Clinical Nurse Specialist 3 Spheres Model Applied to Fall Prevention Program

Clinical Nurse Specialist 3 Spheres Model Applied to Fall Prevention Program


Name: Kimberly Barcus

Rank: CPT


Year: 2016


Clinical Nurse Specialist 3 Spheres Model Applied to Fall Prevention Program
CPT Kimberly Barcus, AN, MSN, ACNS-BC

Specific Aims/Objectives: To reduce Inpatient Falls at Fort Belvoir Community Hospital.
Research design, methods, and statistical analysis: A Root Cause Analysis (RCA) investigation following an inpatient fall with injury prompted an evaluation of the hospitals current fall prevention program. The program evaluation included review of the hospital policy, review of all 32 inpatient falls in 2015 using the Patient Safety Reporting System, and discussions with nursing personnel to determine frontline understanding of the current program.
Theoretical framework: CNS 3 Spheres of Influence Model and the DMAIC Model for Performance Improvement
Study Findings and Implications for Nursing: The fall prevention interventions with the highest levels of evidence were patient education and purposeful hourly rounding/patient centered bedside rounding.
Method of implementation and implications for Nursing: This CNS led program evaluation showed areas of opportunity for further improvement with patient education and communication, nurse understanding and engagement, and a mechanism to put policy into practice. See Table for details. FBCH had 17 inpatient falls in the 6 month prior to the fall program changes and only 9 in the 6 months following our changes in practice even with an increase in inpatient census.
Sphere of Influence Change in Practice
Nurse Conducted CNS led education with over 90% of the nursing staff assigned to the Medical, Surgical, Pediatric and Intensive Care Units. The education included case study, group discussion, and the two most evidence-based interventions – patient education and rounding.
Created Standard Nurse Initiated Order (NIO) Sets in Essentris for Adult Moderate Risk, Adult High Risk, and Pediatric At Risk. Each order set contained evidence-based interventions to prevent inpatient falls.
Patient education and communication is the most evidence-based intervention nurses can do to prevent falls. The CNS led discussions and the NIOs included this intervention to remind nurses to discuss falls with patients.


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DEPARTMENT OF THE ARMY (2014). Standardization of Inpatient Fall Risk Assessment and Documentation Falls Prevention Program. MEDCOM Regulation 40-59.

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Moe, K.; Brockopp, D.; McCowan, D.; Merritt, S. & Hall, B. (2015). Major Predictors of Inpatient Falls. Journal of Nursing Administration, 45:10, 498-502.

Staggs, V. S.; Mion, L. C. & Shorr, R. I. (2015). Consistent Differences in Medical Unit Fall Rates: Implications for Research and Practice. Journal of the American Geriatrics Society, 63:983–987.