Date of Graduation

Fall 12-11-2020

Document Access

Project/Capstone - Global access

Degree Name

Master of Science in Nursing (MSN)


School of Nursing and Health Professions

First Advisor

Dr. Nancy Taquino

Second Advisor

Dr. Catharine Coleman

Third Advisor

Ms. Dawn Harris



Problem: Although many fall prevention protocols have been utilized across hospital settings, the patient fall rate in one acute care medical-surgical microsystem continues to be a significant safety problem. Despite many safety precautions, including external bed and chair alarms, twelve falls were recorded in 2019, and fifteen falls occurred in this unit's 2020 fiscal year.

Context: Despite identifying risk factors for falls and employing several fall prevention protocols, patient falls are the most common adverse and challenging patient safety event for hospitals. One of the most common interventions to reduce falls has been the utilization of in-person sitters; however, this staffing necessity is extremely costly for most healthcare organizations. A new innovative approach is needed to reduce falls and save money.

Intervention: According to several recent authors, new technology has offered a creative solution to this problem. Virtual sitter video monitoring technology has been utilized as an innovative, cost-effective improvement intervention to promote patient safety and reduce falls. A virtual sitter video monitoring system is a real-time centralized video monitoring system that connects the patient to the nursing station or central monitoring. A qualified monitoring technician (MT) observes and communicates with the patients 24/7 for safety. This future improvement project aims to introduce, and pilot test the feasibility and cost-effectiveness of a virtual sitter to be implemented in a 24-bed medical-surgical unit by early 2021. This organization has a labor-management partnership and all staff will have the opportunity to provide feedback.

Measures: The sponsoring organization reprioritized the new technology implementation plan, which has been delayed for this unit until 2021. The project outcome measures address reducing patient fall rates and the associated sitter utilization costs. The primary outcome measures will reduce patient falls and associated costs by 50% annually in the medical-surgical microsystem. The process measure will identify three shift-specific champions who will serve as master trainers in collaboration with the project leader to conduct staff training regarding approved protocols. One balancing measure will include a pre-and post-survey to monitor staff satisfaction levels during the virtual sitter implementation.

Results: A new comprehensive set of workflows and a policy and procedure for introducing virtual sitter video monitoring technology was developed in another medical center within the same integrated care delivery system by a staff team including DNP - CNL and MSN – CNL graduate students. This document will be replicated by the clinical nurse leader (CNL) for future implementation in this 24-bed medical-surgical microsystem. Anticipated results will reflect both the fall rate and estimated costs per fall. Three staff members will be trained as champions or superusers to reach 90% of the unit staff. Staff satisfaction survey results will be analyzed pre and post-implementation to assess potential resistance and acceptance of the new intervention.

Conclusion: The adoption of new technology can save healthcare organizations millions of dollars related to fall injures while maintaining safe staffing. Virtual Sitter Video Monitoring is a practical, cost-effective technology that enhances patient care experience by promoting safety, security, and privacy. Healthcare organizations that pilot test this technology tool can improve staffing ratios, optimize efficient cost savings and workflows, and anticipate employee and patient/family satisfaction. Clinical Nurse Leaders can be instrumental in developing and implementing new interventions in their microsystems. Introducing a fall prevention quality improvement and implementation plan in a complex healthcare organization requires innovative approaches, targeted data analytics, and significant team collaboration across systems

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