N=24 pre & N=20 post) through a pre and post survey in regards to their interviewing skills and identification of patients individualized risk factors as well as a patient’s overall risk to fall. Individual interviews with the nursing staff (N =5) identified a better understanding of individualized characteristics for the fallers on the EUI unit after reviewing the cleaned risk pro data sets to include the demographics of mean age of patient fallers, % of male to female fallers, time of day for falls, and patient story (identified risk factors).

Conclusion: Implementing a student driven interactive fall prevention pilot on a medical surgical unit has its challenges, however, the overall experience of its implementation has been overwhelmingly positive for both sides of the partnership. Although the immediate impact on the fall rate has not been realized the process will be continually monitored and developed to meet the needs of the patient population, clinical practicing staff, and learning needs of the students. This is a dynamic process and as we learn more about the EUI units’ patient population through the patient stories and demographics more opportunities will come into play to fine tune the fall prevention program and promote safer patient care through the use of evidence based multimodal fall interventions.

[1] De Geest, S., Dobbels, F., Schonfeld, S., Duerinckx, N., Sveinbjarnardottir, E., & Denhaerynk, K. (2013). Academic service partnerships: What so we learn from around the globe? A systematic literature review. Nursing Outlook, 61, 447-457.

[2] Oliver, D., Healey, F., & Haines, T. (2010). Preventing falls and fall-related injuries in hospitals. Clinical Geriatric Medicine, 26, pp. 645-692.

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