Date of Graduation

Summer 12-13-2024

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)

College/School

School of Nursing and Health Professions

Program

Kaiser cohort MSN capstone

First Advisor

Carla S Martin, DNP, RN, CIC, CNL, NEA-BC, FACHE

Second Advisor

Cathy Coleman, DNP, RN, CPHQ, CNL

Abstract

Problem: Persons with delirium have an elevated risk of falls. Thus, falls and delirium are inextricably linked. Both should be routinely screened for older adults.

Context: A 40-bed Emergency Department (ED) in the East San Francisco Bay area of Northern California and the first site among all acute care hospitals in the organization to implement the Brief Confusion Assessment Method (bCAM) delirium scoring tool within the Electronic Health Record (EHR).

Interventions: An EHR toolkit for delirium screening using bCAM was developed, tested, and implemented in the ED.

Measures: The outcome measure was the percentage of patients with a reported fall in the ED. The process measures included the percentage of patients with a documented bCAM and those with subsequent documentation of interventions to prevent falls.

Results: The bCAM screenings consistently achieved an average of 89% completion, exceeding the target of 75%. Additionally, fall interventions were documented in 86% of patients. From January to June 2024, the incidence of falls in the ED did not show improvement, with two falls reported each month in May and June, compared to zero falls in the same period in 2023.

Conclusions: Implementing bCAM screenings and fall interventions in the ED achieved a high compliance rate, indicating strong adherence to the department's protocols. However, despite these efforts, the incidence of falls was not reduced. These results suggest that while the screening and intervention protocols were well-executed, additional measures or adjustments may be necessary to reduce falls for older adults in the ED.

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