BID Medication Administration Sarah Rousseau Ferris State University

BID Medication Administration Decrease resident falls Improve resident care / satisfaction

Quality Improvement Project Benefits Improved Resident Sleep Decreased daytime sleepiness Decreased Staff Interruptions During family visits During activities / social times Decreased Falls Improved Resident/Family Satisfaction

Interdisciplinary Team Supervisor Dawn Budzinski BSN, RN Fall QAPI Chair Physician Dr. Mark Jackson Facility Medical Director Staff Development Susan Arnold Director of Certified Nurse Aides Jamie Wilson Staff Development Coordinator Director of Nursing Holly Edmondson, RN Dietary Dietary Team including: Dietician Dietary Managers

Fall QAPI Increase in falls throughout facility Reduced use of alarms Reduced use of restraints Changed current nighttime care protocol Resident only woken when necessary

Research Review Articles Reviewed Articles Reviewed Improving sleep management in the elderly Sleep problems as a risk factor for falls in a sample of community-dwelling adults ages 64-99 years Polysomnographic and Clinical correlates of behaviorally observed daytime sleep in nursing home residents. Sleep problems and associated daytime fatigue in community-dwelling older individuals Gender-specific association between self reported sleep duration and falls in high-functioning older adults Sleep disturbances and falls in older people Beyond the usual suspects: Approaching sleep in elderly people A multicomponent nonpharmacological intervention improves activity rhythms among nursing home residents with disrupted sleep/wake patterns Sleep-related factors and mobility in older men and women Sleep, insomnia and falls in elderly patients

Site and Preceptor Renee Cunningham MSN, RN Grand Traverse Pavilions 240 Bed Medicare/Medicaid Skilled Nursing Facility 7 Units 4 General skilled nursing units 40 beds per unit 2 Locked Dementia care units 40 beds 8 beds 1 Sub-acute Rehabilitation Center 31 beds

Quality and Safety Education for Nurses QSEN KSA Quality Commit to concepts of transparency, managing variability measurement and accountability Teamwork and Collaboration Continuously plan for improvement in self and others for effective team development and functioning Evidence-based Practice Identify efficient and effective search strategies to locate reliable sources of evidence Attitude Discussion with others Skill Monitor and discussion Knowledge Review, research, evaluate

ANA Scope and Standards of Practice Nurse Administrators Implementation Standard 7 Quality of Practice Standard 11 Collaboration

Root Cause Analysis

Change Management Model Kurt Lewin Change Management Model 3 Steps in Process Unfreeze When change is needed Change Develop the process for change Refreeze Establish Stability

Transformational Leadership 4 Components to being a Transformational Leader 1 Charisma Provides purpose and promotes pride Inspiration High expectations Intellectual Stimulation Promotes intelligence and problem solving Individualized Consideration Coaches and advises, personal attention

Evaluating Success Interviews Fall Review Staff Resident Cause of Fall Time of Fall Sleep Pattern

Prediction Decrease falls throughout the facility Improved Sleep Decrease Interruptions Improve Satisfaction

References Bass, B. M. (1990). From transactional to transformational leadership: Learning to share the vision. Organizational Dynamics, 18(3), 19-31. Bergeron, C. A., Crecelius, C. A., Murphy, R., Roth Maguire, S., Osterweil, D., Simonson, W., . . . Zee, P. C. (2008, September 5). Improving sleep management in the elderly. Annals of Long Term Care http://www.annalsoflongtermcare.com/article/8283 Brassington, G. S., King, A. C., & Bliwise, D. L. (2000). Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64-99 years. Journal Of The American Geriatrics Society, 48(10), 1234-1240. Endeshaw, Y. W., Ouslander, J. G., Schnelle, J. F., & Bliwise, D. L. (2007). Polysomnopraphic and Clinical correlates of behaviorally observed daytime sleep in nursing home residents. The Journal of Gerontology, 62(1), 55-51. Giltinane, C. L. (2013). Leadership styles and theories. Nursing Standard, 27(41), 35-39. http://dx.doi.org/10.7748/ns2013.06.27.41.35.e7565 Goldman, S. E., Ancoli-Israel, S., Boudreau, R., Cauley, J. A., Hall, M., Stone, K. L., . . . Newman, A. B. (2008). Sleep problems and associated daytime fatigue in community-dwelling older individuals. The Journal of Gerontology, 63(10), 1069-1075. Kuo, H.-K., H. Yang, C. C., Yu, Y.-H., Tsai, K.-T., & Chen, C.-Y. (2010). Gender-specific association between self reported sleep duration and falls in high-functioning older adults. The Journal of Gerontology, 65A(2), 190-196. Latimer Hill, E., Cumming, R. G., Lewis, R., Carrington, S., & Le Couteur, D. G. (2007). Sleep disturbances and falls in older people. The Journal of Gerontology, 62A(1), 62-66.

References Continued Lesage, S., & Scharf, S. M. (2007). Beyond the usual suspects: Approaching sleep in elderly people. The Journal of Gerontology, 62(1), 53-54. Martin, J. L., Marler, M. R., Harker, J. O., Josephson, K. R., & Alessi, C. A. (2007). A multicomponent nonpharmacological intervention improves activity rhythms among nursing home residents with disrupted sleep/wake patters. The Journal of Gerontology, 62(1), 62-72. Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37. Stenholm, S., Kronholm, E., Sainio, P., Borodulin, K., Era, P., Fogelholm, M., . . . Koskinen, S. (2010). Sleep-related factors and mobility in older men and women. The Journal of Gerontology, 5A(6), 649-657. Stone, K. L., Ensrud, K. E., & Ancoli-Israel, S. (2008). Sleep, insomnia and falls in elderly patients. Sleep Medicine, 9(Suppl.), S18-S22.