Date: 01/09/2018

How can a group of nurses work together to prevent falls and save half a million dollars? By forming a clinical community.

Headed by Maria Koszalka, chief nursing officer and vice president of patient care services at Johns Hopkins Bayview Medical Center, and Joanne Miller, chief nursing officer and vice president of patient care services at Sibley Memorial Hospital, the nursing clinical community — one of 21 such groups in Johns Hopkins’ Armstrong Institute for Patient Safety and Quality focused on improving and standardizing patient care across the health system — has grown over the past year or so from about 35 initial members to over 62 nurses from acute care, ambulatory and home care settings. 

Clinical communities are self-governing clinician stakeholder teams that focus on quality improvement efforts that drive value, says Lisa Ishii, senior medical director of the Office of Johns Hopkins Physicians and chief quality officer, Clinical Best Practices: “They achieve success by creating networks to share best practices and peer learning, and build trusting relationships.” The communities are supported through the Clinical Communities Project Management Office, sponsored by the Armstrong Institute and the Office of Johns Hopkins Physicians.

“We felt strongly about referring to ourselves as a nursing quality clinical community to emphasize the focus on quality and value that nursing can bring, not only to each other but to the entire health system,” Miller says.

The first area the clinical community has focused on is prevention of falls, the leading cause of death and disability for older patients, Koszalka says. About 33 percent of older adults, and 3 percent of all hospitalized patients, fall each year. “We know it is a big problem. Most falls in the hospital are preventable, so what we are doing now is identifying the cause of fall and tools we can use for best practices.”

At Johns Hopkins Bayview, patients at risk for falls can make use of a sitter program, in which a nurse technician sits at the bedside 24/7, but “that’s not cost-effective,” Koszalka says. Nursing staff members have tested a wireless video monitoring system that enables a technician to sit at a nursing station and watch multiple patients at a time. If the technician sees a patient trying to get up, he or she can ask the patient to stay put while they send a nurse to the room. Over a six-month trial, the system avoided over $600,000 in personnel costs. The technology is now considered a best practice at the medical center and is being evaluated for implementation at the other Johns Hopkins hospitals.

The group aims to develop a toolkit of standardized best practices to reduce falls, develop checklists for falls prevention that can be embedded into patients’ electronic medical records and teach patients to prevent falls in the hospital and at home. Part of their charge includes working with pharmacists and physicians to adjust patients’ medications. For example, diuretics given at night could cause patients to wake in the middle of the night needing the bathroom, putting them at risk of a fall when they are disoriented. When the medications are given during the day shift, more staff are available to help patients navigate to the bathroom.

The clinical community also is looking at its nurse call system to make better use of nurses’ time. Patients can press one button to call a nurse for medical needs, and another to call a technician for other assistance.

“We love the collegiality and transparency, and have a true yearning to learn from each other,” Miller says of the group dynamics. “Our members are passionate about eliminating preventable harm and improving our patients’ experience with their care.”