The high prevalence of patient falls within the healthcare system is still on the rise, and fall prevention continues to be a major patient safety issue at all levels of care delivery. In light of this, organizations like The Joint Commission noted that preventing falls remained a national patient safety priority, requiring all hospitals to drastically lower the likelihood of patient fall-related harm. (Aydin et al., 2015). The term "patient fall" derives from an external incident that unintentionally results in the patient falling to the ground because of an underlying instability brought on by their medical conditions. Thus, patient safety takes precedence in every healthcare setup especially with regards to acute care setting like a hospital where the patient’s expected mental and physical. The subsequent portions of the paper will aim at evaluating patient safety by examining the existing fall prevention alternatives to mitigate against the resulting casualties.
Problem Statement
According to the Center for Disease Control, patient falls tend to lengthen the period of hospital stays which simultaneously impact the economics of health care reflected in the adjusted medical costs related to the falls which are estimated in the region of 30 billion US dollars annually (Armstrong & Barton, 2014). The worst affected proportion of the population targets the elderly aged 65 years and older. The complications emanating from such falls have resulted in severe medical conditions leading to both fatal and non-fatal injuries with occasional instances where patient experience traumatic brain injuries and fractures. Therefore, there is a real and urgent need to seek a sustainable solution to the presenting problems which focus on prevention and education to those susceptible to risk (Aydin et al., 2015). Similarly, the proposed interventions to resolve the patient fall issue will invariably involve the leadership and management within the healthcare setup to implement a reduction in falls that continue to be witnessed across the healthcare industry.
The proposed interventions will provide lasting solutions that guarantee favorable health outcomes for the patient. As already highlighted in the previous proceedings, the process of implementing a program focused ion fall education will, therefore, rely on the capable leadership of the healthcare institutions and the corresponding availability of resources (McKenzie et al., 2017). Moreover, the verifiable need for the implementation, monitoring, and evaluation of such a program depends mainly on the documented evidence of adverse effects which consequently form the basis of the fall reduction program. Ultimately, the implementation of the fall reduction program will involve the creation of an interdisciplinary team comprising of health education, promotion and choosing the appropriate practice to utilize (Aydin et al., 2015). Consequently, the fall reduction program will aim at reducing related morbidities while enhancing patient care to prevent harm.
Project Statement
The primary aim of the project is established on the prevention of falls among patients and promote a relatively successful safe hospital stay. Thus, the initiation of preventive measures for falls wishes to take into consideration every aspect of a patient’s health although it will not be possible to entirely prevent such falls from occurring (Casey et al., 2016). However, it becomes imperative to realize that the organization will establish a preventive mechanism to minimize the occurrence of such falls. Critical to the realization of the project's objectives depends on a motivated, dynamic and results-oriented leadership that possess qualities to champion the successful implementation of the project (Armstrong & Barton, 2014).
Safety championing will also engage and subsequently empower the frontline staff
Safety championing will also engage and subsequently empower the frontline staff with the aim of promoting system-level learning which will consequently enhance the sharing of accrued successes and challenges for the provision of peer support (McKenzie et al., 2017). Hence, the implementation of a fall prevention education within the hospital setup will not only decreases mortality rates but invariably lengthen the hospital stay with elaborate emphasis among the aging populations. The purpose of this project will help to evaluate the possible outcomes of fall prevention after being implemented both in acute nursing units and the general hospital setup.
Objectives
To establish the possible outcomes, the project designed both the primary and secondary objectives. The principal objective act as the ideal or desired goal needed to be attained by the project while secondary objective emanates from the need accomplish some of the intended outcomes if the primary one becomes too elusive to achieve or can also get realized alongside the primary aim. Thus, the proposed quality initiative project for falls reduction will become critical in establishing the inherent gaps for fall prevention (Casey et al., 2016).
Imperatively, the researcher will hope to identify and explore the possible ways of reducing extrinsic and internal risk factors that invariably contribute to the high prevalence of patient falls
Imperatively, the researcher will hope to identify and explore the possible ways of reducing extrinsic and internal risk factors that invariably contribute to the high prevalence of patient falls (Armstrong & Barton, 2014). The objectives will also incorporate the varied perspectives of the nurses that provide front-line patient care at the facility level. To decrease the incidence of falls while enhancing the reimbursable care, a prominent objective of the quality improvement project will develop a modern and efficient protocol for the utilization of the unit safety champions within the patient care area (Aydin et al., 2015). Ultimately, the anticipated outcome of the project will help in reducing patient falls while promoting unit efficiency.
