Introduction
In healthcare, clinical service quality indicators seek to make organizations accountable for any safety-related deficiencies affecting patient outcomes, such as patient falls (PF). PF is an NDNQI indicator that is among the subclass of process and outcomes measures and represents a nursing-sensitive quality indicator. This discussion aims to explore PF with reference to federal agencies’ initiatives, actual quality outcomes, ethics, nursing practice, and care provision.
The Indicator and CMS-Driven Incentives and Disincentives
As a service quality indicator, PF has a unique history linked with CMS-initiated policy changes and fines. Thirteen years ago, the CMS refused to continue reimbursing inpatient facilities for all PF-related costs, thus introducing its well-known no-pay policy acting as a disincentive (Fehlberg et al., 2018). Despite difficulties related to determining falls’ actual preventability, the no-pay policy was meant to motivate hospitals to reduce financial losses by increasing the use of fall reduction interventions, including room changes, physical barriers, and bed alarms (Fehlberg et al., 2018). At the same time, there are no direct extra payments or incentives for hospitals to take all precautionary anti-PF measures to promote safety, and reimbursement patterns depend only on the actual outcomes of using fall prevention protocols (Fehlberg et al., 2018). With that in mind, the selected measure is greatly affected by CMS-driven disincentives.
The Indicator, Quality Outcomes, and Ethical Principles
From a systems perspective, PF as a quality measure has a little-to-moderate effect on quality outcomes and can simultaneously promote and challenge prima facie ethical principles, such as beneficence and respect for autonomy. Fehlberg et al. (2018) report that the no-pay policy peculiar to PF led to increases in fall prevention measure utilization in clinical settings, but the evidence for such measures’ contributions to quality improvement is weak and heterogeneous. Specifically, effectiveness and quality improvement potential vary between diverse PF prevention practices, being more explicit for risk-factor-specific patient education provided by RNs and less pronounced for bed alarm use (Fehlberg et al., 2018; Staggs et al., 2020). PF, as a mandatory quality indicator, motivates the timely provision of individualized injury prevention advice tailored to patients’ needs, thus supporting healthcare consumers’ autonomy and the right to participate in intervention selection (Barmentloo et al., 2021). Nevertheless, the most effective PF reduction strategies, such as no toileting alone protocols for hospitalized patients, can benefit service consumers at the expense of autonomy and privacy (Cangany et al., 2018). Therefore, the chosen indicator’s effects on quality and ethics are ambiguous.
The Indicator, Patient Care, and Nursing Practice
The selected quality measure has influenced patient care and nursing practice by motivating experiments with fall prevention measures and protocols. After the recognition of PF as an NDNQI indicator, nursing practice has changed to include more frequent interventions involving bed alarm use, but the practice of using patient sitters has not become more common (Fehlberg et al., 2018). The effects on both practice and patient care depend on patient populations. For instance, physical restriction and no toileting alone policies have become more prominent in post-surgery clients, whereas individual guidance and walking aids usually supplement care measures aimed at the elderly (Barmentloo et al., 2021; Cangany et al., 2018; Fehlberg et al., 2018). Thus, the systems-level changes peculiar to care and nurses’ activities involve further sophistication of internal PF prevention guidelines.
Conclusion
Finally, being underpinned by the CMS no-pay policy, the PF indicator partially supports better quality outcomes and medical ethics and influences patient care and nurses’ practice by increasing the utilization of fall prevention strategies. The refusal to reimburse PF-related expenses caused an increase in the utilization of anti-fall technology, including bed alarms and walking supplies. Also, communication- and education-based interventions for high-risk patients have been encouraged.
References
Barmentloo, L. M., Erasmus, V., Olij, B. F., Haagsma, J. A., Mackenbach, J. P., Oudshoorn, C., Sxhuit, S. C. E., van der Velde, N., & Polinder, S. (2021). Can fall risk screening and fall prevention advice in hospital settings motivate older adult patients to take action to reduce fall risk? Journal of Applied Gerontology, 07334648211004037. Web.
Cangany, M., Peters, L., Gregg, K., Welsh, T., & Jimison, B. (2018). Preventing falls: Is no toileting alone the answer? MedSurg Nursing, 27(6), 379-382. Web.
Fehlberg, E. A., Lucero, R. J., Weaver, M. T., McDaniel, A. M., Chandler, M., Richey, P. A., Mion, L. C., & Shorr, R. I. (2018). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. Web.
Staggs, V. S., Turner, K., Potter, C., Cramer, E., Dunton, N., Mion, L. C., & Shorr, R. I. (2020). Unit-level variation in bed alarm use in US hospitals. Research in Nursing & Health, 43(4), 365-372. Web.