I N SP I R I NG CHANGE
Reducing falls with a safety spotter program By Patricia Primmer, MAS, RN, MSRN; Kathleen K. Borenstein, DNP, RN, CCRN; Michelle T. Downing, MPA, RN-BC; Denise Fochesto, MSN, RN, APN, CCRN; Laura Reilly, MSN, RN, CCRN, CNRN; Rachael Santos, MSN, RN, GNP-BC; Karla Zepeda, AAS; and Trish O’Keefe, PhD, RN, NE-BC
DESPITE NURSES’ concerted efforts, over one million falls are reported in hospitals each year.1 Besides the potential for bodily injury, falls are frightening, can diminish a patient’s independence, and increase hospital length of stay. Keeping patients safe by preventing falls supports the goal of shorter and more patient-centered hospital stays. This article discusses an innovative program that involves educating unlicensed assistive personnel (UAP) to act as Safe Patient Observation Technicians, or “spotters,” for up to four patients grouped in a safety zone. An improvement on the hospital’s use of one-on-one sitters for certain highrisk patients, the new program significantly enhanced patient safety and reduced costs. The spotter program was created by a nursing team and piloted on a 43-bed medicalsurgical unit with a high percentage of older adult patients, then expanded to other areas of the facility.
classified as high risk includes agitation, confusion, impulsive or threatening behavior, physical instability while standing or walking, or inability to follow requests or directions. (See Behaviors guiding sitter and spotter use.) At MMC, the use of a sitter for a 1:1 or 1:2 (two patients in one room) observation requires a healthcare provider’s order. The unit is responsible for the cost of the sitter. Sitters continue to be used at MMC for patients requiring constant oneto-one observation and engagement for safety reasons.
Building on an earlier program At Morristown Medical Center (MMC), a 649-bed general medical and surgical teaching facility in New Jersey, a sitter program has been in place for years. Sitters are specially trained UAP assigned to sit and observe patients who are at risk for self-harm or injury. The goal of this constant vigilance is to protect the patient from injury. Sitters were assigned to patients at high risk for falls and those who needed constant observation for another safety reason. Patient behavior
In 2012, the nursing department recognized that as the numbers of older adult patients increased, more patients were identified as being at high risk for falls, self-injury, or behaviors that interrupt care. These behaviors include pulling out gastric tubes or I.V. catheters and disrupting other patients on the unit. Patients requiring continual verbal cues for safety measures, such as reminders to remain in bed or in a chair, are also identified as high risk for falls. The increase in older adult patients with confusion or episodes of
Keeping patients safe by preventing falls supports the goal of shorter and more patient-centered hospital stays.
delirium triggered the demand for more sitters, making this resource increasingly costly. With a focus on increasing patient safety, decreasing patient falls during hospitalization, and improving each patient’s experience, a leadership team was charged with finding alternative solutions for sitters. They ultimately came up with the spotter concept. Exploring alternatives The leadership team was composed of nurse managers, an informatics specialist, and a business coordinator responsible for sitter oversight. Performing a literature review, the team found a unique and classic article that reported findings from a national survey studying patients requiring constant observation.2 The idea of grouping patients together for ease of observation was made by the authors. In 2010, findings about the use of “patient observers” were presented at Tufts Medical Center and during a webinar hosted by the Massachusetts Organization of Nurse Executives.3 The presentation introduced the idea of patient observers who replaced one-to-one sitters to monitor at-risk patients. Another article that piqued the team’s interest highlighted the work done at Brookwood Medical Center in Birmingham, Alabama.4 This 600bed nonteaching hospital published falls prevention information on the Institute for Healthcare Improvement’s website. The hospital used UAP as hall monitors during change of shift, and UAP headed up prevention teams during the shift.
