Neuroscience Intensive Care Unit Fall Prevention Program Evaluation

ABSTRACTAmanda Davidson: Neuroscience Intensive Care Unit Fall Prevention Program Evaluation(Under the direction of Rebecca Kitzmiller)Falls remain one of the most common adverse events of hospitalized patients with approximately 3-20% of inpatients falling at least once during their hospital stay. Falls can result in an increased length of hospital stay, poor patient outcomes, injuries, and an increased cost to the patient and hospital. Fall prevention programs result in significant fall rate reduction and center around fall-risk assessment, fall prevention interventions, and post fall assessment. In a 37 bed Neuroscience Intensive Care Unit (ICU) at a large academic medical center located in urban North Carolina, fall rates increased from an average 1.79 per 1,000 hospital days to an average of 4.3 per 1,000 hospital days in six months as compared to the prior six months despite having a fall prevention program that followed recommendations found in the literature. Using the Context Input Process Product (CIPP) evaluation model framework, this Doctor of Nursing Practice (DNP) project aimed to examine the effectiveness of the fall prevention program policies and procedures to reduce falls in the Neuroscience ICU and to make recommendations for improvement. Using the CIPP evaluation model framework, qualitative and quantitative data were gathered to assess program knowledge, perceptions about resource availability, perceived barriers to implementation of the program, and process adherence. Analysis of 803-point prevalence audits, a single focus group of four nurses, and nurse stakeholder survey (n=52), revealed opportunities to improve baseline knowledge, provide additional resources to prevent falls, and improve the overall falls prevention program execution. Recommendations based upon project data included (1) increase the rigor of existing audits; (2) provide performance feedback directly to staff; (3) treat falls prevention as a multidisciplinary responsibility, (4) provide additional support staff to assist with fall prevention using sitters or remote video monitoring, (5) increase the frequency of academic detailing; and (6) provide written materials as supplemental educational resources for clinical staff, patients, and families.