Theoretical notions and concepts of the selected theory.

Theoretical notions and concepts of the selected theory.


            I interviewed the director on the unit I work on, surgical/ortho. The director’s name is Aleycia Wilkerson-Coleman MSN, RN, NEA-BC. The interview started with me thanking Aleycia for the time she put aside to allow me to interview her. We talked about ways to prevent falls, the interventions we have in place, interventions she would like to see change, and our numbers of falls since the beginning of the year. Aleycia was also kind enough to print out a detailed power-point of how to use the assessment tool to identify a patients fall risk score.

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The first question I asked Aleycia was what she believed the main reason for patient falls on our unit was. Aleycia responded by saying the population we take care of on unit. Majority of our patients are over the age of fifty. Aleycia explained that with an older population and the medication they are receiving is the main reason for our falls. Patients over the age of fifty cannot metabolize narcotics or anesthesia like a younger patient would. It takes them longer to get those things out of their system. These medications, including the anesthesia can cause confusion in most of our patients, which can be the reason they try getting out of bed without calling.

We use the John Hopkins Fall Risk Assessment tool (JHFRAT) that we document on every shift. Aleycia printed out a power-point that went over the John Hopkins Rall Risk Assessent tool. In the power-point it states that the JHFRAT reduced falls at John Hopkins hospital by 21% and reduced fall injuries by 51%. I asked Aleycia if she believed the John Hopkins Fall Risk Assessment tool is helpful in identifying if a patient is a high fall risk. Aleycia responded by saying, “yes, if it is used properly.” According to the JHFRAT, if a patient scores 0-5, they are considered a low fall risk; if they score a 6-13, they are considered a moderate fall risk; and if the score >13, they are considered a high fall risk. Usually, the patients that have gone under anesthesia within 24 hours are considered high fall risk, no matter what they have scored before the procedure. Aleycia and I spoke about how in depth the JHFRAT goes into in contrast to the Morse Fall Risk Assessment tool. The JHFRAT considers the patients age, the type of medications they are on, if they have any equipment such as IV’s or SCDs placed.

Currently the interventions being placed for our high fall risk patients are what we call our fall bundle. Aleycia explained that our fall bundle consists of a yellow bracelet that says “Fall Risk”, yellow socks, a yellow poster to put outside of the patient’s door, a yellow sticker for their chart, a yellow sign that says “Call, Don’t Fall” to place in their room, and of course making sure the bed or chair alarm is on and working. One of the interventions Aleycia would like to improve is awareness and education. Although it may be difficult for our patients to understand the education given, Aleycia wants to make sure we are constantly educating our patients on the risk of falls on the unit. Aleycia also wants our nurses to be aware of the patients fall risk. Us as nurses want to give our patients autonomy but we have to be realistic and make sure they are safe. One thing Aleycia wants implemented is making sure it is part of our bed side report, making sure we let the oncoming nurse know they are a high fall risk; making sure the alarm is on during bed side report; and making sure it is written on the white board that they are a high fall risk.

Another thing Aleycia wants implemented is a new call light system. Currently, if a bed or chair alarm goes off, all the nurses/techs hear is a loud alarm without knowing exactly where it is coming from. So when an alarm goes off, you see all the nurses running around trying to figure out what room it is coming from. Aleycia would like better technology to let us nurses/techs know exactly which room the alarm is coming from, for us to get there quicker and prevent a fall from happening.

For our floor, surgical/ortho, our numbers have decreased in the past three months. Aleycia says our numbers have decreased due to our nurses having more awareness, using bed and chair alarms, as well as the education our nurses get during our fall meetings every Wednesday when a fall occurs. Aleycia and I also spoke about coming up with a pamphlet our patients can read during their stay at the hospital in regards to patient falls, as an extra education tool.