16 l Nursing2015 l Volume 45, Number 8
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.Nursing2015.com
Using the idea of a monitor or observer as a springboard, MMC came up with the spotter concept in which one dedicated spotter observes up to four patients placed in a safety zone. The safety zone can be composed of two to four geographically clustered rooms, each with two beds, or two to four private rooms if the rooms are in close proximity. Rooms in the safety zone are located in a high-traffic area in a central location on the unit to support the aim of constant observation. The shift from an exclusive one-toone sitter role to the spotter role reduced the number of sitters needed. Instead of one sitter observing one or two patients, the spotter can effectively observe two to four patients. Spotters for a safety zone are still requested through the nursing resource office, but an order isn’t required. Instead, spotters are requested by the nursing unit’s nurse leadership team (manager, coordinator, and charge nurse), which makes the spotter program a nurse-driven initiative. Transitioning from sitters to spotters The leadership team decided to roll out the new concept as a pilot program on a large medical unit with a geriatric focus. The pilot unit was selected based on its high fall rate and significant 1:1 sitter usage. Staff education began in the last few months of 2012. Based on the formal objectives, an education session for all RNs, spotters, and other unit-based UAP was created. Key messages addressed the need to keep patients safe, and spotters were taught safety-enhancing interventions such as reorienting patients and providing diversional activities. Activities consisted of modified arts and crafts activities, word puzzles, classic movies, and large-print books.
Behaviors guiding sitter and spotter use Behavior
Sitter (1:1)
Attempted suicide
Required by law
Unable to follow verbal suggestion, instruction, or command; continues to exhibit risk behavior after being verbally reminded or gently guided
√
Escalating anxiety that requires continual supportive interventions and continual support to prevent harm to self or others
√
Requires isolation precautions
√
Spotter (1:3 or 1:4)
May not be able to follow commands but with frequent verbal reminders can remain safe and isn’t a threat to others
√
Engages in activities and conversation when directed
√
The goals and expectations of the spotter program were explained to all staff. A pretest and posttest were administered to measure the understanding of the information provided. Key content areas were identified by the leadership team. A total of 72 staff members participated in the 1-hour educational sessions. This number represented 100% of the nursing staff for the unit across all shifts. Once the education was completed, the spotter program was initiated on the pilot unit. One spotter was assigned to monitor one to four patients placed in the unit’s safety zone. The spotter assumes a central location and floats from room to room, assisting and observing the patients frequently and as needed. The spotter is relieved for breaks and meals but is otherwise watching and interacting with the patients throughout the shift. The spotter is primarily responsible for patient safety, not routine patient care. The spotter is in addition to the care team of RNs and UAP who are responsible for the patient’s overall
care. While spotters can provide food and drinks, their main responsibility is to frequently observe all patients in the safety zone because their focus is safety. The spotter is responsible for rounding frequently (at least every 15 minutes) on each patient to be certain the patient is comfortable and positioned properly and doesn’t have unmet needs such as toileting. The duration of interactions between the spotter and any one patient is limited to no more than 15 minutes each hour. Each patient must be observed at least four times each hour. Immediate safety concerns are communicated verbally to the RN assigned to the patient. The RN documents patient status, which may include observations called to his or her attention by the spotter. The spotter completes a flow sheet to record the patient’s activity and safety concerns over a 24-hour period. The flow sheet is used for handoff to the next shift. This allows for communication about the safety needs of the patient and potential triage out of the spotter group. August l Nursing2015 l 17
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
I N SP I R I NG CHANGE
a room by a nurse to maintain safety. Activities seemed to keep the patients calmer, reducing stress on the unit. Education for the unit engaged the entire nursing staff, supporting the idea that teamwork remains an important aspect of maintaining safety and preventing falls.5 Nurses and UAP realized that spotters play an important role in supporting the safety of patients entrusted to their care. Not all units within MMC have the same physical layout. As the program expanded to units that have only single rooms, new challenges were identified. For example, spotters have difficulty monitoring four patients when they’re in single rooms spaced far apart. Units with single-occupancy rooms transfer their high-risk fall patients to units with double-occupancy rooms, when appropriate. If a transfer isn’t possible, spotters travel between rooms and maintain an enhanced rounding schedule (every 5 to 10 minutes) for maximum observation.
