Answering the call light (also called call bell a handheld like that is attached to the patient room wall, above the headboard of the bed) in a timely manner by the nursing staff in hospital setting is necessary to prevent falls that can harm, prolonged stays, and unnecessarily increase the cost of healthcare. However, researches concerning call light uses as it relates to patient safety, patient-care management and patient satisfaction are limited (Meade et al. 2006). Patients and their families emphasize that nurses should monitor patients constantly and provide assistance and answer a call light in a timely manner (Yoder, 2011). Note that the falls may be caused by several factors such as physiological, psychological and/or environmental-related to each individual patient (Joint Commission, 2005). The nurse initiating this project will focus on the rate of falls related to a delay in response to the call light.
The hospital, where the Quality Improvement Project (QIP) is done, uses the Hill-Rom system to operate and record the time it takes to respond to a call light prior to the incident as base for the (QIP). The nurse will identify opportunities to improve the quality of care delivered as well as the response time to a patient’s needs. The nurse working on the project used the study done by (Tzeng & Yi Yin, 2009) as a model to follow. In fact, Tzeng & Yi Yin suggested that the goal of the quality care is to reduce the response time to the call bell to a number that is unlikely to lead to a fall.
During their project, the authors explored the contribution of the call bell use rate and the average response time to the fall rate, the injurious fall rate and patient satisfaction scores that occurred in four adult inpatient acute care units (Tzeng & Yi Yin, 2009). Improving the responsiveness to the call light and reducing the fall rate is important for both the safety of the patient and the reputation and success of the organization. Yoder proposed that the patients are becoming more sophisticated and view themselves as “consumers” who can take their business elsewhere (Yoder, 2011).
Since the hospital is a Magnet and applies the shared governance model, there is an organizational structure for nursing quality that can facilitate the project. In fact, each unit has a designated staff member for the Unit’s Council Quality Champion (UCQC). This unit representative functions as a quality improvement resource for the unit council, and performs unit-based monitoring and analysis as well as collaborating with unit staff members on improvement plans. This allows for an opportunity to network and share best practice (MLHS, 2010).
The nurse handling the project can set up a meeting with the UCQC, and ask for input from other members such as patient care manager (leadership in implementing changes), physicians (after assessing the patient, leaving the bed in high position), housekeeping (placing caution signs on a wet floor), pharmacy (flagging medications that can contribute to falls such as sedatives, hypnotics, beta blockers), and dietary service (placing trays within the reach of the patient). The multidisciplinary team allows for a better planning approach to the subject and prevents malpractice (Yoder, 2011)
The information recorded from the patient room call light system was used in this study. The rate of inpatient falls, which have long been perceived as a nursing-sensitive quality indicator, is defined as the rate at which patients fall during their hospital stay per 1000 patient-days (American Nurses Association, in Tzeng & Yi Yin, 2009). As the nurse working on the QIP a notification to the institutional review board will be sent if further approvable are necessary. The only statistical data the nurse could obtain from the manager are related to the numbers of falls per 1000 patient days with injury.
The data gives us information about the rate of falls in reference to the average rate of falls in the hospital. In this unit there is awareness at the managerial level that the longer the call light is on the higher the incidence of fall is. If there is a fall with injury, the manager has the ability to go back and check how long the call light was on prior to a fall. However, this information is not used to prevent and emphasize the relationship between the length of time a call light is on and the rate of fall. Most nurses and patient care technicians are not aware that the manager can back-track the call light and find out this information.
To measure the rate of falls to the length of time a call light is answered, the nurse working on the project choose the histogram. This illustrates the length of time in the Y axis and the rate of falls in the X axis during the period of study (time frame). The histogram itself will include a control group, average answers, and delay answers to call light. This example was imported and modified from a previous study done comparing the numbers of call lights and nursing rounds by (Meade et al. 2006).
A realistic goal of this study is to reduce the fall related to a delay in answering the call light to less than the standard national data base that can be found in National Database of Nursing Quality Indicators (NDNQI). The nurse will be able to compare the data obtained on the unit to similar hospital units by referencing (benchmarking) to the national data from NDNQI. There will be a follow up study and gradual modification of the plan in order to achieve the outcome. The team has to set measurable outcomes and quality indicators. According to Yoder, the goal of quality improvement necessitates a standard of practice and a measurable patient-care outcome or nursing-sensitive outcome (Yoder, 2011).
Yoder signaled that the quality management stresses improving the system rather than assigning blame to employees (Yoder, 2011). Thus, communication is a very important step and strategies in the discussion. It allows both the manager and followers to see the appropriate changes needed without appointing blames. The results of the project can be shared with other floors, included in the computer based training, or presented by nursing leaders during in-service with the staff. Posters could be used to illustrate the importance of the response time to patient’s call light. In recent years some hospitals have initiated hourly rounds to reduce the noise and interruptions caused by unnecessary call lights. (Meade et al. 2006).
Meade concluded that with one-hour rounds, there was a significant reduction in the number of falls that occurred on the units. Others tools used in the hospital to prevent falls are yellow bracelet, non slip red socks, and yellow sticker placed on the chart. As the plan is implemented the team continues to gather and evaluate data to document and compare in order to find out if the outcomes are being met. Revisions are performed if new problems arise during the implementation of the project and a time frame is set during the realization of the project.
In conclusion this QIP can be implemented on the floor by educating the staff about high costs that result from a fall, specifically ones leading to injuries or even death. Also, as patient’s advocates the nurse has to work on securing the patient safety by responding to their needs and reducing the call light response time. Nursing staff must recognize that call lights are legitimate ways for patients to test the responsiveness of the hospital system regarding their needs (Deitrick et al. 2006).
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