Leadership Experience

LEADERSHIP EXPERIENCE A1. Problem: Falls in Healthcare Facilities The problem that I seek to solve is falls in patients at the organization I am currently working for. Falls are encountered in all the facilities that provide patient care. It is in both healthcare providers' and institutions' best interest to develop solutions for this type of problem. Members of the organization should have an active role in preventing and solving the matter of falls. A1a. Explanation of the Fall Problem I currently work in a Clinical Decision Unit as a registered nurse. The problem of falls applies to my area of practice and the healthcare environment because sometimes the hospital admits patients with weakness, dizziness, loss of balance, advanced age, altered mental status, or other factors that can lead to a patient's fall. In addition, environmental factors such as small double bedrooms and clutter can develop unwanted outcomes for the patients. as a result, falls can lead to injury, more extended hospitalization stays, disability, and deaths. A2. Investigation of the Fall Problem I started working in the hospital five years ago, and since then, my coworkers and I have been involved, or whiteness near falls or falls. These falls could be easily avoided or prevented if protocols and policies are followed. Most of the falls that I am aware of on my unit are due to the patients' lack of supervision while in the bathroom or misuse of bed alarms and safety belts. The issue of falls is reaffirmed by the quarterly fall audits that are made throughout the hospital. A2a. Evidence to Substantiate the Fall Problem According to World Health Organization (WHO) (as cited by Glasper, 2019), falls are the second leading cause of unintentional deaths. Furthermore, there are recorded to be 646 000 deaths, with most of the falls are adults sixty-five or older. Worldwide is being documented 37.3 LEADERSHIP EXPERIENCE million falls that need medical attention (Glasper, 2019). Pati et al. (2021) note that 70% of inpatient accidents are due to falls. Moreover, 30% to 50% of the injuries resulted from falls have an average cost of $14 000. Falls can lead to permanent disability, discharge to long-term care facilities, increased healthcare costs and lengths of stay, and even deaths (Pati et al., 2021). The unit manager was also provided with data from our hospital for the 2020 fiscal year. A total of 85 falls across the hospital, with 78% of those were unwitnessed. Patients were left unintended in the bathrooms, or bed alarms were not activated. A3. Analyzing The State of The Situation Using Current Data As previously mentioned, our facility data for the 2020 year shows that there were 85 falls throughout the hospital. What is essential to the discussion is that 78% of those fell unsupervised. Furthermore, the data showed that these falls could be easily prevented if the staff was better trained in supervising the patients during their hospital stay. Finally, data showed that most of the falls occurred in the bathroom or patients exiting the beds. The current policy provides guidelines on how to provide falls within the facility from admission to discharge. These include applying nonskid socks on admission, placing a fall risk band on patients with Morse Fall Score grader or equal to 35, close supervision on patients at risk for falls when ambulating or using the bathroom, and so on. A3a. Analyzing the Factors That Might Contribute To The Fall Problem Factors that can contribute to falls are patients presenting with balance issues, altered mental status, urinary frequency or urgency, or medications. The first factor that might contribute to the problem is the patients present with mobility problems due to strokes, weakness, or dizziness. As a result, the patients usually believe they are capable of ambulating without any type of assistance, which can lead to a fall. A second factor, the patients with altered mental LEADERSHIP EXPERIENCE status might not be aware of their surroundings. As a result, they might believe they are in a different environment and can consequently have a fall. The third factor, urinary frequency and urgency in older adults, can produce a fall as the person can be impulsive and jump out of bed to get to the bathroom to avoid soiling themselves. Finally, the last factor, medication such as pain medication, can make the person drowsy and unstable. Furthermore, drugs can have different side effects on older adults who are at higher risk for falls. All the factors mentioned that could lead to a fall can be prevented if the patients are closely monitored and the gait belt is used when ambulating or using the bathroom. Moreover, bed alarm use on all the patients with the Morse Fall Score grater that 35 implemented and maintained throughout the hospital stay is crucial. A4. Proposed Solution or Innovation for the Fall Prevention My solution in reducing the number of falls in my facility is introducing video monitoring of the patients at higher risk for falls. The video monitoring implementation will help prevent a fall as the patient will be nonstop monitored by a person through a camera placed at the patient's bedside A4a. Justification of the Proposed Video Monitoring to Prevent Further Falls The research study made by Votruba et al. (2016) was done in a 350-bed Magnet Hospital. The research was done on three different inpatient units: neuroscience, senior adult, and critical care. The study showed that implementing video monitoring on patients at higher risk for falls decreased the number of falls by 35% in just nine months of research (Votruba, 2016). This study makes me believe that implementing the same or similar video monitoring can significantly decrease the number of falls within the institution I currently work. LEADERSHIP EXPERIENCE A5. Recommended Resources to Implement the Proposed Video Monitoring. Cost-Benefits Analysis The proposed solution would include 10 portable cameras, which is 10% of the hospital's capacity. The company can lease the cameras for a minimum period of half a year. The company will also provide training, software, and other devices necessary for monitoring. Through a camera, a technician can communicate with the patient. If the patients do not speak English, the