One tool spotters use to help distract confused or agitated patients is the activity cart. The cart, created by a clinical nurse on the unit, is supported by a grant. This cart is filled with arts and crafts supplies as well as games, large-print playing cards, magnifying glasses, headphones, and magazines for reminiscing. These activities help keep patients occupied and may prevent them from trying to get out of bed. Meeting the challenge of change The spotter program, like many new programs, was initially met with some skepticism by the staff. While the idea of observing four patients instead of one took some adjustment, the outcomes were worth the challenges. Initially using one spotter to observe patient behavior for safety seemed inefficient to staff. However, the staff realized that the spotter could reduce the number of visits to
Encouraging fall trends This graph shows falls per month on the pilot unit from January 2012 to January 2013; the program was initiated in February 2013. Note: The October 2013 spike was due to one patient with mental health issues sustaining three falls. 8 7 Spotter Initiation Number of falls
6 5 4 3 2 1 Jan 12 Feb 12 Mar 12 Apr 12 May 12 Jun 12 Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12 Jan 13 Feb 13 Mar 13 Apr 13 May 13 Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13
0
Total falls 2012 = 38 Average falls per month = 3.16
Total falls 2013 = 25 Average falls per month = 2.08
The movement of patients in and out of the safety zone requires additional staff assistance. However, the time spent moving the patient ultimately results in time saved because the patient remains safer and can be observed more carefully by one staff member who’s also watching other patients. As the program rolled out hospitalwide and interdisciplinary and interdepartmental teams became familiar with it, patient flow improved. Healthcare providers request spotter rooms, nurses hold designated spotter beds only for appropriate patients, and the bed management team places patients in these rooms only after collaboration with the healthcare team. Ultimately, the spotter program was embraced by the staff. Positive outcomes The pilot unit has produced a sustained reduction in falls since the initiation of the spotter program. No falls resulting in injury occurred during the initial pilot period. (See Encouraging fall trends.) During this time, approximately 270 shifts of spotter coverage provided observations for over 200 patients identified as high risk for falls. While safety and reduced falls were the primary goals of the spotter team, an interesting resource benefit has also been realized. The overall reduction in spending from the average monthly sitter use in 2012 ($12,083) to the average monthly spotter use in 2013 ($10,499) was substantial, resulting in an approximate savings of 13% annually. Achieving safety Building on the rationale and education established with the pilot program, the spotter program has been translated to other units within MMC. Preliminary outcomes on other units
18 l Nursing2015 l Volume 45, Number 8
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.Nursing2015.com
appear to be consistent with those on the pilot unit, but outcomes will be monitored carefully. Data are being collected to learn more about the patterns of patients assigned to the spotter program and what interactions may strengthen the program. Characteristics associated with high fall risk are being studied to improve the identification of patients at risk. The spotter program leadership team continues to meet with the ongoing goals of providing safety and reducing falls, improving patient care and patient satisfaction, and strengthening the spotter program. A written hospital policy for the use
of spotters in the organization is being drafted. The team remains engaged with managers, spotters, and clinical nurses to learn first-hand what works best and what changes might improve the program. The program continues to be monitored and improvements will be made as it expands throughout the system. ■ REFERENCES 1. Mion LC, Chandler AM, Waters TM, et al. Is it possible to identify risks for injurious falls in hospitalized patients? Jt Comm J Qual Patient Saf. 2012;38(9):408-413. 2. Worley LL, Kunkel EJ, Gitlin DF, Menefee LA, Conway G. Constant observation practices in the general hospital setting: a national survey. Psychosomatics. 2000;41(4):301-310. 3. Gillis D. Tufts Medical Center: Sitter program
overview. PowerPoint slides 44-58 presented at a webinar hosted by the Massachusetts Organization of Nurse Executives, Burlington, MA. 2010. http:// www.patientcarelink.org/uploadDocs/1/MONESitter-Webinar-Slide-Deck.pdf. 4. Institute for Healthcare Improvement. Falls Prevention, Brookwood Medical Center. 2014. http://www.ihi.org/Engage/Memberships/ MentorHospitalRegistry/Pages/FallsPrevention.aspx. 5. Hung WW, Ross JS, Farber J, Siu AL. Evaluation of the Mobile Acute Care of the Elderly (MACE) Service. JAMA Intern Med. 2013;173(11):990-996. At Morristown Medical Center in Morristown, N.J., Patricia Primmer, Kathleen K. Borenstein, Laura Reilly, and Denise Fochesto are nurse managers; Michelle T. Downing is a nursing informatics and research coordinator; Rachael Santos is a geriatric NP; Karla Zepeda is a business coordinator; and Trish O’Keefe is a chief nursing officer. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NURSE.0000469244.89222.27
August l Nursing2015 l 19
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Reducing falls with a safety spotter program By Patricia Primmer, MAS, RN, MSRN; Kathleen K. Borenstein, DNP, RN, CCRN; Michelle T. Downing, MPA, RN-BC; Denise Fochesto, MSN, RN, APN, CCRN; Laura Reilly, MSN, RN, CCRN, CNRN; Rachael Santos, MSN, RN, GNP-BC; Karla Zepeda, AAS; and Trish O’Keefe, PhD, RN, NE-BC
DESPITE NURSES’ concerted efforts, over one million falls are reported in hospitals each year.1 Besides the potential for bodily injury, falls are frightening, can diminish a patient’s independence, and increase hospital length of stay. Keeping patients safe by preventing falls supports the goal of shorter and more patient-centered hospital stays. This article discusses an innovative program that involves educating unlicensed assistive personnel (UAP) to act as Safe Patient Observation Technicians, or “spotters,” for up to four patients grouped in a safety zone. An improvement on the hospital’s use of one-on-one sitters for certain highrisk patients, the new program significantly enhanced patient safety and reduced costs. The spotter program was created by a nursing team and piloted on a 43-bed medicalsurgical unit with a high percentage of older adult patients, then expanded to other areas of the facility.