Primary Objectives
To establish the current proportion of patient falls and why they have become an important safety issue within a healthcare setting
To investigate and the probable risk factors that contribute to patient falls within a healthcare setting
Secondary Objectives
To understand which type of resident patients are more susceptible to falls
To determine the best preventive measures that can be used to reduce risk of falls
To identify whether the nursing assistants are qualified to champion safety within the patient care area
Agency and Identified Need
Having established that falls occur mostly in older individuals, it remains a primary health concern primarily. In most instances, falls occur in older adults diagnosed with multiple impairments cutting across the cognitive, sensory and neurological domains. Falls, therefore, manifest profoundly among older adults undergoing care in institutional healthcare settings, nursing homes, rehabilitative facilities and acute hospitals (Matchar et al., 2017). The frequency with which falls occur in the institutional healthcare settings eventually lead to functional decline characterized by an increased length of stay in an acute hospital environment, and institutional liability (Armstrong & Barton, 2014). More specifically, the project will focus on addressing the inherent risk factors and prevention strategies for elderly patients residing in nursing homes and acute care clinics. As the significant practice site requiring change than any other patient-centered organizations, the patients in nursing homes and other rehabilitative centers across the country form the group, who experience the highest prevalence of falls (Aydin et al., 2015).
According to a recent survey by Casey et al. (2016), approximately 50% of the long-term care setting experience a fall every year. Thus, the fall rate in the nursing homes gets estimated to be 1.5 falls per nursing home bed on an annual basis. Imperatively, when compared to a rehabilitative setup, the falls tend to vary with higher rates associated with a particular group of patients. In a similar regard, acute rehabilitation experiences a fall rate of 3.4 falls annually per bed (Armstrong & Barton, 2014). The population dynamics of the vulnerable groups tend to contribute significantly to the frequency of the falls with an estimated 5% of the total inpatients with recent stroke falling and nearly 10% of those admitted in geriatric units tending to fall. Alternatively, those experiencing other chronic conditions like cancer being likely to suffer high risk of falls. From the preceding, it becomes imperative to recognize that most patients within the acute care setup deserve the most significant priority in the implementation of the falls prevention project (Casey et al., 2016).
Recommendations
Arising Awareness
Raising awareness to help prevent falls is premised on the realization that many falls occur within the acute care setting either because of lack of adequate training for the nurses in charge or communication breakdown on the significance of following safety procedures to help the patients avoid falling (Aydin et al., 2015). Thus, the hospital staff providing care within its hospice will be expected to become aware of the mitigating steps they ought to take to prevent patient falls from enhancing clarity on floor wetness to thoroughly assessing patients for signs for delirium (Armstrong & Barton, 2014). Also, the implementation of the quality improvement project will provide the staff with the requisite knowledge of the implementing mechanisms and other resources inform of continued on-job-training and improved technology such as bed alarms (Matchar et al., 2017).
Creating A Multi-Department Fall Prevention Team
The project will focus on building a multidepartment prevention team that will comprise of doctors, nurses, and other medical practitioners to provide a multidisciplinary approach for accurate and timely intervention in the event of such calls. Providing multiples opinion on various areas of expertise will eventually create clarity on where gaps exist and components needing focused efforts (Armstrong & Barton, 2014).
Using a Standardized Tool for the Identification of the Fall Risk Factors
Invariably, the project quality improvement plan will recommend the implementation of several tools. Importantly, the Morse Fall Scale and other risk assessment tools will help the caregiver conduct an individual risk assessment on every client while taking into consideration their presenting conditions such as gender, age, level of physical function and cognitive ability Aydin et al., 2015). Such measures if put into perspective will help promote prevention of accidental falls.
Developing an Individualized Care Plan
Most importantly, developing an individualized care plan that will focus on every patient’s fall and injury risk factors based on their physical and emotional conditions which will include policies and actions to prevent future falls in the environments where acute and palliative care gets offered (Aydin et al., 2015). Thus, the strategies intended for developing an individualized care plan will also rely on the presenting medical conditions during a patient's initial assessment in the hospital.
