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Patient Falls with Injury Quality Indicator — Formatted Training Script

A Nursing Sensitive Quality Indicator.

Hello everyone. My name is Nathalie, and welcome to this orientation training for new nurses. One of the most important nursing-sensitive quality indicators is Patient Falls with Injury, which we will examine today. As you acquire skills for direct care, it is important to understand this topic because falls are a significant, preventable patient safety issue. You will learn what this indicator is, how it is tracked, and most importantly, how to help prevent patient harm from the get-go.

The National Database of Nursing Quality Indicators (NDNQI) is an electronic database system that collects and analyzes information about nursing-sensitive quality indicators (NSQIs) relating to outcomes associated with nursing care. The NDNQI is created by the American Nurses Association to assist the hospital to evaluate nursing care quality using specific nursing sensitive indicators that are directly influenced by nurses (Wright et al., 2022). This database is intended to assist healthcare organizations in improving patient care though tracking of key outcomes and comparing performance to other hospitals throughout the country.

Nursing-sensitive quality indicators measurements show how nursing care affects patients. Pressure injuries, infections from catheters, patient falls, nurse staffing levels, and other indicators are examples of these indicators. Because they pertain to such aspects of care as nursing has direct control over or can influence, they are termed nursing-sensitive (Alshammari et al., 2023). So, if nurses check on patients regularly or keep the environment safe, we are less likely to see falls or pressure injuries.

For now, our indicator will be Patient Falls with Injury. This indicator monitors how frequently patients tumble and injure themselves at medical facilities. This is important because falls can cause serious injuries such as fractures or head trauma in older or weak patients. Sometimes, these injuries are worse than others and can increase the time spent in the hospital, raise medical costs, and cause permanent damage (Alshammari et al., 2023). By monitoring fall rates, hospitals know where care needs to improve and if safety procedures work.

New nurse needs to know this because they have to prevent falls as part of care on daily basis. So by making sure call bells are in reach, beds are low, and alarms are on will help prevent falls. Accurate documentation of fall risk and the safety action taken helps to follow up on how well patients are protected by the team. New nurses learning how to prevent and report falls helps keep their patients safe, resulting in better care for all.

Quality Indicator Data Collection and Distribution

I spoke to a quality improvement nurse in my interview and learned that data on Patient Falls with Injury is captured from the electronic health record (EHR) system. Nurses must fill out a specific form in the EHR as soon as a fall occurs. The form has details like time, location, cause of the fall, injuries, and what was done after the fall. The incident reports to monitor fall risks, among other things, are reviewed in addition to daily nursing notes and patient assessments (Randell et al., 2024). Some hospitals use safety checklists or bedside rounding forms to document what follow-up an operator does, including, for example, using bed alarms or helping a patient use the restroom.

Nurses work to collect and review this data with the interdisciplinary team of nurse managers, quality improvement staff, and IT specialists. Once data is gathered, it is compiled and analyzed by the quality improvement department. Aggregate data is shared through monthly safety reports, dashboards, and staff meetings (Randell et al., 2024). Trends like an increase in falls or high-risk units are flagged in order to identify improvement strategies for teams to focus on.

Nurses are integral in the collection of data. They have to be clear and state fall risks in their documentation, as well as what safety measures they take or the details of an incident. Without any missing or incorrect information, the hospital may have the whole picture of what the real problem may be. Thus, there will be no instances of lost improvement opportunities (Fu et al., 2022). Accurate input allows the whole team, from physicians to physical therapists to leadership, to identify issues and adjust protocols to prevent more falls from happening or provide more training. Everyone on the team counts on one another to share important data that will translate into better outcomes and safer care.

Enhancing Outcomes

Patient Falls with Injury is one of several nursing-sensitive quality indicators that aid our healthcare organization in improving patient safety, outcomes, and performance overall. Approximately every month, the quality improvement team analyzes the data collected for patient falls and shares information with leadership and unit staff (Oner et al., 2020). Patterns are discovered (e.g., a high fall rate in one unit) so that interventions are targeted. These can include simple actions such as extra staff training on fall prevention, checking the equipment, or even extra staff during times of high risk. Fall rates are reported monthly in dashboards that compare performance to national benchmarks. The organization also uses these results in performance evaluations and safety improvement plans. For example, if a unit reduces falls, this may be deployed as a best practice model (Oner et al., 2020). By doing so, indicators help direct honest choices that affect care directly, and that holds team members accountable for providing safer, more reliable care.

Evidence-Based Practice Guidelines

The Patient Falls with Injury indicator provides clear, evidence-based standards of practice for nurses to use in the prevention of falls and improved outcomes. Through research, these guidelines are created and reviewed regularly. For instance, nurses are trained to use time-delimited validated fall risk tools, such as the Morse Fall Scale, to assess risk for falls during every shift based on fall data. If a patient is at high risk, nurses follow protocols such as using bed alarms, giving the patient nonslip socks, and ensuring frequent toileting. Nurses can address overdue safety checks through reminders from the alerts on EHR software and electronic rounding tools (Randell et al., 2024). By following these standardized steps, nurses provide this same care time and time again and decrease injuries. These guidelines protect patients and increase satisfaction by demonstrating that staff observe and are active in keeping things safe.

References

Alshammari, S. M., Aldabbagh, H. A., Al Anazi, G. H., Bukhari, A. M., Mahmoud, M. A., & Mostafa, W. S. (2023). Establishing standardized nursing quality sensitive indicators. Open Journal of Nursing, 13(08), 551–582. https://doi.org/10.4236/ojn.2023.138037

Fu, S., Thorsteinsdottir, B., Zhang, X., Lopes, G. S., Pagali, S. R., LeBrasseur, N. K., Wen, A., Liu, H., Rocca, W. A., Olson, J. E., Sauver, J. S., & Sohn, S. (2022). A hybrid model to identify fall occurrence from electronic health records. International Journal of Medical Informatics, 162(1), 104736. https://doi.org/10.1016/j.ijmedinf.2022.104736

Oner, B., Zengul, F. D., Oner, N., Ivankova, N. V., Karadag, A., & Patrician, P. A. (2020). Nursing‐sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open, 8(3), 1005–1022. https://doi.org/10.1002/nop2.654

Randell, R., McVey, L., Wright, J., Zaman, H., Cheong, V., Woodcock, D. M., Healey, F., Dowding, D., Gardner, P., Hardiker, N. R., Lynch, A., Todd, C., Davey, C., & Alvarado, N. (2024). Practices of falls risk assessment and prevention in acute hospital settings: A realist investigation. Health and Social Care Delivery Research, (1), 1–194. https://doi.org/10.3310/jwqc5771

Wright, J., D'Ausilio, J., Holmberg, J., Timpson, M., Preston, T., Woodfield, D., & Snow, G. (2022). Identification of quality indicator codes associated with falls in inpatient rehabilitation facilities. Archives of Physical Medicine and Rehabilitation, 103(3), e31. https://doi.org/10.1016/j.apmr.2022.01.085