Recommended Citation
Dumas N, Mayton C. Leveraging a Standardized Toileting Improvement Plan (TIP) Sheet to Reduce Patient Falls and Injuries on General Medicine and Renal Units. Poster presentation at: Academy of Medical-Surgical Nurses Conference; September 24-26, 2026; Palm Springs, CA.
Presentation Notes
Poster presentation at: Academy of Medical-Surgical Nurses Conference; September 24-26, 2026; Palm Springs, CA.
Abstract
Purpose Patient falls and toileting‑related falls with injury remain persistent challenges across acute care settings. The General Medicine and Renal units identified deficits in communication between nurses and nursing assistants regarding key fall‑related safety factors including, fall risk, toileting frequency, ambulatory status, and required assistance method. Both units implemented a standardized Toileting Improvement Plan (TIP) sheet to improve proactive communication and toileting, increase situational awareness, and reduce patient harm. This project evaluated the impact of the TIP sheet on fall outcomes, proactive patient toileting, and safety‑related communication behaviors.
Description Beginning August 2025, both units conducted baseline assessments revealing gaps in communication during shift handoffs and inconsistent documentation of toileting needs. The intervention consisted of: (1) development and deployment of a TIP sheet placed on each patient’s bathroom door or whiteboard, (2) staff education delivered via meetings and huddles, (3) structured communication expectations guided by four standardized talking points (fall risk, toileting frequency, ambulatory status, and required toileting method), and (4) ongoing data collection through surveys, audits, and call light logs.
Evaluation / Outcomes On the Renal Unit, post‑intervention surveys demonstrated increases across all safety talking points, with frequency of toileting rising from 0.08 to 0.44 and method of toileting from 0.08 to 0.40. Fall outcomes improved with a 33% reduction in falls and zero falls with injury during the project period. On the General Medicine Unit, toileting‑related call lights decreased from an average of 44 per week to 18 per week post‑intervention, representing a 59% reduction. Falls with injury declined from five baseline events to two during the project period—a 60% reduction—with zero injurious falls reported in November. Together, both units demonstrated meaningful reductions in falls, call‑light burden, and harm through improved communication and proactive toileting practices.
Conclusion Implementation of a standardized Toileting Improvement Plan (TIP) sheet significantly enhanced communication reliability and reduced fall‑related harm across two medical‑surgical units serving distinct patient populations. These findings demonstrate the TIP sheet’s adaptability and effectiveness, supporting its broader adoption into routine clinical workflow, staff onboarding, and ongoing competency based education to sustain safer patient outcomes.
References
Agency for Healthcare Research and Quality. (2023). Preventing falls in hospitals: A toolkit for improving quality of care. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit.html Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., … & Bates, D. W. (2020). Evaluation of a fall prevention tool kit on patient falls: A cluster-randomized trial. JAMA Network Open, 3(11), e2025889. https://doi.org/10.1001/jamanetworkopen.2020.25889 Lyse Harden, K., Wall, P., Galunas, L., Eastman, D. J., & Frederick, T. S. (2021). Managing Falls: Implementation of a Three-Intervention Initiative to Improve Quality of Care for Patients With Cancer. Clinical journal of oncology nursing, 25(2), 188–193. https://doi.org/10.1188/21.CJON.188-193 Swenson, P., Besaw, K., & Olmstead, J. (2019). Fall prevention using proactive toileting: Acute care performance improvement success. Nursing management, 50(12), 16–18. https://doi.org/10.1097/01.NUMA.0000605176.95810.b4
Document Type
Poster
Affiliations
Atrium Health Wake Forest Baptist