09/07/2026
CNSs amplify cooperation for better patient safety! Missy Moreda's multidisciplinary pilot program is a great example. The pilot explored how targeted sensory and motor screening could help identify fall vulnerabilities in patients with diabetes.
🏥 The setting: Duke Raleigh Hospital, a campus of Duke University Hospital, Orthopedic Unit
❗️ The problem: In FY 2024, 35% of falls on the orthopedic floor involved patients with diabetes, and 46% of those falls resulted in injury. Diabetes can silently damage nerves and blood vessels, contributing to sensory deficits, muscle weakness and impaired balance — vulnerabilities that aren’t routinely included in inpatient fall-risk assessments.
💡 The solution: Missy, a diabetes clinical nurse specialist, brought together the MedSurg CNS, medical quality director, nurse manager, PT and OT to create a targeted screening process for surgical patients with diabetes who were already identified as being at elevated fall risk and had PT/OT consults. The team added brief assessments of foot structure and sensation, lower-extremity strength, ankle strength and reflexes, and functional mobility, along with diabetes foot-care education.
👍 Why it worked: As a CNS, Missy was trained to identify opportunities for improvement, organize teams to create efficient solutions, and study the results. The pilot used existing clinical resources and skills, with just one newly created and approved educational resource. The five brief assessments required minimal equipment and less than ten minutes, making them practical additions to routine care while helping clinicians identify previously unrecognized sensory and motor vulnerabilities.
📈 Impact: 38 patients were screened, with an average age of 64.82 years. Two patients fell before the intervention; no patients fell after the intervention during the pilot (although there have been two falls in the two years since then). Screening also identified gaps in foot-care knowledge, reduced foot sensation, lower-extremity weakness, ankle weakness and decreased plantar-flexor endurance.
Learn more about how clinical nurse specialists are making a difference in patient safety and health care:https://nacns.org/wp-content/uploads/2023/10/How-CNSs-Make-a-BIG-Difference-in-Health-Care-Final-.pdf
