Date of Award


Degree Name

Nursing (D.N.P.)


College of Nursing

First Advisor

Dr. Sandra Spoelstra

Second Advisor

Dr. Marie VanderKooi

Third Advisor

Dr. Deborah Bambini

Fourth Advisor

Amanda Himes


Introduction: Falls are the most common accident reported in acute care hospitals and patients who are 65 and older are the most vulnerable. Falls can lead to physical and emotional injury, reduced mobility and functioning, increased length of hospital stay, increased healthcare costs, and admission to long-term care facilities. In 2008, the Center for Medicare & Medicaid Services (CMS) has eliminated reimbursement to hospitals for treatment of injuries resulting from a fall during hospitalization. Research on fall prevention in adult acute care found multifactorial interventions that address multiple risk factors for falls are the most successful at prevention. This project focused on implementing a regular, intentional rounding and toileting schedule (TS) to decrease falls on an Acute Care of the Elderly (ACE) unit at a large Midwestern hospital. Methods: Simulation and written education were used to introduce steps and frequency of rounding and toileting to registered nurses and nurse technicians. Observation; survey; discussion with staff; chart audits; and number of fallers, falls with injury, and number of patient falls per 1,000 patient days were evaluated. The goal was to decrease falls in the elderly population on this unit. Implementation: Kotter’s 8 step change model guided implementation. Results: Rounding and toileting increased but were not implemented to the fullest extent. Number of fallers decreased from mean of 1.8 (standard deviation [SD 0.98]) fallers to 1 (SD 0) per month post implementation. Falls per 1,000 patient days increased from an average of 3.48 in the prior 37 months (SD 2.63) to 5.47 in the first 30 days post-implementation. No falls with injury occurred post-implementation. Conclusion: Simulation was effective at increasing staff knowledge. Intentional rounding and toileting are a promising intervention to decrease falls in this population when fully implemented.

Included in

Nursing Commons