classified as high risk includes agitation, confusion, impulsive or threatening behavior, physical instability while standing or walking, or inability to follow requests or directions. (See Behaviors guiding sitter and spotter use.) At MMC, the use of a sitter for a 1:1 or 1:2 (two patients in one room) observation requires a healthcare provider’s order. The unit is responsible for the cost of the sitter. Sitters continue to be used at MMC for patients requiring constant oneto-one observation and engagement for safety reasons.
Building on an earlier program At Morristown Medical Center (MMC), a 649-bed general medical and surgical teaching facility in New Jersey, a sitter program has been in place for years. Sitters are specially trained UAP assigned to sit and observe patients who are at risk for self-harm or injury. The goal of this constant vigilance is to protect the patient from injury. Sitters were assigned to patients at high risk for falls and those who needed constant observation for another safety reason. Patient behavior
In 2012, the nursing department recognized that as the numbers of older adult patients increased, more patients were identified as being at high risk for falls, self-injury, or behaviors that interrupt care. These behaviors include pulling out gastric tubes or I.V. catheters and disrupting other patients on the unit. Patients requiring continual verbal cues for safety measures, such as reminders to remain in bed or in a chair, are also identified as high risk for falls. The increase in older adult patients with confusion or episodes of
Keeping patients safe by preventing falls supports the goal of shorter and more patient-centered hospital stays.
delirium triggered the demand for more sitters, making this resource increasingly costly. With a focus on increasing patient safety, decreasing patient falls during hospitalization, and improving each patient’s experience, a leadership team was charged with finding alternative solutions for sitters. They ultimately came up with the spotter concept. Exploring alternatives The leadership team was composed of nurse managers, an informatics specialist, and a business coordinator responsible for sitter oversight. Performing a literature review, the team found a unique and classic article that reported findings from a national survey studying patients requiring constant observation.2 The idea of grouping patients together for ease of observation was made by the authors. In 2010, findings about the use of “patient observers” were presented at Tufts Medical Center and during a webinar hosted by the Massachusetts Organization of Nurse Executives.3 The presentation introduced the idea of patient observers who replaced one-to-one sitters to monitor at-risk patients. Another article that piqued the team’s interest highlighted the work done at Brookwood Medical Center in Birmingham, Alabama.4 This 600bed nonteaching hospital published falls prevention information on the Institute for Healthcare Improvement’s website. The hospital used UAP as hall monitors during change of shift, and UAP headed up prevention teams during the shift.
