Académique Documents
Professionnel Documents
Culture Documents
Zachariah E. Bingham
Quality Improvement
NUR 4144
Dr. Ellcessor
Patient safety within health care systems combines a variety of approaches. Design,
tools, accessories and protocols are adopted by each health care system to ensure the safety of
each and every patient. Joint Commission, State, external and internal inspection teams routinely
inspect and review health system safety policy, measures and interventions. The safety of staff
and clients should reside atop every managers radar. Sentinel events, events causing death
injury or harm to a patient, are major safety issues plaguing health care. In many cases sentinel
events are due to falls. According to The Joint Commission falls with serious injury are
consistently among the Top 10 sentinel events reported to The Joint Commission Sentinel
The Progressive Care Unit (PCU) of Bon Secours has seen an increase in falls over the
last quarter. Bon Secours Richmond Health Systems Policy defines a falls using three terms:
Fall, Assisted Fall (staff member minimizes fall impact and helps patient to ground) and
suspected intentional fall (patient falls on purpose) (Bon Secours Health Systems Inc, 2017).
Each type of fall runs the risk of becoming a sentinel event. Due to the severity of falls and an
alarming increase in the amount of recent falls, the manager of PCU implemented a Bedside
Schmid Tool. Utilizing the four domains of leadership and the five practices of exemplary
leadership, this paper will address the implementation and outcomes of the Bedside Schmid
Tool.
In the book, Lead Like Jesus, written by Ken Blanchard and Phil Hodges, managers gain
insight into the four domains. The heart, head, hands, and habits are direct reflections of the
style of leadership one uses with Jesus as a role model (Blanchard, K. & Hodges, P. 2005). In
this domain the heart and head drive decisions. These internal factors are influenced by a
QUALITY IMPROVEMENT
persons desire for change, prior experiences, learned knowledge and inspirations. The hands
and habits represent external factors. These factors are what allow managers to set and achieve
goals, measure the need for change and direct or support their motivation for the change.
Combining the domains create a better leadership approach. Used appropriately, together the
four domains reflect integrity and openness. This allows employees and others to better
understand what drives a managers desire for change, as well as grant insight into why the
Prior to instituting a change the manager must accept and understand how the change is
received personally and by the unit. In Lead Like Jesus, we are told internal domains, the heart
and head, are domains which reflect the individual. These are the domains that drive a person.
Internal domains are the reason why managers want to better the care of their patients and staff,
driving their desire to care. Combined with external domains, the hands and habits, managers
Implementation of the bedside Schmid tool can be linked to the heart domain through the
managers responsibility to his or her patients and staff. The manager is responsible for taking
care of the patients on the unit in their times of need. Equally important is the managers duty to
keep staff safe. Establishing an assessment tool used to reduce falls, the manager is calls on the
head domain. Instituting this new tool into practice has involved much thought and planning.
The manager must understand how to motivate his or her staff to accept the tool into their
respected practices. Use of the bedside Schmid should be described as a tool used to benefit the
Motivated by internal domains the managers roll out of the new tool is accepted by all.
Dedication to patient safety and the benefits of the new tool is reflected in the managers hands.
Combined with evidence of how the Schmid can reduce falls, the manager now has concrete data
he or she can used to back their internal desire for implementation. As the staff begins to use the
tool, it is important that they are reminded of the tools benefits. Relying on the habits of a
servant leader the manager must study and improve applications as needed. The manager then
has the responsibility of reviewing data with the staff. This open communication allows for
supportive input from staff and can be used to improve the tool moving forward.
