Susan Mascioli

Director, Nursing Quality and Safety, Department of Nursing Administration

Publications

Hourly rounding and patient falls: what factors boost success?
Hourly rounding and patient falls: what factors boost success?
Goldsack J, Bergey M, Mascioli S, Cunningham J

Nursing 2015 Feb;45(2):25-30

PMID: 25585219

Abstract

BACKGROUND: Falls are a persistent problem in all healthcare settings, with rates in acute care hospitals ranging from 1.3 to 8.9 falls per 1,000 inpatient days, about 30% resulting in serious injury.
METHODS: A 30-day prospective pilot study was conducted on two units with pre- and postimplementation evaluation to determine the impact of patient-centered proactive hourly rounding on patient falls as part of a Lean Six Sigma process improvement project. Nurse leaders and a staff champion from Unit 1 were involved in the process from the start of the implementation period, while Unit 2 was introduced to the project for training shortly before the intervention began.
RESULTS: On Unit 1, where staff and leadership were engaged in the project from the outset, the 1-year baseline mean fall rate was 3.9 falls/1,000 patient days. The pilot period fall rate of 1.3 falls/1,000 patient days was significantly lower than the baseline fall rate (P = 0.006). On Unit 2, where there was no run-in period, the 1-year baseline mean fall rate was 2.6 falls/1,000 patient days, which fell, but not significantly, to 2.5 falls/1,000 patient days during the pilot period (P = 0.799).
DISCUSSION: Engaging an interdisciplinary team, including leadership and unit champions, to complete a Lean Six Sigma process improvement project and implement a patient-centered proactive hourly rounding program was associated with a significant reduction in the fall rate in Unit 1. Implementation of the same program in Unit 2 without engaging leadership or front-line staff in program design did not impact its fall rate.
CONCLUSIONS: The active involvement of leadership and front-line staff in program design and as unit champions during the project run-in period was critical to significantly reducing inpatient fall rates and call bell use in an adult medical unit.
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Improving the inpatient influenza vaccination process
Improving the inpatient influenza vaccination process
Pal C, Mascioli S, Gibson-Gerrity J

Nursing 2015 Feb;45(2):17-8

PMID: 25585215

Abstract

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Do patients accurately perceive their fall risk?
Do patients accurately perceive their fall risk?
Sonnad SS, Mascioli S, Cunningham J, Goldsack J

Nursing 2014 Nov;44(11):58-62

PMID: 25321438

Abstract

BACKGROUND: In U.S. hospitals, from 700,000 to 1 million inpatients fall each year. About a third of these falls could have been prevented.
OBJECTIVES: This project's purpose was to document patient perceptions of their inpatient fall risk and determine how these perceptions were associated with clinical indicators of fall risk.
METHODS: From six medical-surgical units, 193 patients were randomly selected and surveyed about their perceived fall risk during their hospital stay. For 101 of them, the Schmid fall risk assessment score, age, and gender were recorded. A retrospective review of the Schmid scores of all patients who fell during a 6-month historical sample period was reviewed for comparison.
RESULTS: Most patients (88%) reported that they didn't feel at risk for falling during their hospital stay. No correlation between their Schmid score and their perceived fall risk was found. Historical review of all inpatients who'd fallen in a prior period showed that the 358 patients with known Schmid scores had a full range of scores. These are normally distributed from 0 to 6, with over 40% of patients experiencing falls having Schmid scores of less than 3.
CONCLUSIONS: Patient perceptions of falls match neither their clinical risk nor their actual likelihood of falling. When designing fall prevention strategies, it may be important to remind providers of this gap in patient knowledge, which includes overconfidence in the role of the care team in preventing falls
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Patient falls: searching for the elusive "silver bullet"
Patient falls: searching for the elusive "silver bullet"
Goldsack J, Cunningham J, Mascioli S

Nursing 2014 Jul;44(7):61-2

PMID: 24937623

Abstract

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