NURS 4106 Week 3 Quantified Problem Statement Example

Quantified Problem Statement: Injurious Falls per 1,000 Patient-Days: One Medical-Surgical Unit, Rising Across Four Quarters

Student Name

College of Nursing, Walden University

NURS 4106: Patient Safety and Quality Improvement

Instructor Name

Month Day, Year

Quantified Problem Statement: Injurious Falls per 1,000 Patient-Days: One Medical-Surgical Unit, Rising Across Four Quarters

The Number

On the composite medical-surgical unit in this project, a 20-bed floor, falls with injury rose in each of the last four quarters, from 0.50 to 0.99 per 1,000 patient-days, as shown in Table 1. The rate is the standard measure because it adjusts for census: more patients, and more days, mean more opportunities to fall.

Table 1

Injurious Falls per 1,000 Patient-Days, Last Four Quarters

Trend and Comparison

The trend is upward in every quarter, while census stayed nearly flat. For comparison, a national study of falls in U.S. hospitals reported an injurious fall rate of 0.93 per 1,000 patient-days overall, higher on medical units at 1.08 and lower on surgical units at 0.67 (Bouldin et al., 2013). The unit's annual rate of 0.75 sits between those, but its most recent quarter, 0.99, is now above the national overall figure and approaching the medical unit figure, and the direction is the concern more than any single quarter. The organization also reports falls to an external nursing quality database, where the unit's Q4 rate placed it above the median of similar units.

Consequences

The consequences are counted in harm and in cost. The 18 injurious falls over the year included two hip fractures and one head injury requiring imaging. Patients with serious fall-related injuries in a study at three hospitals had operational costs about $13,000 to $14,000 higher and stayed about 6 to 7 days longer than matched patients who did not fall (Wong et al., 2011). For patients, an injurious fall can mean surgery, lost independence, and leaving the hospital for a nursing facility instead of their own home.

Data Sources and Their Limits

Fall counts come from the hospital's incident reporting system, where each fall is classified by injury level after review by the unit manager; patient-days come from the midnight census. Two limits matter. First, falls that are not reported are not counted, so a real rise and an improvement in reporting look the same in this table; the unit's reporting practices did not change during the year, which makes a reporting artifact less likely but not impossible. Second, with small counts, a single fall moves the quarterly rate by about 0.17, so quarter-to-quarter changes should be read as a trend across the year rather than as proof of a change in any one quarter. Both limits argue for tracking the rate monthly on a run chart once the project begins, rather than waiting for quarterly reports.

SMART Aim

By the end of the next two quarters, reduce the unit's rate of injurious falls from 0.99 per 1,000 patient-days in Q4 to 0.50 or lower, measured quarterly from the incident reporting system and census data, through a unit-based fall prevention bundle aligned with the multifactorial approach recommended for older adults (Panel on Prevention of Falls in Older Persons, 2011).

References

Bouldin, E. L. D., Andresen, E. M., Dunton, N. E., Simon, M., Waters, T. M., Liu, M., Daniels, M. J., Mion, L. C., & Shorr, R. I. (2013). Falls among adult patients hospitalized in the United States: Prevalence and trends. Journal of Patient Safety, 9(1), 13-17. https://doi.org/10.1097/PTS.0b013e3182699b64

Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. (2011). Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society, 59(1), 148-157. https://doi.org/10.1111/j.1532-5415.2010.03234.x

Wong, C. A., Recktenwald, A. J., Jones, M. L., Waterman, B. M., Bollini, M. L., & Dunagan, W. C. (2011). The cost of serious fall-related injuries at three Midwestern hospitals. The Joint Commission Journal on Quality and Patient Safety, 37(2), 81-87. https://doi.org/10.1016/S1553-7250(11)37010-9