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Course Name
Clinical Improvement Project II CAPSTONE
Graduation Year
2025
Faculty Advisor
Dr. Sarah Lee
Abstract
BACKGROUND: The Safe Steps Project aimed to reduce falls at Pine Creek Care Center, a skilled nursing facility located in Roseville, CA. Before this intervention, the fall rate at Pine Creek Care Center had been rising above their 15% goal in the first few months of 2025. Through an in-service education, this project has helped educate and increase nursing staff knowledge on fall prevention, such as intentional rounding with the 4 Ps (pain, position, potty, and possessions).
AIM: The Safe Steps Project addresses a major cause of injury in older adults, falls. The aim of this project was to improve knowledge regarding fall prevention to nursing staff at Pine Creek Care Center through an education in-service, ultimately reducing fall rates.
METHODS: This project was conducted through planned education in-services with a pre- and post-questionnaire, along with an interactive activity. Utilizing this method was aimed at increasing knowledge on fall prevention through a concise in-service that staff were already accustomed to this education format. The interactive activity provided the opportunity for staff to recall their knowledge prior to taking the post-survey. Data was collected from 56 participants via these questionnaires and analyzed using SQUIRE.
RESULTS: Results from 45 participants with completed surveys showed an improvement in knowledge regarding intentional rounding and the 4 Ps. Certified nursing assistants (CNAs) represented the largest group of participants. The mean participant age was 33.8 years old. The mean survey score increased from the pre-survey to the post-survey.
CONCLUSIONS: The Safe Steps Project was conducted at Pine Creek Care Center, where participating nursing staff exhibited improvement in knowledge of fall prevention education related to intentional rounding and the implementation of 4 Ps. The provision of continued education opportunities for facility nursing staff on fall prevention and access to educational materials is essential to improve and sustain positive outcomes in older adults in SNFs who are at higher risk of experiencing falls and fall injuries.
Keywords
fall prevention, fall education, fall injury, falls in older adults, unwitnessed falls, staff knowledge, patient safety, skilled nursing facility, intentional rounding, 4 Ps, nursing staff
Recommended Citation
Cabrera, Maiana; Le, Nicole; Tran, Yen; and Turcotte, Madeline, "The Safe Steps Project: Fall Prevention Amongst Older Adults in a Skilled Nursing Facility" (2025). ELMSN E-Portfolio. A collection of Scholarly and Creative Works. 33.
https://scholarlycommons.pacific.edu/nursing-portfolios/33