16 l Nursing2015 l Volume 45, Number 8
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.Nursing2015.com
Using the idea of a monitor or observer as a springboard, MMC came up with the spotter concept in which one dedicated spotter observes up to four patients placed in a safety zone. The safety zone can be composed of two to four geographically clustered rooms, each with two beds, or two to four private rooms if the rooms are in close proximity. Rooms in the safety zone are located in a high-traffic area in a central location on the unit to support the aim of constant observation. The shift from an exclusive one-toone sitter role to the spotter role reduced the number of sitters needed. Instead of one sitter observing one or two patients, the spotter can effectively observe two to four patients. Spotters for a safety zone are still requested through the nursing resource office, but an order isn’t required. Instead, spotters are requested by the nursing unit’s nurse leadership team (manager, coordinator, and charge nurse), which makes the spotter program a nurse-driven initiative. Transitioning from sitters to spotters The leadership team decided to roll out the new concept as a pilot program on a large medical unit with a geriatric focus. The pilot unit was selected based on its high fall rate and significant 1:1 sitter usage. Staff education began in the last few months of 2012. Based on the formal objectives, an education session for all RNs, spotters, and other unit-based UAP was created. Key messages addressed the need to keep patients safe, and spotters were taught safety-enhancing interventions such as reorienting patients and providing diversional activities. Activities consisted of modified arts and crafts activities, word puzzles, classic movies, and large-print books.
Behaviors guiding sitter and spotter use Behavior
Sitter (1:1)
Attempted suicide
Required by law
Unable to follow verbal suggestion, instruction, or command; continues to exhibit risk behavior after being verbally reminded or gently guided
√
Escalating anxiety that requires continual supportive interventions and continual support to prevent harm to self or others
√
Requires isolation precautions
√
Spotter (1:3 or 1:4)
May not be able to follow commands but with frequent verbal reminders can remain safe and isn’t a threat to others
√
Engages in activities and conversation when directed
√
The goals and expectations of the spotter program were explained to all staff. A pretest and posttest were administered to measure the understanding of the information provided. Key content areas were identified by the leadership team. A total of 72 staff members participated in the 1-hour educational sessions. This number represented 100% of the nursing staff for the unit across all shifts. Once the education was completed, the spotter program was initiated on the pilot unit. One spotter was assigned to monitor one to four patients placed in the unit’s safety zone. The spotter assumes a central location and floats from room to room, assisting and observing the patients frequently and as needed. The spotter is relieved for breaks and meals but is otherwise watching and interacting with the patients throughout the shift. The spotter is primarily responsible for patient safety, not routine patient care. The spotter is in addition to the care team of RNs and UAP who are responsible for the patient’s overall
care. While spotters can provide food and drinks, their main responsibility is to frequently observe all patients in the safety zone because their focus is safety. The spotter is responsible for rounding frequently (at least every 15 minutes) on each patient to be certain the patient is comfortable and positioned properly and doesn’t have unmet needs such as toileting. The duration of interactions between the spotter and any one patient is limited to no more than 15 minutes each hour. Each patient must be observed at least four times each hour. Immediate safety concerns are communicated verbally to the RN assigned to the patient. The RN documents patient status, which may include observations called to his or her attention by the spotter. The spotter completes a flow sheet to record the patient’s activity and safety concerns over a 24-hour period. The flow sheet is used for handoff to the next shift. This allows for communication about the safety needs of the patient and potential triage out of the spotter group. August l Nursing2015 l 17
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
I N SP I R I NG CHANGE
a room by a nurse to maintain safety. Activities seemed to keep the patients calmer, reducing stress on the unit. Education for the unit engaged the entire nursing staff, supporting the idea that teamwork remains an important aspect of maintaining safety and preventing falls.5 Nurses and UAP realized that spotters play an important role in supporting the safety of patients entrusted to their care. Not all units within MMC have the same physical layout. As the program expanded to units that have only single rooms, new challenges were identified. For example, spotters have difficulty monitoring four patients when they’re in single rooms spaced far apart. Units with single-occupancy rooms transfer their high-risk fall patients to units with double-occupancy rooms, when appropriate. If a transfer isn’t possible, spotters travel between rooms and maintain an enhanced rounding schedule (every 5 to 10 minutes) for maximum observation.
