Patient fall was serious alarming threat in patient safety. The author was a state registered nurse in private hospital in Kuala Lumpur, Malaysia with seven years of working experienced. Based on the statistic showed from 0.04% in January 2017 increased to 0.10% in February 2017 (Quality Department, Author’s Hospital, March 2017). The management had gathered a team and conducted the root cause analysis (RCA). The result of the RCA showed it was due to communication failure between patient and nurse during orientation, inadequate patient fall risk assessment done by nurses, understaffing and latest technology devices to prevent fall were not available.
The management had sense of urgency to implement change in order to decrease the percentage of patient fall in the hospital. As cited by Bradley (2016), there were necessary to change to develops in ordered to meet the goal. Minority of the nurses showed a positive respond in changes because they believe changes helps to improve their knowledge and provide better nursing care in preventing patient fall. However, they were majority of senior staff nurses showed negative respond were against the changes. As summarized by Umble and Umble (2014), change creates to uncertainty which leads to fear as perceived as threat to their security and finally lead
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The internal audit was done by nurse manager and clinical educator by doing round with the staff during the inspection. The staff became more vigilant in proving care. Meanwhile the external audit will be done by staff who allocated by Ministry of Health (MOH) or from Malaysia Society for Quality in Health (MSQH) for inspection. Randomly wards were chosen for auditing. Audit was to ensure the overall continuity and internal consistency (Gopalakrishnan and Haleem, 2015). The audit was to maintaining the good quality of care and monitors the