Document Type
Final Project
Graduation Date
Spring 5-8-2025
Degree Name
Doctor of Nursing Practice
First Advisor
Dr. Liane Connelly
Abstract
Background: As our society ages, falls have emerged as a leading cause of accidental injury and death globally, significantly impacting older adults’ quality of life (Matchar et al., 2017; WHO, 2021). The consequences of falls are profound, encompassing physical injuries, psychological distress, and substantial healthcare costs. In the U.S., Medicare spends approximately $31.3 billion annually on fall-related care (Gettel et al., 2020). These statistics underscore the need for standardized fall prevention strategies in primary care.
Purpose: This Doctor of Nursing Practice (DNP) project aimed to implement a standardized systems-level process change for fall risk screening and education during Medicare Annual Wellness Exams (MAWEs) at a rural clinic in southeast Nebraska. An organizational practice audit revealed inconsistent screening and no prior educational intervention, prompting project organization case managers to request a formal process improvement.
Design: Using the Plan-Do-Study-Act (PDSA) model, the team developed and tested a fall prevention protocol. This included administering fall risk screening questions and providing corresponding educational handouts to at-risk patients. A staff education session was held to introduce the workflow, and a project team member was on-site to support implementation.
Methods: The intervention involved organizational staff using three CDC STEADI-based fall risk screening questions during MAWEs. Responses were documented in the electronic health record, and patients screening positive received risk-specific educational handouts. Data collection focused on adherence to the protocol, specifically the completion of screening and delivery of handouts. An assessment of the feasibility of intervention and fidelity of implementation was completed monthly.
Results: Of the 378 MAWEs completed during the intervention period, only 57.1% of patients were fully screened. Educational handouts were provided to just 7.1% of the total patients, with approximately 20-26% of people who reported ‘yes’ to each category receiving education. Among those who received handouts, 63% were given all handouts appropriate to their identified risk factors, indicating inconsistent delivery of education.
Conclusion: The project revealed important gaps in screening fidelity and patient education. Despite initial training, fall prevention practices were inconsistently applied. Gender differences were also noted, with women more likely to report fall-related fears and unsteadiness when walking. Men and women experienced falls at similar rates. This intervention highlights the importance of workflow integration, accountability, and staff engagement to enhance fall prevention efforts. Standardizing fall risk screenings and education in primary care can improve patient safety, reduce injuries, and support aging-in-place.
Recommended Citation
Zimmerman, Joscelyn C. and Peterson, Kamrie L., "Keep Me Upright" (2025). Doctor of Nursing Practice Projects: College of Nursing. 51.
https://digitalcommons.unmc.edu/con_dnp/51