presented by Pat Quigley
Analysis of fall prevention programs requires more than examination of aggregated fall rates. Program evaluation is a systematic way to evaluate structures and processes that lead to improvement in outcomes. This session informs rehabilitation nurses about structure and process of fall and fall injury program attributes at the organization, unit and patient levels. This level of program assessment leads to opportunities to enhance practice, clinical skills, and program infrastructure and capacity. As a result, rehabilitation nurses are better positioned as clinical leaders to implement and spread interventions to improve patient and program outcomes.
Dr. Patricia Quigley, PhD, MPH, APRN, CRRN, FAAN, FAANP, Nurse Consultant, is a retired Associate Director of the VISN 8 Patient Safety Research Center of Inquiry and is both a Clinical Nurse Specialist and a Nurse Practitioner in Rehabilitation. Her contributions to patient safety, nursing, and rehabilitation are evident at a national level, with emphasis on clinical practice innovations designed to promote elders’ independence and safety. For over 40 years, Dr. Quigley has practiced in the field of rehabilitation nursing, including 32.5 years with the Veterans Administration. She serves as patient safety expert for fall and injury reduction to the American Hospital Association, Washington State Hospital Association, Alaska State Hospital and Nursing Home Association, and their Hospital Engagement Networks – now Hospital Improvement Innovation Networks. She also served as fall and fall injury prevention subject matter expert for the 2013 AHRQ National Falls Toolkit and the 2008 and 2013 Institute for Healthcare Improvement Reducing Serious Injurious Falls on Medical Surgical Units. Dr. Quigley serves as a committee member of the NQF Patient Safety Standing Committee and past member of the NQF Patient Safety Complications Steering Committee, nominated by ANA. Her leadership resulted in redesign measurement of patient safety indicators for falls and fall injuries that link organizational, unit, and patient-level variables that are relevant and evidence-based. With a legacy as primary and co-investigator on health services and rehabilitation research, she has conducted large-scale studies to examine trends and cost savings on national interventions to reduce harm from falls. Dr. Quigley has served as principal or co-investigator in 35 research studies, totaling over $7.5 million. She has a track record of interdisciplinary research with health economists, epidemiologists, and statisticians for population-based outcomes research. Dr. Quigley has co-authored and served as associate director for eleven VISN 8 Patient Safety Center of Inquiry center grants from 1999-2016, totaling over $13 million. She has authored or co-authored more than 60 peer-reviewed manuscripts and more than 50 non-peer-reviewed manuscripts, book chapters, products, and media works. Dr. Quigley is grounded in practice, with a legacy of leadership in healthcare outcomes related to functional improvement, rehabilitation outcomes, and continuum of care. For over 20 years, she led an interdisciplinary clinical team in the development of evidence-based assessment tools and clinical guidelines related to assessing veterans’ risk for falls and fall-related injuries across multiple medical centers. Additionally, she provides ongoing consultation to the nursing staff, quality management, and patient safety coordinators for management of complex patients at risk for falls.
All rehabilitation nurses want to evaluate the outcomes of their fall prevention practices. These outcomes are dependent on each patient’s risk factors, each unit’s context, and overall organizational characteristics. Rehabilitation nurses experience these complexities 24 hours a day, and therefore are vital to the preparation phase to plan for and initiate an evaluation. During this session, rehabilitation nurses will learn basic components of program evaluation and apply these components to fall and fall injury prevention programs, creating a more precise road map at the patient, unit, and organizational level.
Understanding changes in outcomes requires that structures and processes be clearly defined, linked, and trended to the correct outcome. Structures and processes must be measured twice as much as outcomes in order to discover, in real time, barriers and facilitators to program improvement. Simply monitoring a fall rate or counting number of days between falls is insufficient to determine fall program effectiveness. In this session, rehabilitation nurses will define and contrast three types of falls and align specific actions to reduce each type of fall, deconstruct structures and processes to reduce serious injuries, and assess baseline program status in order to initiate prioritized actions.
High-reliability organizations (HROs) commit to a culture of safety and transparency through continuous systems of improvement. These systems rely on valid, reliable, and continuous measurement to track implementation and then evaluation. During this chapter, rehabilitation nurses will utilize post-fall huddle data analysis and organizational self-assessment as two tools to evaluate fall and fall injury programs.
High-reliability organizations (HROs) and organizations of excellence strive to showcase how their organizations compare and outperform like units and organizations. HROs commit to a culture of safety and transparency through continuous systems of improvement. Program evaluation invites inquiry into the uniqueness of each culture, and this inquiry can excite new methods of program evaluation. In this chapter, rehabilitation nurses will be introduced to innovative methods of program evaluation to be considered within their unit and organization.