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P33 - Nursing Informatics and Fall Injury Prevention: At the Forefront of Change


Falls and injuries from falls continue to challenge healthcare organizations throughout the continuum of care. Organizations have implemented technology and bedside devices as well as sitter programs in the prevention of falls. The complexity of patient falls and the variability of identifying the need for a patient safety attendant led to the development of a systematic process outlining key indicators for patient falls with guidelines for clinicians that assisted in decreasing falls as well as decreasing the financial impact of falls.

The patient safety attendant assessment yool (PSAAT) was imbedded via a power form and IVIEW documentation from the emergency department and throughout the inpatient care areas within the electronic healthcare system at UMC El Paso. An interdisciplinary approach with quality management, information management, educators, process improvement clinicians, clinical bedside nurses and administration, nursing informatics, risk management, physician teams, and other essential healthcare teams utilizing PDSA and change management theory moved the organization toward decreasing falls and identifying patients that needed a safety attendant at the bedside.

Risk factors with a total score for requiring a patient safety attendant were implemented utilizing evidence based practice and the Agency for Healthcare Research and Quality guidelines on decreasing falls. Testing and retesting along with data aggregation of the impact the tool made in changing practice to include decreasing falls and decreasing the financial impact of falls proved positive.

One fall is one too many falls for any patient and family. The implications of implementing fall prevention programs focused on creating safer environments and improving on current prevention strategies continues to foster continuous improvement plans with sharing of information and data. UMC El Paso showed a decrease in falls in several departments and improvement in the utilization of the PSAAT throughout the continuum of care. Data from the utilization of PSAAT as well as data based on national benchmarks on patient falls continues to guide clinical practice at UMC El Paso toward improved outcomes.

Learning Objective:

  • After completing this learning activity, the participant will be able to assess innovations being used by other professionals in the specialty and evaluate the potential of implementing the improvements into practice.