6051 Assignment Flowchart

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Paper title

Student Name

Walden University

NURS 6051N, Section XX

Date

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Paper title here

Information regarding the level of risk a patient has for falling can be conveyed in many

ways such as in a report from one nurse to another, as part of the assessment, a diagnosis, in the

daily safety briefing, and as recorded in the electronic health record (EHR). Incorporating

technology into the workflow can help prevent falls and improve patient safety. "Workflow is the

sequence of physical and mental tasks performed by various people within and between work

environments" (U.S. Department of Health & Human Services, n.d.). Falls are dangerous,

bringing further complications and injury to patients. This paper describes the present way

information is conveyed from admission onward regarding a patient's risk for fall and explores

areas where improvement can occur.

Explanation of Flowchart

A patient came to the emergency room and admitted to the hospital. Depending on

diagnosis and emergency healthcare staff involved with the patient a determination is made

regarding the patient's risk for falling. If the patient's diagnosis is fall, change in mental status,

or ambulatory dysfunction the patient is automatically classified being at high risk for falling. In

this case patient interventions to prevent falls should be initiated in the emergency room by the

nurse caring for the patient. When admitting this patient, it is evident the patient is at high risk

for falling.

The patient with a different diagnosis is not considered a falls risk until information is

gained to status otherwise. When admitting this patient to the floor, the nurse has no knowledge

of the degree of risk for falling, unless the ER nurse has completed a falls risk assessment of the

patient. Emergency nurses have access to the falls risk assessment but rarely complete this

assessment if it is not related to the patient's admitting diagnosis. "There is evidence in the falls

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prevention research literature which suggests that in excess of 50% of potential falls relating to

older adults are avoided as a result of ongoing falls prevention interventions" (Hamm, Money,

Atwal & Paraskevopoulos, 2016, p.319).

When a patient arrives on the floor, the present instructions for the admitting nurse are to

review the patient's medications, complete a database, and assessment, all done within the within

the patient's EHR. While reviewing medications and completing the database, determining the

patient's orientation is quickly assessed. If a patient is not entirely oriented, they are then

determined to be at risk for falls. At this time the nurse initiates the falls risk protocol or

delegates this task to the clinical assistant. The protocol includes yellow socks and blanket,

alarms for the bed and chair, as well as placing a falls risk sign outside the room. The nurse also

must choose a care plan for the patient called "risk/actual for fall" in the electronic health record.

If the patient is fully oriented they are not considered at risk for falling at this time, unless

previously determined.

As the process of admission continues the nurse completes the full assessment. The nurse

then charts on the patient in the electronic health record using a modified Morse Falls Risk

assessment tool to determine if the patient is at risk for falling. The needed information to

complete the falls risk is a history of falls, secondary diagnosis, ambulatory aid, IV or attached

equipment, and orientation. A score generates from the assessment questions. With a score more

than or equal to 45, the falls risk protocol is put into place if less than 45 the patient is not at risk

for falling. At this time if the patient scores 45 or higher the care plan "risk/actual for fall" is

automatically entered into the care plan segment of the electronic health record.

Once the patient is on the floor, the policy states the falls risk assessment tool should be

completed once daily until discharge occurs, if there is a change in mental status, or the patient

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falls. Conveying of the patient's the risk of falling is done at bedside report to the oncoming

nurse. Education to the patient regarding the risk of falling is completed by the day shift nurse

when reviewing the daily care plan. Charting in the electronic health record documents the

assessment, teaching, and outcomes of the falls risk/prevention.

The Metric

Metrix used to calculate the falls is measured by how many falls occur within a 1000

patient hospitalization day, if the falls prevention protocol was in place at the time of the fall, and

outcomes of the fall. Falls are reported through an event reporting system and reviewed by

management and the Falls Council.

The Falls Council includes floor nurses, managers, clinical nurse leaders, and nursing

assistants. They track, initiate, and adapt the fall protocol taking into consideration evidence-

based practices and the measured outcomes from our falls prevention protocol. "Although many

tools to accomplish workflow redesign are available, the best method is the one that compliments

the organization and supports the work of clinicians" (McGonigle & Mastrian, 2015, p.241).

Having nurses and nursing assistants as part of the Falls Council ensures clinicians have a say in

the workflow. Improvements can be made in the workflow of falls prevention.

