1. Kratz, Ann MSN, RN, APRN, ANP-BC, APNP

Article Content


The literature is clear that prevention of falls involves multifactorial interventions and interdisciplinary collaboration. Falls are the most common cause of nonfatal injuries for people older than 65 years old in the United States and increases the person's morbidity and mortality.



Based on the new CMS guidelines, decreasing patient falls is an important intervention for all hospitals.



An innovative approach to fall analysis and prevention was led by transformational leaders.



The philosophy of Planetree as well as a partnership between nurses and patients. All patients admitted to the medical-surgical unit at Aurora Medical Center Washington County, a Magnet-recognized rural community hospital, were included. A systematic QI process through round-table discussion on every fall experienced was initiated in mid-2008. An interdisciplinary approach, in-depth analysis, and brainstorming for opportunities for improvement for each fall were the goal of these discussions. The literature was reviewed and summarized during the round tables. The team included quality staff, staff nurses, mangers, clinical nurse specialists, and staff from other disciplines related to each fall.



Interventions falls were designed and implemented that focused on partnership behaviors to decrease. Innovative interventions included the implementation of a fall safety protocol on all stroke patients, hourly rounding with scripting, late-evening MORSE fall scale assessment, and improved nursing education and competency for nursing staff as well as the interdisciplinary team. In November of 2008, the team investigated sitter usage with a goal to prevent falls while decreasing the use of sitters.



This unit experienced a 22% decrease in falls and reached the national benchmark for falls. Since the inception of the reduction of sitter's initiative, this unit has decreased sitter usage in November and December of 2008 by 98% while maintaining a fall rate for those months of 2.1. The fall rate continues to be below the national benchmark.



Transformational leadership through critical analysis was beneficial in meeting the benchmark for patient falls. Continued awareness and prevention are important in this healthcare environment. Other hospitals could replicate these innovative interventions to improve patient falls in the journey to provide evidence-based care to patients.


Implications for Practice:

Further testing of these innovations should be considered at larger hospitals throughout the United States to ensure the interventions are best practice.


Section Description

The 2010 National Association of Clinical Nurse Specialists (NACNS) Annual National Conference is planned for Portland, Oregon, on March 3 to 6. More than 375 clinical nurse specialists (CNSs), graduate faculty, nurse administrators, nurse researchers, and graduate students are expected to attend. This year's theme, "CNS as Internal Consultant: Influencing Local to Global Systems," demonstrates the breadth and depth of CNS practice and leadership at multiple levels in organizations and on healthcare.


A total of 142 abstracts were submitted for review, and 58 (not including student posters) were selected for either podium or poster presentations. Again, this year, there is a CNS student poster session; student abstracts will appear in a later issue of the journal. The abstracts addressed CNS practice in all 3 practice domains as described in the Spheres of Influence Framework for CNS Practice. Abstracts emphasized patient safety and quality care outcomes, leadership, CNS education, evidence-based practice, and new ways to shape CNS practice. Topics include CNS work activities incorporated into the 3 Spheres of Influence, the role of the CNS in developing clinical inquiry skills among staff nurses, use of simulation technology, strategies to maintain clinical excellence, the role of the CNS in National Database for Nursing Quality Indicators (NDNQI) activities, and many new and thoughtful ideas to support CNS education, practice, and research. Collectively, the abstracts represent the breadth, depth, and richness of the CNS's contribution to the well-being of individuals, families, and communities, as well as contributing to the advancement of the nursing profession.


The conference abstracts are published to share new knowledge with those unable to attend the conference. As you read each abstract, appreciate the intellectual talent and clinical scholarship of your CNS colleagues who are advancing the practice of nursing and contributing to the health of society through improved outcomes for patients and healthcare organizations. We encourage you to contact individual presenters to network, collaborate, consult, or share your thoughts and ideas on the conference topics.


Watch for next year's call for abstracts and consider submitting for presentation at the next NACNS annual conference scheduled for March 9-12, 2011, in Baltimore, Maryland.