Exemplary Leadership
Acting as a servant leader the manager can use the five exemplars of servant leadership to
guide and motivate implementation of the bedside Schmid tool onto the unit. Found in the
power points covered in Dr. Barbra Ellcessors class Professional Role Development: Servant
Leadership, the exemplars are model the way, inspire a shared vision, challenge the process,
enable others to act, and encourage the heart (Ellcessor, PPT, 2017). Acting within the heart
domain, the manager is able to model the way by educating the unit why this tool is an important
asset for individual and unit practice. The manager explains the impact falls have on the patient,
unit, health system and health care as a whole. To inspire a shared vision the manager may
remind the staff of their responsibilities to cause no harm and how the bed side tool solidifies this
commitment. Allowing the unit to own and accept their responsibilities for increased safety will
allow staff to reflect on their practice and share the vision of reducing falls. Implementation of
the new bedside Schmid tool challenges the process. Falls are occurring and causing harm to our
patients. Motivated by the Bon Secours Health System Value of innovation, the manager can
empower staff and patients to seek solutions to falls. In this case the Schmid tool has moved
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from connect care to the wall of the patients room. In some cases there may be staff following
different process on other units or specialties. In these cases, the manager must enable others to
act. Fostering collaboration through specialties will only improve patient safety. In the case of
the bedside Schmid tool, other specialties can now see patient mobility in the room. The teams
no longer need to call or seek nurses to ask mobility questions. Furthermore, some specialties
may be able to instantly update the patients bedside Schmid tool, allowing the patient more
movement privileges, reflecting the Bon Secours value of quality care. Finally, the manager
must continue to motivate his staff, or encourage the heart. Show support when and if fall
numbers are reduced. Allow for continuous improvement and input from staff across the health
system. Set the expectation for the unit and update the unit frequently. By seeing the results of
their work the unit will feel more inspired to improve each and every day.
Adjustment to this new policy may take time. As a professional leader it is important to
motivate change, allowing the staff to invite the change as a positive. In some cases added steps
may seem burdensome on the nurses already lengthy assessment. In this case the manager of
PCU has taken the time to teach the staff the proper use of bedside Schmid tool and how it aids
in reducing falls. With proper use, the manager showed how the bedside Schmid tool allowed
Finally the nurse manager was able to link the new Schmid tool with patient education.
By taking charge of their care nurses were reminded to educate the patient about their new
environment, available resources to request assistance and the importance of using safety
equipment when ambulating. Regardless of how a patient ambulated at home or outside of the
hospital, the Schmid tool should be used during daily assessments. Previously independent
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patients should be reminded why their fall risk may be increased while in the hospital. Nurses
should educate the patient on how new environments; medicines or recent procedures may
impact their gait and movement. Educating the nurses on the benefits and positives behind the
new practice allows for minimal resistance and increased individual implantation of the new tool
Outcomes Evaluation
Implementation of the new bedside Schmid tool is expected to reduce the amount of falls
occurring on the unit. When combined with Bon Secours Dionnes Egress Test, an assessment
tool used to document patients up ad lib privileges, the tool should enhance patient mobility
safety. Furthermore the bedside tool alerts other staff members to the patients fall risk. Found
easily at the bed side, the Schmid will tool will reduce falls due to staff transporting patients
unknowingly, as well as reducing the time it takes to find a nurse to ask about a patients gait or
fall risk.
Understandably the new assessment tool will take time to show its full impact. By
monitoring the units Hospital Consumer Assessment of Healthcare Providers and Systems
(HCAHPS) scores and falls documented the manager should begin to see trends. Information
gathered from these trends will show if the new tool has reduced falls. Units can then measure
their fall numbers against those of other units. If the data shows a decreased amount of falls the
manager may suggest other units adopt the bedside Schmid tool, which will provide further
References
Bon Secours Health Systems Inc. (2017). Adult fall prevention. HSO
Policy / Procedure
http://spweb/localsystems/virginia/locations/maryimmaculate/policiesandprocedures/Provision%
20of%20Care/Falls%20Prevention%20Policy%20BSHSI%20w%20MIH%20Addendum.
Blanchard, K. & Hodges, P. (2005). Lead like Jesus. Nashville, TN: Thomas Nelson.
The Joint Commission. (2015). Sentinel Event Alert 55: Preventing falls and fall-related injuries