Integrating Best Practices
Integrating a raft of best practices into individual and general fall prevention mechanisms gets envisioned as eventually paying dividends in eradication predisposing factors that promote instances of patient injuries. Alongside other targeted interventions, the fall prevention project will contain a form of standardized mechanisms for decreasing the likelihood of terminally ill patients succumbing to their injuries. Similarly, patients will be able to receive information regarding their risks and how to avert their consequences (Aydin et al., 2015).
Using the Patient as an Avenue for Training Opportunities
Ultimately, the project aims at establishing the causes of the falls, the existing knowledge gaps and how to use the opportunities for training hospital staff. Hence, the project will strive to impart an inclusive approach to correcting staff when they err as assisted by an able and dedicated fall-prevention team (Matchar et al., 2017). Similarly, healthcare executives will get the opportunity of reporting falls more transparently to facilitate efficient tracking for prevention purposes. Consequently, patient falls will get evaluated and reassessed to track changes in their physical conditions thus averting injuries from escalating.
Change Agents
Team effort will play an integral part in ensuring the successful implementation of the quality improvement plan. Change agents are those who will play an active role in the implementation phase and will be tasked with the actual intervention mechanisms. In a similar regard, nurses will become the primary change agents given their active role in patient management within the acute patient care setting (Matchar et al., 2017). Nurses play a significant role in keeping the patients safe and can relate to at least one incident that they witnessed or provided intervention. Since nurses are more knowledgeable and hands-on regarding various healthcare issues, it becomes imperative to engage them. Another group that forms the change agent team is the hospital leadership. The leadership will enhance the motive for compliance by providing mentorship and direction (Aydin et al., 2015).
The hospital leadership will also be crucial in providing dispute resolution platforms during the implementation phase. Similarly, the hospital management can efficiently involve the nurse and the physicians in examining and administering the fall assessment tool along with the identification of patients at high risk and needing the safety practices in healthcare. The change implementation process makes nurses have authority to help modify the physical environment to increase patient safety (Matchar et al., 2017). Thus, the hospital management bears a considerable responsibility in initiating and encouraging the utilization of the fall prevention program both at the hospital and the community level.
Project Approach
Plan-Do-Study-Act Model
Most quality improvement projects often aim at making considerable changes within the healthcare setup by effecting favorable outcomes. The model enhances a rapid cycle improvement implementation with an effective feedback system. One of the unique elements of the plan-do-study-act model provides a cyclical nature of efficiently impacting and assessing change hence for maximum results; a small PDSA is encouraged at the expense of bigger ones before changes are integrated within the entire system (McKenzie et al., 2017). The primary aim of the PDSA model in quality improvement enhances the establishing of a functional relationship between the intended changes and their expected outcomes. The PDSA outlines the goals of the project, measures of success and outcomes and means of achieving results. Invariably, the PDSA cycle begins with the determination of the problem, changes to be affected, who to involve and how to measure the impact of change.
Root Cause Analysis
Often regarded as a formalized investigative and problem-solving method, the root cause analysis focus on the identification and understanding of the underlying reasons that affects an event (Aydin et al., 2015). Thus, there exists an inherent need to perform an RCA to the patient fall prevention project and based on the results; the implementing organization will then organize and develop, and an action plan aimed at improvements to reduce any potential future risk of patient falls while also monitoring their effectiveness within a clinical setting. More importantly, the RCA technique helps in the identification of trends and assessment of risks (Matchar et al., 2017). An RCA typically begins after an event has occurred followed by the retrospective outlining of the sequence of events that lead to the problem, charting causal or predisposing factors, and eventually identifying the causes.
Theory
The proposed theory to be used in this study is called the Lippitt's Theory mostly used in the healthcare setting by the nursing fraternity to introduce change, monitor, evaluate and make permanent healthcare best practices. The Lippitt's theory comprises of four fundamental elements which include:
Assessment
During the assessment period, the nurse makes a systematic and detailed evaluation of the patient under their care and entails the capture of biographical details, relevant clinical history, social data and the presenting medical observations. The assessment phase is often characterized by various nursing procedures and is regarded as the initial part of such processes which inherently continue throughout a patient’s period of care (McKenzie et al., 2017).
