Translating the Missed Nursing Care Model to Improve Accountability in Executing Standards for Fall Prevention

Purpose:
The purpose of this project was to reduce the incidence of patient falls through improved accountability with evidence-based fall standards by applying the conceptual framework of Missed Nursing Care and implementing a Just Culture.

Significance:
Falls are the most widely reported safety concern in hospitals and add significant costs. For patients they are associated with functional decline, disability, loss of independence, and even death. For hospitals, costs of injuries range from $4,000 to $30,000+.

Strategy and Implementation:
To promote a culture of safety & quality hospital staff must consistently use safe practices. It's known that inconsistency in practices are why some organizations cannot obtain sustainable results. We will share how Beatrice Kalisch's model of Missed Nursing Care was translated as a method for establishing improved levels of accountability for nursing staff in executing standards of care for fall prevention. Understanding how to proactively intervene when standards are omitted before patients fall, promoting a learning environment when standards are misunderstood, addressing system issues, & holding staff accountable when standards are consciously disregarded are fundamental to our success. We will share strategies that transformed our nursing culture from one of “picking and choosing standards to one of standardizing fall prevention.” Patient preference will also be discussed. The notion of standardization, plus consistency have been critical success factors for our organization.

Evaluation:
Our data indicates that the implementation of the Missed Nursing Care model has contributed to a reduction in falls from 3.45/1000 patient days to 2.51/1000 patient days. Evaluation of feedback loops to coach managers and staff will be discussed.

Implications for Practice:
In an era of pay-for-performance clinical leaders will continually be challenged by administrators and payers alike to meet the clinical benchmarks that result in the greatest payment for their organization. This is a great way to do that!