Areas of Improvement

There are many areas which need improvement when conveying information regarding

the falls risk of patients. Once a patient is assessed as a falls risk there should be a notification

which shows a red "Falls" sign in the electronic record. "Often, however, this underlying design

conflicts with the needs of clinicians, who must see a wide range of information in formats that

allow quick review" (Koppel & Kreda, 2010, p. 9). Completion of the falls risk assessment

should take place when the patient is in the emergency room and the protocol should then be put

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into place once the patient is determined to be at risk for falling. There have been incidences

where a patient is brought up from the emergency room by transport and placed in their room

without notification to the nurse receiving the patient. Enacting the protocol in the ER, the

patient would have yellow socks and blanket indicating to the transport staff the patient is at risk

for falling. Having a red "Falls" flag advising all the staff from the floor secretary to the clinical

assistants, the patient is at risk for falling. ER nurses have access to the falls risk assessment tool

in their electronic assessment, and it should be utilized to help prevent falls.

Another area of improvement utilizing technology will be placing a falls diagnosis on the

patients' electronic health record if the patient has fallen recently. It would then be part of the

electronic record and help by giving the floor nurse a heads up that the patient has had a previous

fall. Emanuele (as cited in Huser, Rasmussen, Oberg, & Starren, 2011) suggested:

Work-flow-enabled EHR system, which can communicate bi-directionally with a

Workflow Management System…send EHR event notifications to the work-flow engine

and display in the EHR system tasks and alerts generated by the workflow engine. (p.19)

Also, since completion of the electronic patient database is before the patient assessment, it

would be wise to consider the falls risk assessment be part of the database and if positive for risk

of falls it could generate a falls risk care plan and intervention in the nurse's patient assessment.

Finally, I suggest the patient falls risk score as a requirement each shift rather than daily.

Many patients who are not at risk for falls during the day shift, become falls risks at night. This

risk is missed by only requiring the fall assessment daily.

Conclusion

Using the workflow of conveying falls risk information has encouraged thinking and

planning with the use of technology beyond the current protocol to prevent falls and increase the

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safety of patients. There are many new technologies used to enhance nursing care and workflow.

Technology can help convey and alert healthcare workers of relevant information regarding

patients. According to Choi, Lawler, Boenecke, Ponatoski, & Zimring (2011), Fall-prevention

models can assist hospital staff with the development of a balanced fall prevention plan including

technology to prevent falls and fall-related injuries" (p.2522). It is important to be aware of and

step back to evaluate the process making sure the technology is effectively being used to

improve patient care and outcomes. Technology can alert nurses that a patient is at risk for

falling by having a positive falls risk score, and it can convey this finding by placing a record of

the score on the patient's electronic health record.

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References

Choi, Y., Lawler, E., Boenecke, C. A., Ponatoski, E. R., & Zimring, C. M. (2011). Developing a

multi-systemic fall prevention model, incorporating the physical environment, the care

process and technology: a systematic review. Journal Of Advanced Nursing, 67(12), 2501-

2524 24p. doi:10.1111/j.1365-2648.2011.05672.x

Hamm, J., Money, A. G., Atwal, A., & Paraskevopoulos, I. (2016). Fall prevention intervention

technologies: A conceptual framework and survey of the state of the art. Journal Of

Biomedical Informatics, 59 319-345 27p. doi:10.1016/j.jbi.2015.12.013

Huser, V., Rasmussen, L. V., Oberg, R., & Starren, J. B. (2011). Implementation of workflow

engine technology to deliver basic clinical decision support functionality. BMC Medical

Research Methodology, 11(1), 43-61. doi:10.1186/1471-2288-11-43

Koppel, R., & Kreda, D. A. (2010). Healthcare IT usability and suitability for clinical needs:

challenges of design, workflow, and contractual relations. Studies In Health Technology

And Informatics, 157, 7-14.

McGonigle, D., & Mastrian, K. G. (2015). Nursing informatics and the foundation of knowledge

(3rd ed.). Burlington, MA: Jones and Bartlett Learning.

U.S. Department of Health & Human Services. (n.d.) Workflow assessment for health IT toolkit.

Retrieved from http://healthit.ahrq.gov/portal/server.pt/community

/health_it_tools_and_resources/919/workflow_assessment_for_health_it_toolkit/27865

CA/RN Apply falls

risk interventions

+ Fall Risk

Assess Daily for Risk of Fall

+Falls Risk

Conveying Fall Risk Information

- Falls Risk

Pt in ER Admitted

Floor RN calls ER RN for report

Pt. not fully oriented Pt. fully oriented

RN completes admission (med review, data base, and assessment)

- Falls Risk Risk

Pt. dx falls/CMS/ ambulatory dysfunction

Other dx