Tools for Measuring Quality- Fall Prevention in Hospitals
Quality indicators provide key information used to monitor performance and determine outcomes. These indicators are usually standardized and are backed by evidence. They identify potential areas for improvement, the need for further research, and provide periodic tracking of changes. Rate-based indicators (RBIs) embrace data concerning occurrences that are anticipated with a certain frequency (Quentin et al., 2019). These might be presented as ratios, percentages, rates, or averages for a statistical sample. Proportional or RBIs incorporate two parameters: a numerator and a denominator. These parameters identify the target population and the time frame within which a specific event occurs.
The Three Rate-Based Measures of Quality
The first rate-based measure (RBM) is hospital-related falls. This refers to the number of falls that occur per bedday in the hospital. AHRQ.gov (2019) reports that the incidence of falls in the USA is approximately three to five falls per one thousand bed days. Furthermore, more than 700,000 hospital-related falls are recorded annually. Hospital-related falls are classified into accidental, physiologically anticipated, and physiologically unanticipated (AHRQ.gov, 2022). Environmental hazards such as slippery floors, spillages, and weak handrails are the principal causes of accidental falls. Notably, physiologically anticipated falls are recorded among individuals with a high risk of falls. These individuals have predisposing factors such as altered mentation and abnormal gait (AHRQ.gov, 2022). On the other hand, physiologically unanticipated falls are caused by unforeseen events such as stroke and seizures (AHRQ.gov, 2022). I selected this measure because it identifies the incidence and prevalence of hospital-related falls hence the need for preventive measures.
The second RBM is the standardized risk assessment (SRA) rate. This refers to the percentage of hospitalized patients who have been assessed for their risk for falls. SRA guides the decision-making process when formulating care plans (AHRQ.gov, 2022). For instance, healthcare providers will initiate close patient monitoring for patients at risk of physiologically anticipated falls. Also, SRA allows healthcare providers to embrace targeted preventive interventions. As a result, the incidence of physiologically anticipated and unanticipated falls is lowered. Furthermore, SRA provides an opportunity for interdisciplinary collaboration because common terms are used to describe the risk of falls among patients (AHRQ.gov, 2022). SRA is accomplished using specific assessment tools. These tools assess various aspects such as fall history, high-risk medications, mentation, mobility issues, and other risks such as poor eyesight that could increase the risk of accidental falls (AHRQ.gov, 2022). I selected this measure because it identifies the risk of falls for each patient and forms the basis for individualized care plans.
The third RBM is morbidity and mortality rates. The morbidity rate refers to the frequency of injury or disability among a specific patient population (Hernandez & Kim, 2022). On the other hand, mortality rate refers to the frequency of deaths among a specific population (Hernandez & Kim, 2022). Morbidity and mortality rates are expressed as percentages or ratios. Typically, they are reported per one thousand individuals. LeLaurin and Shorr (2019) report that hospital-related falls result in approximately 260,000 injuries and more than 10,000 deaths annually. Furthermore, about one in four falls cause injuries. Ten percent of these injuries are categorized as severe (LeLaurin & Shorr, 2019). Morbidity and mortality rates are measures of concern because they reflect the quality of services provided to patients. High rates indicate that healthcare facilities have not formulated pertinent fall prevention strategies. I selected this measure because it identifies the impact of falls and the necessity for fall prevention.
Deconstruction of Each Rate-Based Measure
The Definition of the Measure
As earlier stated, hospital-related falls refer to the number of falls that occur per bed day in the hospital. This can be represented as a percentage or ratio of falls that occur in various healthcare facilities. AHRQ.gov (2019) reports that the incidence of falls in the USA is approximately three to five falls per one thousand bed days. Furthermore, more than 700,000 hospital-related falls are recorded annually. This measure is relevant because it enables stakeholders to acknowledge the existence of the problem of hospital falls and the need to mitigate them.