cameras have incorporated up to 200 languages communication phrases to help the technician to redirect the patients. A video monitor technician can monitor up to twelve patients at once. There will be a need for at least three technicians trained to monitor patients, to cover all the shifts in a week. The cost for leasing 10 cameras for half a year would come to $300,000. This cost would include the devices and training necessary to implement the newly proposed solution. Also, the monitor technician's hourly salary would be $17. Also, the The justification of this high cost for implementing the video monitoring cameras is that it reduces the cost for a 1:1 sitter and the price for treating the falls resulting in injury. For example, a study done by Kowalski et al. (2018) showed that a total of $1,383,910.30 were saved over three years by introducing the video monitoring system. Furthermore, the cost was saved by reducing the falls that resulted in injury and the number of 1:1 sitters used during three years (Kowalski et al., 2018). A6. Timeline The proposed plan will be implemented over six months. In the first week, I would meet with a small group of stakeholders, including support and clinical staff. During the meetings, the group would go over current fall prevention policies, develop new practices and procedures to share with the healthcare staff, and research companies that will provide the cameras and LEADERSHIP EXPERIENCE software needed for the new proposal. During week two, the formed group will meet with the budget team to elect the company that will provide the monitoring system and go over other costs, including the technician's salary, training costs, and materials. The following week, the stakeholder group will meet with the educational department to develop the training necessary for the monitoring technicians and the healthcare staff. Finally, technicians would receive 12 hours of training for video monitoring and installing the new monitors and new software during week four. Also, the new policy and procedure will be delivered to the nursing staff and personnel directly involved with patient care. The start of the new proposed plan will be at the beginning of the second month. Cameras will be sent to the patient's room that needs 24/7 monitoring. During a period of six months, the data will be collected to compare results with the previous six months. Questions, recommendations, and concerns can be addressed during the period of the trial. A7. Importance of Stakeholders or Partners The first stakeholder important in implementing the innovating plan is the unit manager. The manager would be the one who would be ok to follow through with the proposed project. Because the cost for implementing the plan is high, the approval of the hospital CEO and the budget team is also vital. After the budget is approved, the education department has a significant role in developing the new policy and procedures and educating staff directly involved in the process. A7a. Engagement with the Key Stakeholder When I first met with the unit manager, I voiced my concerns about the increased number of falls that my coworkers and I witnessed over the past year. I explained to her that most falls were patients left unattended in the bathroom while the nursing staff would assist other patients. LEADERSHIP EXPERIENCE Also, falls in confused patients were due to a lack of placing the bed alarms or not getting in time when the bed alarms were going off. I explained that I had researched ways to prevent falls and encountered video monitoring of the patients at higher risk for falls. The nurse manager agreed with the information I provided and suggested proceeding with the plan developed. A7b. Future Success For the project to be successful is essential back and forth open communication between the stakeholders and me. With the initial contact in place and everyone agrees with the process, continuous feedback must occur during the trial. For example, every week, I would bring to the stakeholders the data collected and get new concerns or recommendations from the nursing staff. In return, the stakeholders will voice any concerns and additional questions or requirements that I have to address and answer for the project to be successful. A8. Implementation The proposed innovation can be executed on a regular shift. First, the nurse identifies that the patient is at risk for falls due to, for example, confusion and requests a video monitoring camera. The camera is placed at the bedside, where the patient is monitored 24/7 or until the patient is more alert and can follow commands or use the call bell. Then, when the patient tries to leave the bed, the technician will use the voice command to redirect the patient. After the sixmonth implementation of the proposed plan, the data collected will be compared with the previous six-month period to see if the proposed solution was successful. B. Roles Fulfilled During the Investigation and Development Process B1. The Role of Scientist I took the role of a scientist when I identified the reoccurring problem within our facility. I then asked how I could decrease this problem and collect the data that shows that this is an LEADERSHIP EXPERIENCE issue. I also looked at the national level to see how falls can impact a patient and an organization. After I collected the data next step was to analyze it and compare it to our organization. As a result, I fulfilled my scientific role in this project. B2. The Role of Detective Using my detective role, I could develop a solution that can significantly decrease the number of falls and save the organization of unnecessary costs. By researching new ways of preventing falls that other organizations started to implement, I stumbled over the video monitoring system. I also identified that it reduces falls and saves the organization a significant amount of money that they spend annually on medical treatments for patients that fall in the hospital. B3. Role of Manager of the Healing Environment Falls can have a negative impact on both patients and nursing staff. As a manager of the healing environment, I tried to give the nurses the tools to help prevent future falls, therefore, decrease the negative impact of anxiety and stress that comes with it.