According to Spath (2018), FOCUS PDCA is a frequently used quality improvement model used to improve processes. This change model has two phases. The first phase, FOCUS, consists of finding a process needing improvement, organizing a team, clarifying the current process and areas needing change, understanding why improvement is needed, and selecting actions to adjust the process (Spath, 2018). The second phase, PDCA, includes planning through investigation, identification, and brainstorming ways to improve the measure, do or incorporate the process improvement on one unit, check the process to make sure changes are improving the measure, and acting to maintain improvements (Spath, 2018). This model provides the structure through analysis, planning, outcomes, and feedback.
FOCUS PDCA is a change model that can be used to decrease falls. Falls during toileting is one safety concern that needs improvement. The quality team, along with other care team members, were organized to clarify current practices and policies and noted care team members are not staying within arms-reach of patients that trigger high fall risk. It is imperative to keep an open line of communication between the team and frontline staff (Godlock, Christiansen, & Feider, 2016). Understanding the policy deviations and brainstorm to select appropriate interventions to decrease falls during toileting. Interventions that need to be changed requires education to all care team members about the falls policy and how important it is to stay within arms-reach of patients that trigger high fall risk. Education also needs to be provided to CNA’s on certain medications that would make patients higher risk like blood pressure-lowering medications, and diuretics. These interventions will be rolled out to one unit to determine the efficacy of changes. These interventions need to be reviewed for improvement and modified if necessary. Once improvement has been met, it is crucial to maintain these improvements. Maintaining improvements can be accomplished through monthly quality improvement meetings.
I selected the quality improvement model of FOCUS-PDCA. This model is split up into two separate phases the FOCUS phase and the PDCA phase. F is for finding a problem that need improvement. Falls can be a detrimental occurrence than can affect patients and staff that is involved. Nursing times stated that as many as 20% of hospitalized patients experience a fall at some point during their stay (Grant, 2013). Even though falls are not always preventable they can be decreased with proper staff and patient education. If one fall can be prevented by a changed policy that can be one less patient that avoids an extended hospitalization or additional injury. O if for organizing a team. The team I have selected for the improvement project is my nurse manager and mentor as well as some floor nurses from both shifts and our patient care techs. C is to clarify the current policy and changes that need to be made. Our current policy is a yellow falling star sign that can sometimes be confusing to patients and family members. U is for understanding the causes of variation. Variations from standard fall precautions could be patient confusion or patient noncompliance. Another variation could be that staff coming in to assist your patient may not be aware they are on fall precautions if the proper prevention measures are not in place. S is for selecting the actions needed to improve the process. There needs to be something more in depth for each patient not just something generic. In the next phase, P is for plan to change the process. In a study by Lipsett patients falls were decreased by color coded mobility cards being placed in each patient room depending on how they required assistance (Lipsett, 2019). This would be much easier to see and associate with then just a generic fall risk or no fall risk. D is to do the change on a small scale. We will pilot the fall risk mobility cards on our unit. We have a mix of post op, post-partum, and medical surgical patients. C for checking the data to determine its effectiveness. We will compare the falls for the next months after the implementation with the fall rate prior to implementation. Lastly is A to act to maintain the gains. Randomly compliance should be monitored to make sure that falls risk mobility cards are being used. With this model we will put plans into place and follow up to make sure the best plan possible is put into place.
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