Similarly, as aforementioned, the standardized risk assessment rate refers to the percentage of hospitalized patients who have been assessed for the risk of falls. SRA guides the decision-making process when formulating care plans (AHRQ.gov, 2022). SRA is accomplished via an assessment tool. The assessment tool should be standardized to allow comparison with other healthcare facilities. Furthermore, it should be individualized for a specific patient population. The Morse Fall Scale is an example of an assessment tool (AHRQ.gov, 2022). It is worth noting that hospitals should modify their assessment tools to address their individualized needs. SRA rate is a relevant measure because it enables healthcare providers to make informed decisions and develop patient-centered care plans.
As earlier stated, morbidity rate refers to the frequency of injury or disability among a specific patient population. On the other hand, mortality rate refers to the frequency of deaths among a specific population (Hernandez & Kim, 2022). Morbidity and mortality rates are expressed as percentages or ratios. Typically, they are reported per one thousand individuals (Hernandez & Kim, 2022). This measure is relevant because it identifies the impact of falls and the necessity for fall prevention.
Numerical Description
The first measure is hospital-related falls. This measure is constructed by two parameters. The numerator represents the total number of falls recorded among patients receiving inpatient services. The denominator represents the total number of patients admitted to the inpatient unit during the hospitalization period. This measure can be reported as a percent, average value, proportion, or rate. For instance, it can be reported as 20 falls per 100 bed days. This represents the number of falls recorded within 100 days. It can also be reported that five percent of patients in the inpatient unit suffered from falls.
The second measure is the standardized risk assessment rate. The measure is constructed by two parameters. The numerator represents the number of hospitalized patients who have been assessed for fall-related risk factors, while the denominator represents the total number of patients hospitalized in the healthcare facility. This measure can be reported as a percent, proportion, or rate. For instance, it can be reported that standardized risk assessment was conducted among 40 percent of hospitalized patients.
The third measure is morbidity rate and mortality rate. For morbidity rate, the numerator represents the number of patients that have suffered fall-related injury or disability. The denominator represents the total number of hospitalized patients who experienced a fall during that period. Regarding mortality rate, the numerator represents the number of fall-related deaths recorded among hospitalized patients. The denominator represents the total number of hospitalized patients who experienced a fall during that period.
Data Collection
Data on hospital-related falls is collected from different sources using various strategies. Firstly, it is sought from administrative data. This data reports key aspects such as patient identity, primary diagnosis, secondary diagnosis, and the type of services offered. Information on the patient’s diagnoses provides invaluable information about hospital-related falls. Secondly, medical records provide key information about hospital-related falls. Medical records provide an in-depth source of information compared with administrative data. Thirdly, survey data provides information on hospital-related falls. This is accomplished by administering questionnaires to patients.
Administrative data, medical records, survey data, and direct observation provide critical information on standardized risk assessment rates. As earlier stated, administrative data reports key aspects such as patient identity, primary diagnosis, secondary diagnosis, and the type of services offered. These records indicate whether SRA was done. Medical records provide an in-depth evaluation of the patient, hence a record of SRA. Furthermore, survey data obtained from administering questionnaires to patients can help determine whether SRA was conducted. Direct observation at the time of admission will facilitate data collection.
Administrative data and medical records provide information related to mortality and morbidity rates. Data from administrative and medical records indicate patient identity, primary diagnosis, secondary diagnosis, interventions, and patient progress. By so doing, these data sources provide information on morbidity and mortality rates.
Comparison of Measurement
Data from the National Database of Nursing Quality Indicators (NDNQI) allows various healthcare facilities to compare the performance of their quality indicators. Hospital-related falls are an example of the metrics monitored and reported by the NDNQI (Oner et al., 2021). Quarterly and annual reports enable healthcare facilities to compare the performance of their quality indicators with that of other local facilities at the state and federal levels. The comparison forms the basis for formulating improvement plans to optimize the performance of quality indicators. In this context, the actual rate refers to the number of hospital-related infections divided by the total number of patients admitted to the inpatient unit during hospitalization. It is specific to the healthcare facility. Percentile ranking indicates the frequencies of percentages that are similar to or lower than an organization’s percentage (NWEA.org, 2022). In this context, percentile ranking refers to the percentage of the healthcare facility’s hospital-related falls compared to that of other healthcare facilities.
