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Nursing 473: Project Proposal

Reducing Secondary Falls and Improving Functional Recovery After Hip Fracture

Assessment and Identification of the Problem/Need

Issue that led to identification of your project topic:

On our inpatient rehabilitation unit, informal conversations with nurses and physical therapists surfaced a shared concern: patients recovering from hip fracture surgery were routinely discharged with non-individualized activity instructions rather than a structured home exercise plan. A review of discharge documentation confirmed this impression, showing inconsistent exercise teaching across patients, with some receiving only a printed handout and others receiving no instructions at all. This gap is clinically significant because many patients who fall once are readmitted within months due to a repeat fall, and the absence of a standardized, evidence-based exercise pathway leaves a preventable risk unaddressed at the point of discharge.

Main purpose of your project:

The purpose of this project is to design a nurse-led, multicomponent exercise rehabilitation pathway for patients discharged from the unit after hip fracture surgery, in order to reduce secondary falls and improve functional mobility during the post-discharge recovery period.

Currently informed by best evidence:

The project is grounded in a synthesis of current literature, including systematic reviews and randomized controlled trials showing that multicomponent, home-based exercise rehabilitation (strength, balance, and functional training) improves mobility outcomes more consistently than single-element programs (Lee & Lee, 2022; Pantouvaki et al., 2023). It further draws on evidence that caregiver involvement and structured follow-up improve adherence and reduce fear of falling (Prieto-Moreno et al., 2024, 2025), and that coordinated discharge planning and orthogeriatric co-management are associated with better long-term outcomes than fragmented care (Dakhil et al., 2021; Rocha et al., 2024).

Planning

Nursing/leadership/change theory or model guiding this project:

IHI Model for Improvement, using the Plan-Do-Study-Act (PDSA) cycle.

Primary QSEN Competency addressed:

Quality Improvement — using data on screening rates, exercise adherence, and mobility scores to test and refine practice changes.

Project Title:

Nurse-Led Exercise Rehabilitation Pathway to Reduce Secondary Falls After Hip Fracture

Personal Opportunity Statement:

I would like to help adult post hip fracture surgery patients on my unit leave the hospital with a clear, individualized plan for regaining strength and mobility, rather than generic advice that leaves them vulnerable to another fall.

Overarching Project Goal (THINK BIG):

Reduce secondary falls and improve functional mobility among patients discharged after hip fracture surgery.

Aim Statement:

Within six months of implementation, at least 90% of hip fracture patients on the unit will receive a standardized fall-risk and mobility screening at admission and an individualized exercise plan prior to discharge, with the goal of reducing 30-day secondary fall/readmission rates and improved functional mobility between discharge and 30-day follow-up.

Measures

Outcome Measure(s):

Rate of secondary falls or fall-related readmissions within 30 days of discharge.

Change in functional mobility score between discharge and 30-day follow-up.

Process Measures:

Percentage of patients who receive a fall-risk and mobility screening (TUG, Morse Fall Scale) at admission.

Percentage of patients/caregivers who receive the exercise handout and discharge teaching prior to discharge.

Percentage of patients/caregivers reached for the 2-week follow-up call.

Balancing Measures:

Nursing time spent on screening and follow-up calls, to monitor added workload burden.

Patient/caregiver-reported difficulty completing the exercise program (assessed at follow-up call).

Changes to Test:

Introduce a brief fall-risk and mobility screening (TUG, Morse Fall Scale) at admission for all hip fracture patients.

Provide a standardized, multilingual exercise handout and caregiver-inclusive teaching prior to discharge.

Conduct a follow-up phone call approximately two weeks post-discharge to assess adherence and troubleshoot barriers.

Strategy Timeline

Specify each step required to plan, implement, and evaluate the project:

Nursing 473: Professional Pathways Template for Project Proposal with PDSA Worksheet

Assessment and Identification of the Problem/Need

Planning

· Measures

For the family of measures, please include the unit of measurement (a percent or number). Example: The percent of nurses that attend the educational training.

· Changes to Test:

Nursing 473: Project Proposal

Reducing Secondary Falls and Improving Functional Recovery After Hip Fracture

Assessment and Identification of the Problem/Need

Issue that led to identification of your project topic:

On our inpatient rehabilitation unit, informal conversations with nurses and physical therapists surfaced a shared concern: patients recovering from hip fracture surgery were routinely discharged with non-individualized activity instructions rather than a structured home exercise plan. A review of discharge documentation confirmed this impression, showing inconsistent exercise teaching across patients, with some receiving only a printed handout and others receiving no instructions at all. This gap is clinically significant because many patients who fall once are readmitted within months due to a repeat fall, and the absence of a standardized, evidence-based exercise pathway leaves a preventable risk unaddressed at the point of discharge.

Main purpose of your project:

The purpose of this project is to design a nurse-led, multicomponent exercise rehabilitation pathway for patients discharged from the unit after hip fracture surgery, in order to reduce secondary falls and improve functional mobility during the post-discharge recovery period.

Currently informed by best evidence:

The project is grounded in a synthesis of current literature, including systematic reviews and randomized controlled trials showing that multicomponent, home-based exercise rehabilitation (strength, balance, and functional training) improves mobility outcomes more consistently than single-element programs (Lee & Lee, 2022; Pantouvaki et al., 2023). It further draws on evidence that caregiver involvement and structured follow-up improve adherence and reduce fear of falling (Prieto-Moreno et al., 2024, 2025), and that coordinated discharge planning and orthogeriatric co-management are associated with better long-term outcomes than fragmented care (Dakhil et al., 2021; Rocha et al., 2024).

Planning

Nursing/leadership/change theory or model guiding this project:

IHI Model for Improvement, using the Plan-Do-Study-Act (PDSA) cycle.

Primary QSEN Competency addressed:

Quality Improvement — using data on screening rates, exercise adherence, and mobility scores to test and refine practice changes.

Project Title:

Nurse-Led Exercise Rehabilitation Pathway to Reduce Secondary Falls After Hip Fracture

Personal Opportunity Statement:

I would like to help adult post hip fracture surgery patients on my unit leave the hospital with a clear, individualized plan for regaining strength and mobility, rather than generic advice that leaves them vulnerable to another fall.

Overarching Project Goal (THINK BIG):

Reduce secondary falls and improve functional mobility among patients discharged after hip fracture surgery.

Aim Statement:

Within six months of implementation, at least 90% of hip fracture patients on the unit will receive a standardized fall-risk and mobility screening at admission and an individualized exercise plan prior to discharge, with the goal of reducing 30-day secondary fall/readmission rates and improved functional mobility between discharge and 30-day follow-up.

Measures

Outcome Measure(s):

Rate of secondary falls or fall-related readmissions within 30 days of discharge.

Change in functional mobility score between discharge and 30-day follow-up.

Process Measures:

Percentage of patients who receive a fall-risk and mobility screening (TUG, Morse Fall Scale) at admission.

Percentage of patients/caregivers who receive the exercise handout and discharge teaching prior to discharge.

Percentage of patients/caregivers reached for the 2-week follow-up call.

Balancing Measures:

Nursing time spent on screening and follow-up calls, to monitor added workload burden.

Patient/caregiver-reported difficulty completing the exercise program (assessed at follow-up call).

Changes to Test:

Introduce a brief fall-risk and mobility screening (TUG, Morse Fall Scale) at admission for all hip fracture patients.

Provide a standardized, multilingual exercise handout and caregiver-inclusive teaching prior to discharge.

Conduct a follow-up phone call approximately two weeks post-discharge to assess adherence and troubleshoot barriers.

Strategy Timeline

Specify each step required to plan, implement, and evaluate the project: