Page 26 nursing.elitecme.com Complete Your CE Test Online - Click Here organization. Employees should also come forward with thoughts about systems and processes that work well. This type of shared vigilance must be constant. Concerns and successes should be shared with staff members. Hearing about what works in one department or on one nursing unit might trigger staff members to think about adapting known successes to their own practice setting. 4. HROs defer to expertise. In healthcare, organizations are sometimes reluctant to admit that another organization (or a competitor) has a better way of doing things than they do. Senior staff may also be reluctant to acknowledge that subordinates have identified problems or come up with solutions that are better than theirs are. This is a serious mistake. HROs accept and value input from everyone. HRO leaders encourage leaders to visit staff members at their workplaces to best encourage input, not in meetings, via email, or texting. Being in the actual work setting (e.g. nursing units) increases effectiveness of communication. Employees should also be asked about experiences employees have had in other organizations. This is especially true for newly-hired staff members. They come to the organization with “fresh” perspectives and are excellent resources. For example, a question that might be asked is, “Based on your prior work experiences, what are some ideas for improving processes and systems here?” Nursing consideration: It is a good idea to ask employees for ideas about workplace improvement. However, they need to be assured that there will be no retaliation if they talk about things that “don’t work.” They also need to be acknowledged when their ideas contribute to and enhance safety and patients’ well-being. 5. HROS are resilient. Leaders are able to respond quickly to errors and failures in systems and processes. The ability of these leaders to take steps to solve problems swiftly and make improvements readily is a necessary trait of all HRO leaders (and staff members). HROs are evidence-driven and know about the latest research and how findings affect the way they do business. There are three types of unexpected events to which HROs respond swiftly to reestablish safety. These events are (Quigley & White, 2013): ● ● When an event that was expected to happen failed to occur. ● ● When an event that was not expected to happen does happen. ● ● When an event that was simply un-thought of does happen. These kinds of events in healthcare are often associated with adverse events and violations of the culture of safety. Research indicates that such issues are most likely to occur when (Quigley & White, 2013): ● ● There have been recent changes in supervision. ● ● Delegation has occurred without appropriate follow-up. ● ● There is a lack of a questioning attitude. Nursing consideration: Healthcare leaders must be alert to an environment where employees are reluctant to question the wisdom of current systems and processes. Are they afraid of being labeled “trouble-makers?” Are they afraid of retaliation in the form of negative performance evaluations or unfair workloads? Do they believe that nothing will be done to address their concerns or ideas? A questioning attitude cannot exist if leaders implement overt (and covert) barriers to honest and open communication. ● ● Missed step in a procedure. ● ● People not “on the same page”. In other words, there is no clarity about expectations, goals and objectives, and/or how to correctly implement processes or procedures. ● ● Staff members are spread too thin. This is another way of saying that staffing is inadequate for the number and complexity of the patients who must be cared for. ● ● Distractions from work. Pressure in the form of patient complexity, staffing issues, and other issues can interfere with focus and concentration. This can lead to job dissatisfaction and other adverse events. Nursing consideration: Nurses must also consider the problem of alarm fatigue as it relates to the issue of falls. Research shows that the constant bombardment of alarms in patient care environments are distracting and interfere with nurses’ ability to concentrate and provide patient care to the best of their ability. The high number of “false alarms” has led to a failure to respond to alarms when they sound. A recent study observational study showed only a 47% response rate to cardiac monitor alarms. This means that nurses did not respond to more than 50% of the alarms that occurred during the observation period. Failure to respond to fall alarms could lead to disastrous consequences as well. When addressing the problem of falls, and developing a fall prevention program, nurses MUST consider the impact of alarm fatigue as a danger to patients (Stokowski, 2014). In summary, there are many factors that influence how a fall assessment program is developed. It is important that nurses gather information from multiple resources to establish an assessment process that ultimately decreases falls and enhances safety. The entire organization must be alert to factors that contribute to falls and how to reduce them. Strategies for fall prevention: Effective implementation Lillian is a staff nurse who is the co-chair of the Nursing Practice Council. One of the Council’s recent projects was to evaluate the occurrence of falls and the effectiveness of the organization’s fall prevention program. The ways nurses and other staff members assess fall risk has been deemed to be effective. However, the actual implementation of the fall prevention program seems to have some inadequacies. Lillian and the other committee members have reviewed the organization’s fall prevention program and (with input from members of the nursing department) revised the fall prevention program. Now they must determine the best way to educate staff member about the program and its implementation. Lillian and her colleagues face a challenge that many nurses face. No matter how well written and evidence based a fall prevention program, unless the strategies that it identifies are properly implemented, it will be no more than a document that has no impact on safety. Agency for Healthcare Research and Quality recommendations As the Agency for Healthcare Research and Quality notes, “No matter how good your fall prevention program is in concept, if it is not used by the staff, it will not be successful” (Agency for Healthcare Research and Quality, 2013a). There are multiple aspects of implementation of a fall prevention program. The Agency for Healthcare Research and Quality (2013a) recommends asking and answering the following three questions: What roles and responsibilities will staff have in preventing falls? How is the organization going to assign roles and responsibilities? In order to make appropriate assignments, the organization must base assignments on evidence. Healthcare organizations vary in the way they staff departments and the ways that they do business. It is essential that not only staff nurses, but all members of the organization be involved in fall prevention. For example, a housekeeper should be able to recognize dangers such as a call bell that is located beyond a patient’s reach and take appropriate action. Although nurses bear a significant amount of the responsibility for fall prevention, they are not alone. Unless ALL employees take ownership for patient safety, it is doubtful that safety will be enhanced and a reduction in falls will occur. What fall prevention practices go beyond the unit? The focus of many fall prevention programs is the nursing unit. However, fall prevention programs should address fall prevention throughout the entire organization. Falls occur on nursing units, therapy departments, in hallways, and while being transported to and from tests and procedures. All fall prevention strategies must be broad enough to involve all employees and all areas of the organization. Ways to manage this process include: ● ● Make sure that staff members are well trained in their roles and responsibilities pertaining to fall prevention. ● ● Ensure that staff members know the goals and objectives of fall prevention and the rationale behind any changes. ● ● Identify any barriers to implementation and reduce or eliminate them before the revised fall prevention program is put into place. Prior to implementation, the program should be piloted in specific areas to help identify problems (and correct them) before the program is implemented throughout the organization.