Planning
Planning follows the assessment phase and is characterized by the collaboration of the nurses with the patient and other relevant stakeholders through a multidisciplinary approach where the determination of how to address the needs of the patient are outlined (Aydin et al., 2015). During planning, resource mobilization and community engagement get encouraged to maximize benefits of the project.
Implementation
The implementation phase often relates to the nurse facilitating the rolling out and documentation of best practices previously agreed upon during the planning phase. During the implementation phase, the nurse is required to effectively bring the espoused positive change through the recommended actions (Matchar et al., 2017).
Evaluation
Evaluation is a systematic and continuous process that goes on during the provision of care and often links back to the assessment phase of the nursing process. Evaluation provides the opportunity for regular assessment on the efficacy of how the best practices are committed to bringing change. Essentially, Lippitt’s theory incorporates the Lewin’s theory by complementing the unfreezing stage with its assessment phase which acts as the primary framework for change agents and also entails the assessment of motivation for change (McKenzie et al., 2017).
Conclusion
Barriers to Implementation
As much as change remains inevitable, several barriers can advertently or inadvertently impede any meaningful progress. First, competing priorities for limited resources within a healthcare system portends failure in the system where patient safety is not considered as a top priority. Alternatively, lack of adequate resources coupled with inadequate staffing and work overloads can make the nurses fail to meet their mandate in the implementation processes (Matchar et al., 2017). Secondly, inadequate availability and cost of patient safety technology may jeopardize chances of valuable gains because patients requiring specialized care may eventually fail to get enhanced medical attention to cope with their various ailments especially injuries resulting from falls. Thirdly, the project may encounter an uphill task when the nursing staff refuses to embrace change and stay adamant about their role in improving patient health outcomes (McKenzie et al., 2017). Lastly, the culture of apportioning blame and lack of senior leadership may complicate the implementation process. Lack of leadership becomes a recipe for unprecedented chaos thus breeding a culture where the workforce abdicates responsibility through a cover-up.
Strategies to Overcome Barriers
It is espoused that effective leadership will almost guarantee effective implementation of the quality improvement plan. A dedicated leader will monitor the effectiveness of the nursing staff in implanting the project objectives by acting as an example to the rest thereby serving as the decisive change agent in the implementation phase (Matchar et al., 2017). The management will also efficiently ensure that the nursing staff is well oriented to understand their roles and pursue the desired outcomes (Aydin et al., 2015). Top leadership will also involve every team member comprising of clinicians, nurses, psychologists, and middle managers to own the change process. Invariably an active monitoring of the implementation process will serve to highlight potential and evident problems as they arise while providing informed intervention measures while also sustaining the management support.
Evaluation Plan
The evaluation plan will provide the desired framework that will establish and measure the project's outcomes. Part of the evaluation plan will focus on the role of staff providing adequate supervision and whether they are working towards fulfilling their mandate (Aydin et al., 2015). The evaluation plan will seek to determine resource availability and how they influence the fall prevention mechanism. Invariably, the role of the staff in controlling the fall patterns will also get evaluated
References
Armstrong, G., & Barton, A. J. (2014). QUALITY AND SAFETY EDUCATION FOR NURSES. Introduction to Quality and Safety Education for Nurses: Core Competencies, 39.
Aydin, C., Donaldson, N., Aronow, H. U., Fridman, M., & Brown, D. S. (2015). Improving hospital patient falls: leveraging staffing characteristics and processes of care. Journal of Nursing Administration, 45(5), 254-262.
Casey, C. M., Parker, E. M., Winkler, G., Liu, X., Lambert, G. H., & Eckstrom, E. (2016). Lessons learned from implementing CDC’s STEADI falls prevention algorithm in primary care. The Gerontologist, gnw074.
Matchar, D., Duncan, P., Lien, C. T., Ong, M. E., Lee, M., Sim, R., & Eom, K. (2017). FALL PREVENTION AND REDUCTION: THE STEPS TO AVOID FALLS IN THE ELDERLY (SAFE) STUDY. Innovation in Aging, 1(suppl_1), 267-267.
McKenzie, G., Lasater, K., Delander, G. E., Neal, M. B., Morgove, M., & Eckstrom, E. (2017). Falls prevention education: Interprofessional training to enhance collaborative practice. Gerontology & geriatrics education, 38(2), 232-243.
