presented by Pat Quigley
Rehabilitation nurses have expert clinical knowledge to determine a patient’s fall and injury risk status. This session will build upon current practices and processes to move practice beyond the use of a fall risk score to assessment of multifactorial fall risk factors. Participants will be guided in the assessment of select fall and injury risk factors (postural hypotension, lower extremity sensory neuropathy, fracture risk) as examples of the the difference between a fall risk screening and an assessment as the basis for individualized fall patient care planning. The information will allow the participants to understand the implications of modifying their practice and implementing patient-centered individualized care plans to reduce falls and fall-related injuries.
Dr. Patricia Quigley, PhD, MPH, ARNP, 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.
Within healthcare organizations, fall risk determination is underestimated because of an over-reliance on the use of fall risk screening tools that generate a score and then universal fall precautions. This chapter builds upon best practice to engage rehabilitation nurses in multifactorial fall and injury risk assessment as the basis for individualized fall and injury prevention plans of care.
National guidelines serve as the foundation to reaffirm rehabilitation nurses’ vital role in using clinical assessment and decision-making skills to determine fall and injury risk factors and integrate findings into interdisciplinary care planning. Select fall risk factors will be featured during this session as examples of the importance of developing nurses’ clinical knowledge and skills.
The examination of clinical practice skills generates opportunities to verify accuracy and competency of care. Often, variations in practice are found that should not occur, or risk factors are omitted from current assessment that deserve priority inclusion in the fall and injury risk assessment policies. This session offers rehabilitation nurses live demonstration of clinical assessment of the fall and injury risk factors in practice: history taking, physical exam, risk factor determination, individualized interdisciplinary care referral, and planning.