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Running head: SELF-REFLECTIVE JOURNAL: Quality Improvement

Self-Reflective Journal: Quality Improvement Name Course Professor Date

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SELF-REFLECTIVE JOURNAL: Quality Improvement

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Self-Reflective Journal: Quality Improvement Pre-Planning The definition of quality improvement (QI) is “Using data to monitor the outcomes of care processes and using improvement methods to design and test changes to continuously improve the quality and safety of health care systems” (QSEN, 2020). The role of professional nurses in quality improvement is to implement interdisciplinary developments to achieve the organization’s objectives and to measure, improve, and monitor sensitive parameters that affect particular patient outcomes and nursing duties. All levels of nursing play a role in promoting quality in healthcare organizations. Introduction Quality Improvement is implemented in all hospital settings to ensure more desirable outcomes and provision of care to patients in an inpatient setting. Falls in the acute care setting are a major issue in the current health care system and are a main topic of interest for students to address in order to demonstrate their competency in risk reduction, health promotion, and evidence-based practice. The adverse event of a patient fall, regardless of the outcome, has the potential to cause physical and emotional harm to patients, staff, and the organization. In-hospital patient falls are the leading cause of injuries among the older population and can lead to patient injuries, prolonged hospital stays, and higher cost to the institution of care (Dunne, Gaboury, & Ashe, 2014). This paper will focus on the measures that can be taken to reduce the risk of patient falls as well as how to implement them based on previous hospital statistics and protocol. Background This week I encountered a 70 year old female patient who was admitted for severe obesity. She was 1 day post op from a gastric sleeve procedure and had been placed on fall precau-

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tions. She had a yellow fall risk ID band placed on her wrist as well as a sign outside of her door indicating that she was a fall risk patient. This patient had no history of falls and was strictly placed on precautions due to the surgical procedure. Based on this information, I was adamant in providing assistance with using the restroom, ambulating in the hallway, and assessing for any other signs and symptoms that could contribute to a fall. Noticing Kaiser Permanente uses the Hester Davis Fall Score Assessment to determine the risks and likelihoods of patients experiencing a fall. Upon reviewing my patients chart, I found that her score was an 8, which is indicative of a low risk score. In 2021, Kaiser Permanente’s statistics relayed that age groups between 51-64 had the second highest number of falls. Furthermore, these falls occurred more often in males than in females and these incidents took place mostly in the patients room. Lastly, more falls happened when the patient was unassisted as opposed to having assistance. Upon further review, I obtained that my patient was also taking two blood pressure medications (Losartan and Metoprolol), which are both known for causing side effects that include dizziness as well as muscle weakness. Interpreting Based on the above mentioned data, I realized that given my patients age, it rendered her more susceptible to a fall. Following the administration of her blood pressure medication, I made sure to include patient teaching about the side effects that may occur in relation to falls. At one point, I was assisting the patient to the restroom, and she stated “it’s okay if you leave the room, I can use the restroom by myself.” After this comment, I felt it important to educate her on the fact that since she was considered a fall risk, I was unable to leave her unattended while she is out of

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bed. I encouraged her to do as much as she could on her own, while still maintaining a close distance and assisting her when necessary. Responding The patient responded well to the medications and didn’t experience any bouts of dizziness or muscle weakness after administration. The doctor put in orders to have the patient ambulate in the hallway if capable. Before having the patient ambulate, I made sure the environment was free of any clutter, ensuring it was safe for movement. Next, I assured that the patients IV pole was mobile and could be used during ambulation. Lastly, the patient and I established a goal of walking halfway down the hallway and back to her room, with an agreement that she would let me know if at any point she felt as if she may fall or couldn’t handle the duration of the walk. My patient successfully ambulated the entire distance without any complications and required minimal assistance from me during this process. Reflection-in-action When fall risks are identified, the appropriate precautions are initiated per hospital protocol. According to Kaiser Permante’s protocol in relation to falls, the prevention of falls is the responsibility of every staff member and fall precautions are initiated and maintained for all patients. I made certain I followed these protocols by providing education to my patient on specific safety measures to prevent falls, ensuring the call light was within reach at all times, routinely assisting my patient to the restroom, and aiding in the ambulation process to reduce any fall instances. Reflection-on-action and clinical learning This experience taught me the importance of analyzing and exploring perspectives regarding fall prevention in the healthcare setting. I was able to utilize this knowledge and expand my

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nursing skills by learning the importance of how to properly identify the level of patient mobility, determine and monitor patient’s elimination patterns, and discover if my patient had any previous history of falls. Furthermore, this experience taught me how to gather information regarding perspectives on the current fall prevention protocols. By properly implementing all fall protocols, I guaranteed the best possible outcome for my patient as well as prevented any falls that could have potentially caused further harm.

References

Dunne, T. J., Gaboury, I., & Ashe, M. C. (2014). Falls in hospital increase length of stay regardless of degree of harm. Journal of evaluation in clinical practice, 20(4), 396-400.

SELF-REFLECTIVE JOURNAL: Quality Improvement

QSEN.org. (2020). Quality and Safety Education for Nurses [Video]. https://qsen.org/

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