NUR 640 Module 4 Individual Assignment 3: Innovation Model, PESTLE and Human-Centered Design for a Clinical Issue Example

Falls at Night: An Innovation Model, a PESTLE Scan and Human-Centered Design for a Medical-Surgical Unit

Student Name

Edson College of Nursing and Health Innovation, Arizona State University

NUR 640: Integrative Theories of Innovation in Health Care

Instructor Name

Month Day, Year

Falls at Night: An Innovation Model, a PESTLE Scan and Human-Centered Design for a Medical-Surgical Unit

Central Node: Reducing Falls on 5 West at Night

Over the past year, the unit's fall rate was above the hospital's target, and 70% of falls occurred between 2200 and 0600, most on the way to the bathroom.

Branch 1: Proposed Innovation Model

Greenhalgh's model of diffusion in service organizations fits because it treats spread as dependent on the innovation, the people adopting it, the unit's readiness and the outer context, and because it expects implementation to be nonlinear (Greenhalgh et al., 2004). A falls bundle that worked elsewhere will succeed here only if it fits our staff, patients and workflow.

Branch 2: Complexity Factors

Interacting agents: nurses, patient care technicians, patients, families, pharmacy and physical therapy. Nonlinearity: a small change in the timing of evening diuretics can change bathroom trips at 0200. Local adaptation: night staff already improvise, such as moving high-risk patients near the station. Unpredictability: staffing and census change nightly.

Branch 3: PESTLE Scan

Branch 4: Human-Centered Design

Inspiration: I interviewed six patients who fell or nearly fell and spent two night shifts observing. Patients said they woke needing the bathroom urgently and did not want to wait for a call light response. Night staff said 0100 to 0400 was their busiest charting time.

Ideation: In a session with eight night staff we generated ideas, including scheduled toileting rounds at 2200, 0000 and 0300, moving evening diuretics earlier and placing a commode beside the bed for patients who agree.

Implementation: We will prototype the scheduled rounds on half of the unit for two weeks, collect feedback and adjust before spreading (IDEO.org, 2015).

Branch 5: Implementation Decisions

Start with scheduled toileting rounds and a pharmacy review of evening diuretic timing, both low-cost and supported by staff. Assign two night-shift champions. Report weekly fall data at huddles. Use the existing fall risk assessment rather than introducing a new tool.

Branch 6: Measures and Timeline

Outcome measure: falls per 1,000 patient days at night. Process measure: percentage of scheduled rounds completed. Balancing measure: patient-reported sleep disruption. Timeline: two-week prototype, two-week revision, three-month spread across the unit, review at six months.

Evidence Note

In a randomized trial across acute care hospitals, a fall prevention toolkit tailored to each patient lowered fall rates, supporting a tailored, patient-centered approach rather than a single intervention (Dykes et al., 2010).

References

Dykes, P. C., Carroll, D. L., Hurley, A., Lipsitz, S., Benoit, A., Chang, F., Meltzer, S., Tsurikova, R., Zuyov, L., & Middleton, B. (2010). Fall prevention in acute care hospitals: A randomized trial. JAMA, 304(17), 1912-1918. https://doi.org/10.1001/jama.2010.1567

Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x

IDEO.org. (2015). The field guide to human-centered design. IDEO.org.