Clinical TopicsMagnet® and Pathway to Excellence®Patient SafetyWorkplace Management

A hospital’s Magnet® redesignation drive spurs efforts to improve patient safety


My first exposure to a Magnet® redesignation initiative occurred in 2008 when I served
as a member of our hospital’s house-wide falls committee. The medical/oncology floor had a higher-than-average number of patient falls, and one of the Magnet appraisers challenged me with two questions:

  • What’s unique about your med/onc patient population?
  • What interventions are you using specific to this population?

After the appraisers’ visit, I approached my role on the falls committee with renewed energy, determined to answer these questions and decrease falls on the med/onc floor. While reviewing patient fall data for one calendar year (2008), I discovered several interesting facts about patients on that floor: They were younger (mean age 59) than those typically studied in falls research (age 65); about 30% of oncology patients who fell on our med/onc floor were age 55 or younger, and 49.6% were younger than age 65. Also, more than half the total falls occurred among patients in or on their way to the bathroom.

A nurse researcher and unit director supported a retrospective study to explore characteristics of fallers among oncology patients on the med/onc floor. Study results showed oncology patients who fell had a higher use of therapy services and were twice as likely to be discharged to somewhere other than the home. These data were shared in a poster presentation at a local research- and evidence-based practice conference. Combined with the knowledge that most falls were bathroom-related, they led to the first intervention for our adult oncology population: A commode was placed in each patient room on the floor. Subsequently, the fall rate decreased from 67 falls in 2008 to 39 in 2009.

As the unit champion, I took on the task of tracking and evaluating each patient fall on the med/onc floor and educating staff through "lunch and learns," morning "huddles," and yearly skills validations. Focused fall-prevention activities include ongoing fall risk and intervention education, close monitoring of each fall event, and review of all variances. I initiated a proactive fall-risk assessment now performed on all patients quarterly; the resulting data are disseminated to staff in daily staff huddles and have been shared via a poster presentation at a regional conference. Through webinars, I continue to engage in learning about patient falls.

Since the last Magnet appraisers’ visit, the fall rate on the med/onc floor has decreased significantly; for seven of the last eight quarters, it has been at or below the national benchmark. On implementation of the proactive fall-risk assessment, that floor went 54 days without a fall. Staff took pride in this success and celebrated a fall-free February on March 2, 2011. The med/onc floor is now a safer place for patients.

On a personal level, I’ve grown since the last Magnet appraisers’ visit. Currently, I’m enrolled in an RN-to-master’s degree bridge program. Also, I’m a co-principal investigator in a research project that will study the role of fatigue and fall risk in hospitalized oncology patients. Recently, my facility received a J. Patrick Barnes Grant for Nursing Research and Evidence-Based Practice to study the relationship of cancer-related fatigue to falls and fall risk in a hospitalized oncology population. I am grateful to the Magnet Recognition Program® for challenging my colleagues and me to advance our nursing skills and provide safer patient care.

Brenda Wolles is a clinical care coordinator at Sanford USD Medical Center in Sioux Falls, South Dakota.

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