1. BID Medication Administration
Sarah Rousseau
Ferris State University

2. BID Medication Administration
Decrease resident falls
Improve resident care / satisfaction

3. 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

4. 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

5. 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

6. 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 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

7. 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

8. 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

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

10. Root Cause Analysis

11. 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

12. 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

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

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

16. References
Bass, B. M. (1990). From transactional to transformational leadership: Learning to share the vision.
Organizational Dynamics, 18(3),
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
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 years. Journal Of The American Geriatrics Society, 48(10),
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),
Giltinane, C. L. (2013). Leadership styles and theories. Nursing Standard, 27(41),
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),
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),
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),

17. References Continued
Lesage, S., & Scharf, S. M. (2007). Beyond the usual suspects: Approaching sleep in elderly people. The Journal of Gerontology, 62(1), 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), Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 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), Stone, K. L., Ensrud, K. E., & Ancoli-Israel, S. (2008). Sleep, insomnia and falls in elderly patients. Sleep Medicine, 9(Suppl.), S18-S22.