One tool spotters use to help distract confused or agitated patients is the activity cart. The cart, created by a clinical nurse on the unit, is supported by a grant. This cart is filled with arts and crafts supplies as well as games, large-print playing cards, magnifying glasses, headphones, and magazines for reminiscing. These activities help keep patients occupied and may prevent them from trying to get out of bed. Meeting the challenge of change The spotter program, like many new programs, was initially met with some skepticism by the staff. While the idea of observing four patients instead of one took some adjustment, the outcomes were worth the challenges. Initially using one spotter to observe patient behavior for safety seemed inefficient to staff. However, the staff realized that the spotter could reduce the number of visits to
Encouraging fall trends This graph shows falls per month on the pilot unit from January 2012 to January 2013; the program was initiated in February 2013. Note: The October 2013 spike was due to one patient with mental health issues sustaining three falls. 8 7 Spotter Initiation Number of falls
6 5 4 3 2 1 Jan 12 Feb 12 Mar 12 Apr 12 May 12 Jun 12 Jul 12 Aug 12 Sep 12 Oct 12 Nov 12 Dec 12 Jan 13 Feb 13 Mar 13 Apr 13 May 13 Jun 13 Jul 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13
0
Total falls 2012 = 38 Average falls per month = 3.16
Total falls 2013 = 25 Average falls per month = 2.08
The movement of patients in and out of the safety zone requires additional staff assistance. However, the time spent moving the patient ultimately results in time saved because the patient remains safer and can be observed more carefully by one staff member who’s also watching other patients. As the program rolled out hospitalwide and interdisciplinary and interdepartmental teams became familiar with it, patient flow improved. Healthcare providers request spotter rooms, nurses hold designated spotter beds only for appropriate patients, and the bed management team places patients in these rooms only after collaboration with the healthcare team. Ultimately, the spotter program was embraced by the staff. Positive outcomes The pilot unit has produced a sustained reduction in falls since the initiation of the spotter program. No falls resulting in injury occurred during the initial pilot period. (See Encouraging fall trends.) During this time, approximately 270 shifts of spotter coverage provided observations for over 200 patients identified as high risk for falls. While safety and reduced falls were the primary goals of the spotter team, an interesting resource benefit has also been realized. The overall reduction in spending from the average monthly sitter use in 2012 ($12,083) to the average monthly spotter use in 2013 ($10,499) was substantial, resulting in an approximate savings of 13% annually. Achieving safety Building on the rationale and education established with the pilot program, the spotter program has been translated to other units within MMC. Preliminary outcomes on other units
18 l Nursing2015 l Volume 45, Number 8
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.Nursing2015.com
appear to be consistent with those on the pilot unit, but outcomes will be monitored carefully. Data are being collected to learn more about the patterns of patients assigned to the spotter program and what interactions may strengthen the program. Characteristics associated with high fall risk are being studied to improve the identification of patients at risk. The spotter program leadership team continues to meet with the ongoing goals of providing safety and reducing falls, improving patient care and patient satisfaction, and strengthening the spotter program. A written hospital policy for the use
of spotters in the organization is being drafted. The team remains engaged with managers, spotters, and clinical nurses to learn first-hand what works best and what changes might improve the program. The program continues to be monitored and improvements will be made as it expands throughout the system. ■ REFERENCES 1. Mion LC, Chandler AM, Waters TM, et al. Is it possible to identify risks for injurious falls in hospitalized patients? Jt Comm J Qual Patient Saf. 2012;38(9):408-413. 2. Worley LL, Kunkel EJ, Gitlin DF, Menefee LA, Conway G. Constant observation practices in the general hospital setting: a national survey. Psychosomatics. 2000;41(4):301-310. 3. Gillis D. Tufts Medical Center: Sitter program
overview. PowerPoint slides 44-58 presented at a webinar hosted by the Massachusetts Organization of Nurse Executives, Burlington, MA. 2010. http:// www.patientcarelink.org/uploadDocs/1/MONESitter-Webinar-Slide-Deck.pdf. 4. Institute for Healthcare Improvement. Falls Prevention, Brookwood Medical Center. 2014. http://www.ihi.org/Engage/Memberships/ MentorHospitalRegistry/Pages/FallsPrevention.aspx. 5. Hung WW, Ross JS, Farber J, Siu AL. Evaluation of the Mobile Acute Care of the Elderly (MACE) Service. JAMA Intern Med. 2013;173(11):990-996. At Morristown Medical Center in Morristown, N.J., Patricia Primmer, Kathleen K. Borenstein, Laura Reilly, and Denise Fochesto are nurse managers; Michelle T. Downing is a nursing informatics and research coordinator; Rachael Santos is a geriatric NP; Karla Zepeda is a business coordinator; and Trish O’Keefe is a chief nursing officer. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NURSE.0000469244.89222.27
August l Nursing2015 l 19
www.Nursing2015.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
