Solving the Problem of Patient Fall with Injury

Solving the Problem of Patient Fall with Injury

Introduction and purpose statement

The patient safety goals of 2007 identified patient fall with injury as a critical indicator of the quality of care. According to the Joint Commission (2015), patient falls is the rate at which cases of falls occur in 1,000 patient days. The American Nursing Association noted that nurse-led interventions could be helpful in reducing patient falls. In essence, nurses play a key role in reducing patient falls; this paper proposes a change process that would reduce patient falls at the University of Maryland Medical Center. The project proposes the use hourly or intentional rounding to solve the problem of patient fall

Patient Care Problem


At the University Maryland Medical Center, there have been cases of patients fall with injury; the risk caused by such falls requires the hospital to be responsive to the problem. Orthopedic unit is responsible for the care of patients who are at a greater risk of fall, and the results of such falls can be damaging to patient health condition, thus the need of an intervention to ensure the safety of all patients.


According to CDC (2016), falls rank thirds among unintentional injuries leading to death among people of all ages and the third leading cause of death among people at 65 years and above. Patient falls originate from several factors, from patients physical and psychological condition to safety design and handling of patients while receiving care.


A good prevention model should be accurate in assessing, recording and responding to the problem, this project proposes hourly or intentional rounding as a solution to the problem of patient fall with injury. The Joint Commission noted falls as acquired hospital conditions that are preventable; it produced a sentient alert on best practices to prevent falls, which included hourly or intentional rounding.

Practice Change

Hourly or intentional rounding is critical to the improvement of patient safety. The process that nurses should check on the condition of the patient on regular basis. The checks require doctor the doctor to take critical details on patient safety, which includes

  • Pain assessment- assessing the patient pain level
  • Patient personal need- offering patients what they need most which can be in the form of nutrition, hydration and toilet services among other assistance a patient may need
  • Position- helping patient to assume the appropriate position to avoid the problem of skin burns
  • Placement- allow the patient to access what they need by placing then the correct position
Patient Care Problem Intervention Measure of Success
Patient Falls With Injury Hourly or intentional Rounding Reduce Fall by 50%


Alignment with Mission, Vision, and Values

A plan for change must serve to enrich organization mission, values and mission for it to be useful (Marquis  & Huston, 2015).University of Maryland Medical Center has an obligation to deliver the best quality services to all patients, which include ensuring patient safety from fall. The hospital believes that patients should live free from the fear of falls leading to additional deterioration in health while receiving care, thus, the change is aligned with the organization objectives, mission, vision, and values all created to ensure quality care. The change also aligns the Joint Commission’s recommendations and Commission Center for Transforming Healthcare’s regulations on protecting patients from falls

Change Model

While many models exist to help organization effect change,most organizations will settle on either Lewin’s Model, Kotter’s 8-Step model or McKinsey 7-S model. An important feature of the McKinsey model is its ability to offer an effective way of diagnosing an organization but it requires all the parts to operate in a unified fashion to realize its rational and emotional components. The Kotter’s 8-step model focus on organization preparedness and acceptance of change, not the actual change. Therefore, a total transition is easy with the Lewin’s model. According to Shirey (2013), Lewin’s models have the advantage of being easy to implement, thus preferable in the case of theUniversity of Maryland Medical. It involves three steps; unfreeze (reducing the tendency of people to offer resistance to change), transition (once people become susceptible to change, the transformation begins, this requires effective leadership and reassurance) and finally refreeze (once the change running, the organization becomes stable and incorporate the change into its culture) (Mitchell, 2013).

Facilitating Change

Changing an established organization culture is difficult, in healthcare; the complex interactions between the parties increase the challenges of implementing the change (Marquis & Huston, 2015). However, the Lewin’s model provides an easy way of effecting the change. During unfreezing stage, it is critical to understand the organization structure and overcoming possible barriers (Mitchel, 2013). A notable concern is overcoming theresistance of nurses and inviting the involvement of top management. Without the engagement of the management support, change becomes impossible to achieve (Marquis & Huston, 2015). The second stage of the process is introducing the stakeholders to the new system of handling patient falls, all parties must show understanding of the needs to change and accept to follow the guidelines, and each member must be willing to play their roles (McAlearney, 2014). The hierarchy of reporting will follow the established chain of command at the hospital. Once the change is operational, the final stage of Lewin’s model will require a refreeze in which the practices becomes part of the organization culture (Shirey, 2013).

Despite the ability to increase patient safety, the organization setup is designed in such a way that it can resist change. Some organization during the implementation staff tend to offer resistance in favor of the old system. The resistance must be overcomes through proper planning and integration of the intervention into the model.


To effect the change at University of Maryland Medical Center, involved stakeholders include Administration staff, the healthcare providers, patients and patient relatives. Stakeholders must be competent for their role (Marquis & Huston, 2015). McAlearney et al., (2014) recognized the three elements of change as people, process, and perspective; the roles assigned to each stakeholder must align to the importance of the three elements to an organization. The administration and the healthcare provider will take part in drafting the guidelines for use in the case of a patient fall with injury and provide the necessary resources. The healthcare providers, which includes the Social workers, Physicians, Pharmacists, Nurses,Paramedical personnel, Physiotherapists and Respiratory technologists are responsible for transforming the formula into practices. The success of the project depends on corporation from the patient and relatives the results of the fall and permission to conduct impact assessment after a fall. The change requires leadership by anexperienced nurse who supervises the response to a case of patient fall and the successive procedures.

The process of requires the involvement of staff, as such, the staff requires training to fit the new role. The nurse manager must manage the change by preparing the nurses for their role in the implementation of the new project. The staff can only begin hourly or intentional rounding after and effective training. Competency checklist are also important to ensure the success of the project.

Summary and Conclusion

Preventing patient fall with injury is complex, a considerableamount of literature has discussed possible prevention measures, and these include standardized assessment formula and identification of risk factors, analysis of patient condition with preventive motives and intervention targeting individual patients. Systematic reporting and analysis of fall also form part of the detailed fall prevention methods. Numerous toolkits are available for adoption by anorganization that seeks to improve their quality of care. Agency for Healthcare Research and Quality (AHRQ), ECRI Institute and the Joint Commission are some of the organization involved in the identification of risk prevention model. However, some of the healthy facilities do not feature advanced initiatives to prevent patient fall, University of Maryland Medical Centerrequires change. Contrary to accidental change, a planned change allows things to happen in the desired way (Marquis & Huston, 2015). The project proposes hourly or intentional rounding. Implementation of the change will observe the Lewin’s change model. It utilizes the physician skills and corporation from patients and their relatives to create a safer hospital environment. If the project is asuccess, a target reduction of hospital fall by 50% is possible.















Joint Commission (2015). Preventing falls and fall-related injuries in health care facilities. A complimentary publication of The Joint Commission, issue 55

Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th Ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

McAlearney, A., Terris, D., Hardacre, J., Spurgeon, P. Brown, C., Baumgart, A &Nyström, M. (2014). Organizational coherence in health care organizations: Conceptual guidance to facilitate quality improvement and organizational change. Quality Management in Health Care, 23(4), 254–267 doi: 10.1097/QMH.0b013e31828bc37d

Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK20(1), 32–37. doi: 10.7748/nm2013.

Shirey, M. R. (2013). Lewin’s Theory of Planned Change as a strategic resource. The Journal of Nursing Administration43(2), 69–72. doi:10.1097/NNA.0b013e31827f20a9

Center for Disease Control and Prevention, (2017). Falls are leading cause of injury and death in older AmericansCDC Press Release. Retrieved 23 March 2017, from