The standardized risk assessment rate is compared with other healthcare facilities. Quality initiative reports from organizations such as the Agency for Healthcare Research and Quality facilitate this comparison. However, healthcare facilities may modify their assessment tools based on their individualized needs. The actual rate refers to the percentage or proportions that are specific to the healthcare facility. In this context, it refers to the number of hospitalized patients assessed for fall-related risk factors divided by the number of patients hospitalized in the facility. As mentioned earlier, percentile ranking indicates the frequencies of percentages that are similar to or lower than an organization’s percentage (NWEA.org, 2022). In this context, it refers to the percentage of hospitalized patients assessed for fall-related risk factors in the healthcare facility compared to assessment rates of other hospitals.
Mortality and morbidity rates can be compared with other healthcare facilities. Like SRA rates, quality initiative reports from organizations such as the Agency for Healthcare Research and Quality form the basis for comparison. Additionally, reports from the NDNQI enable healthcare facilities to compare their hospital fall morbidity and mortality rates with other facilities. In this context, the actual rate refers to the number of patients who have suffered fall-related injury or disability divided by the total number of hospitalized patients who experienced a fall during that period. Furthermore, percentile rank refers to the percentage of fall-related morbidities in the healthcare facility compared to the percentage of morbidities in other hospitals.
Risk Adjustment
The rate-based measures are not risk-adjusted. It is anticipated that the three measures will give unbiased results. Furthermore, it is anticipated that patient-related factors such as attitudes will not affect the effectiveness of the measures. As such, the measures will give generalizable results.
Goal Setting
Healthcare facilities are likely to set goals to reduce hospital-related falls, mortality, and morbidity rates and increase standardized risk assessment rates. A reduction in hospital-related falls reflects an increase in the quality of healthcare services. Furthermore, it implies that the facility has initiated pertinent measures to mitigate falls. An example of a specific goal is to lower the incidence of hospital-related falls from 10 percent to 3 percent by the end of six months. Also, a reduction in fall-related morbidity and mortality rates reflects an increase in the quality of healthcare services. An example of a specific goal is to reduce morbidity and mortality rates by 15% and 5% to 5% and 1%, respectively, within four months. Increased standardized risk assessment rates imply that individualized care plans will be formulated to mitigate hospital-associated falls. An example of a specific goal is to increase standardized risk assessment rates from 60 percent to 95 percent within seven months.
Importance of Each Rate-Based Measure
Hospital-related falls are relevant to a hospital such as Memorial Hermann-Texas Medical Center. This measure will enable the hospital to determine the performance of this benchmark metric and the need for changes. For instance, the underperformance of this metric will motivate the members of the interdisciplinary team to initiate pertinent measures to prevent falls. By so doing, the facility will optimize its workflow and set specific goals to reduce the incidence of hospital-related falls.
Standardized risk assessment rates will enable the hospital to evaluate and enforce adherence to standard procedures and protocols. Hospitals have standard procedures that guide the activities of members of the interdisciplinary team. For instance, low SRA rates will form the basis of goal setting to increase risk assessment rates, develop individualized care plans, and reduce the incidence of hospital-related falls. Additionally, this measure will enable the hospital to determine the need to modify its assessment tool to meet its needs.
Morbidity and mortality rates will enable the hospital to acknowledge the impact of hospital-related falls. For instance, high morbidity and mortality rates reflect poor quality of care. This measure will form the basis for formulating individualized and general fall preventive strategies to reduce the number of injuries and deaths related to falls.
Relation to Patient Safety, Healthcare Cost, and Quality of Care
Hospital-related falls, standardized risk assessment rates, and morbidity and mortality rates impact patient safety, healthcare costs, and the quality of care. Firstly, hospital-related falls indicate that the hospital delivers poor-quality healthcare services. Also, it indicates that the hospital lacks elaborate strategies for mitigating falls. Hospital-related falls lower patient safety by predisposing them to injuries, fractures, and deaths. It is also likely to prolong hospitalization and increase treatment costs. Secondly, low standardized risk assessment rates will likely lower the quality of healthcare services and patient safety. SRA enables healthcare providers to make informed decisions and develop individualized care plans. A low rate of SRA is likely to increase the incidence of falls and prolong hospitalization; hence, patients incur extra healthcare costs. Thirdly, high morbidity and mortality rates indicate poor quality of healthcare services and low patient safety. Conversely, high morbidity rates are associated with prolonged hospitalizations, hence high healthcare costs.
