Date of Award


Document Type


Degree Name

Doctor of Health Administration


College of Health Professions

First Advisor

Kit N. Simpson

Second Advisor

Jaqueline Close

Third Advisor

Margaret Talley

Fourth Advisor

James S Zoller


Objective: This study aims to evaluate the impact of implementing a Patient Safety Agreement (PSA) on hospital fall rates. Despite implementation of numerous interventions, patients continue to fall. The PSA program goal is to decrease patient falls in the acute care hospital by engaging patients in their plan of care. Implementing a Patient Safety Agreement program (PSA) can empower patients to become active participants in their own safety and fall prevention measures while in the hospital (Tzeng & Yin, 2014). Many of the current fall prevention intervention program elements employed to reduce patient falls require little active participation from the patient. There is little evidence to show the effectiveness of approaches that engage patients in fall prevention care for reducing fall incidents during hospital stays (Tzeng & Yin, 2014). Prevention of patient falls in the hospital setting has gained an increasing amount of interest over the last decade and is noted as the most frequent adverse event reported in hospitals. The Agency for Healthcare Research and Quality (AHRQ) reports that nearly 1 million patient falls are recorded in U.S. hospitals every year, equating to 2–10% of hospital inpatients falling sometime during their hospital stay (Hefner, Scheck McAlearney, Mansfield, Knupp, & Moffatt- Bruce, 2015). Methods: A pre- and post-evaluation study of a quality improvement initiative in the hospital setting comprised of 11 inpatient care units was conducted to assess the effect of a Patient Safety Agreement (PSA) program on fall rates. Four types of patient care units participated (acute medical and surgical, progressive or intermediate, and critical care areas), in the implementation of the PSA. The National Database of Nursing Quality Indicators (NDNQI) was resourced to ensure a standardized definition and categorization of falls, and uniform method of rate calculation. Patient demographics, LOS, and fall risk scoring were abstracted from the study site’s electronic medical record. The time span for this study will be 1 year to include fall rate pre- and postimplementation. Results: Based on the statistical analysis performed, there was no statistically significant difference in patient falls while in the hospital during the pre- and post-evaluation period. There was no effect realized for patients with a Morse Fall Score (MFS) of 0 on admission. There may be a protective effect, but there is not a statistically significant difference in effect until patient’s have an admission Morse Fall Scale score > 55, at the p <.05 level. Additionally during this study period, there was an increase in falls in patients who had a MFS score between 5 and 45 on admission. Discussion: The anticipated outcome of the PSA is a reduction in patient fall rates. Examination of the patients who experienced a fall while in the hospital setting showed different patterns of fall risk based on mental cognition, length of stay, and medications. Variations in fall risk scores as reported by the Morse Fall Scale were evident. Patient falls were analyzed by fall score and type of fall. Anecdotal findings indicated that the Patient Safety Agreement was generally well accepted by patients, family members/significant others, and staff. Medical Staffs supported the implementation of the PSA process and assisted with reinforcing fall prevention measures. “Patient engagement in their health care could translate into measurable improvements in safety and quality (Tzeng & Yin, 2014)”. Potential limitations to the study include staff adoption of the PSA, language and comprehension barriers, patient cognition, and inconsistent implementation and execution across nursing units.


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