References
AHRQ.gov. (2019). Falls. https://psnet.ahrq.gov/primer/falls
AHRQ.gov. (2022). Preventing Falls in Hospitals. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/practices.html#3-4
Hernandez, R. B. J., & Kim, Y. P. (2022). Epidemiology Morbidity and Mortality. https://www.ncbi.nlm.nih.gov/books/NBK547668/
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing Falls in Hospitalized Patients: State of the Science. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007
NWEA.org. (2022). What is a percentile rank? https://connection.nwea.org/s/article/Explanation-of-Percentile-Rank-1405100524418?language=en_US#:~:text=A%20percentile%20rank%20indicates%20how,students%20in%20the%20norm%20group.
Oner, B., Zengul, F. D., Oner, N., Ivanova, N. V., Karadag, A., & Patrician, P. A. (2021). Nursing-sensitive indicators for nursing care: A systematic review (1997–2017). Nursing Open, 8(3), 1005–1022. https://doi.org/10.1002/nop2.654
Quentin, W., Partanen, V. M., Brownwood, I., & Klazinga, N. (2019). Measuring Healthcare Quality. https://www.ncbi.nlm.nih.gov/books/NBK549260/#:~:text=Rate%2Dbased%20indicators%20are%20the,receive%20antibiotic%20prophylaxis%20before%20surgery.
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Question 
reflect on tools for measuring quality in nursing practice.
Select three rate-based measurements of quality that you would like to focus on for this Assignment.
Note: These measurements must relate to some aspect of clinical or service quality that directly relates to patient care or the patient’s experience of care. For the purposes of this Assignment, an analysis of staffing levels is not permitted.
Tools for Measuring Quality- Fall Prevention in Hospitals
You can find useful information on quality indicators that are of interest to you on these websites and resources. You may choose only one of the three measures to be some form of patient satisfaction measure.
Consider how the three rate-based measures (you will select) are defined, how the rates were determined or calculated, how the measures were collected, and how these measures are communicated to both internal and external stakeholders.
Reflect on how the three rate-based measures (you will select) may relate to organizational goals for improved performance.
Reflect on the three rate-based measures (you will select), and consider the importance of these measures on patient safety, cost of healthcare, and overall quality of healthcare.
THE ASSIGNMENT: (8–10 PAGES)
Describe the three rate-based measures of quality you selected, and explain why.
Deconstruct each rate-based measure to include the following:
Describe the definition of the measure.
Explain the numerical description of how the measure is constructed (the numerator/denominator measure counts, the formula used to construct the rate, etc.).
Explain how the data for this measure are collected.
Describe how the measurement is compared externally to other like settings, and differentiate between the actual rate and a percentile ranking. Be specific.
Explain whether the measure is risk adjusted or not. If so, explain briefly how this is accomplished.
Describe how goals might be set for each measure in an aggressive organization, which is seeking to excel in the marketplace. Be specific and provide examples.
Describe the importance of each rate-based measure to a chosen clinical organization and setting.
Using the websites and resources, you can choose a hospital, a nursing home, a home health agency, a dialysis center, a health plan, an outpatient clinic, or private office; a total population of patient types is also acceptable, but please be specific as to the setting. That is, if you are interested in patients with chronic illness across the continuum of care, you might home in a particular health plan, a multispecialty practice setting or a healthcare organization with both inpatient and outpatient/clinic settings.
Note: Faculty appointments and academic settings are not permitted for this exercise. For all other settings, consult the Instructor for guidance. You do not need actual data from a given organization to complete this Assignment.
Explain how each rate-based measure (you selected) relates to patient safety, to the cost of poor quality, and to the overall cost of healthcare delivery. Be specific and provide examples.
8 – 10 pages