Interventions for Proposed Clinical Change Project on Patient Falls Essay
Patient falls are a problem that arises with aging and the typical decline in bodily functions that goes along with it. Many senior citizens are at risk of suffering avoidable morbidity and mortality from falls. In fact, falls account for the majority of injuries among this demographic (Kenny et al., 2017). Between 3.3 and 11.5 patient falls per 1,000 hospital stays are reportedly documented in healthcare settings in the United States (AHRQ, 2018). In addition to the financial and reputational costs to the healthcare facility, this quality issue also costs the patients in terms of morbidity and mortality. This is due to a policy of the Centers for Medicare and Medicaid Services, or CMS, which prohibits payment for services provided to hospital patients who have fallen accidentally (Fehlberg et al., 2017). The purpose of this paper is to recommend some interventions based on retrieved scholarly evidence from current literature to prevent falls. Interventions for Proposed Clinical Change Project on Patient Falls Essay
Clarification of the Issue under Study
Preventing the numerous patient falls that occur among the older patient population is urgently needed. This was discovered to be particularly prevalent in skilled nursing institutions set up for the rehabilitation of elderly people away from their homes. The number of senior persons requiring competent nursing care at aged care facilities has been increasing as a result of a rapidly aging population and longer lifespans that are linked to better healthcare. However, due to age-related declines in physical capability, this demographic of older persons is more susceptible to unintentional falls. The fact that this patient population also has a high prevalence of other numerous pre-existing chronic medical and mental conditions further increases the risk of patient falls in this patient population. These are conditions such as heart disease, hypertension, diabetes, arthritis, and Alzheimer’s dementia among others.
ORDER HERE A PLAGIARISM-FREE PAPER HERE
For instance, if an elderly patient gets out of bed abruptly without support, heart disease raises the risk of syncope. If diabetic, the possibility of hypoglycemia is a persistent danger for an unintentional fall because senior patients are not constantly watched and forced to leave their beds only when required and with help. This patient population is more susceptible to gait abnormalities due to chronic musculoskeletal diseases like osteoarthritis, which also limits their range of motion and puts them at risk for falling. Obviously, an older patient in these skilled nursing care facilities will not understand the risk they are putting themselves in when they abruptly exit their beds with no support because of the existence of neurocognitive illnesses like Alzheimer’s dementia (APA, 2022). This must be kept in mind. Interventions for Proposed Clinical Change Project on Patient Falls Essay
The Proposed Solutions Based on the Literature Review
The proposed solutions to preventing and reducing patient falls among the elderly include the following:
- Staff education and training on risk identification and what to do to prevent that risk of falls (AHRQ, 2018; Guirguis-Blake et al., 2018).
- Intentional hourly rounding by nurses on duty (AHRQ, 2018; Gavaller et al., 2019; Guirguis-Blake et al., 2018).
- The use of intelligent bedside alarms o warn nurses of an impending fall incident (Gavaller et al., 2019; Mileski et al., 2019).
- Making sure that the patients at risk always stay in a safe environment such as that which is not characterized by wet slippery floors.
- Rehabilitating the cognitively impaired to restore some cognitive ability; such as with games, art, and craft.
The nurses’ hourly rounds during a shift provide them the opportunity to spot older patients who might be about to fall early on. They then take the appropriate step or steps to avoid that. Additionally, the nurses attend to any patient needs that would cause them to desire to get out of bed on their own during these hourly rounds (AHRQ, 2018; Gavaller et al., 2019; Guirguis-Blake et al., 2018). This includes providing the patient with the resources they require and, if pain is what the patient is now experiencing, alleviating it.
The second step is to train and educate nurses on how to recognize fall risks and how to prevent them by taking proactive action (AHRQ, 2018; Guirguis-Blake et al., 2018). As a result, training is necessary for nurses working in senior skilled care institutions to develop the skills necessary to stop patients from falling accidentally. This, among other things, encourages the establishment of a culture where safety is a core value. Once appropriately trained, these nurses who often engage with their patients will take over the responsibility for educating their patients about the risks and dangers of unintentional falls. Given that some of the patents may be insane, they will do this when it is practical and possible.
The use of electronic devices in the form of intelligent bedside alarms is part of the other evidence-based nursing intervention bundle to minimize unintentional patient falls (Gavaller et al., 2019). When a patient tries to get out of bed unaided, these will immediately warn the nurses. The evidence that is currently available has demonstrated that deploying these alarms alone may not be as beneficial in preventing patient falls. However, it has been discovered that employing them together in a bundle with hourly rounds and staff education is quite beneficial (Mileski et al., 2019). The Agency for Healthcare Research and Quality (AHRQ, 2018) gives the same recommendation of a bundled approach to prevention. Interventions for Proposed Clinical Change Project on Patient Falls Essay
Last but not least, the elderly residents in nursing homes and other aged care facilities must be properly rehabilitated. This is to enable them get back at least some form of cognitive ability to know what is going on. This can be done effectively through engaging them in conversations and playing games with them. Some may be given tasks such as crafting objects or painting. Some of the most stimulating games in this case are jigsaw puzzles.
Comparison of Other Views on Patient Falls and the Interventions
The use of bedside alarms alone in addressing patient falls is a practice alternative that cannot work unilaterally. It has been taken into account in this case in the prevention bundle outlined above, together with hourly rounding and training/ education. Alarming is a technological response to the issue of frequent falls in the older patient demographic. But for the technology to function well, human cooperation is still necessary.
The above is necessary so that the nurse can react quickly to the bedside alarm. The patient will still fall if the nurse ignores the alarm because they are worn out or disturbed. The other danger is the chance that the nurse will turn off the alarm so that it does not go off when the individual in question gets out of bed. To avoid being bothered by the alarm’s repeated sounding, they may also lower the volume. All these actions will compromise the effectiveness of the intervention due to the human factor.
APRN Role in the Interventions and Implications for Practice
The accomplishment of the implementation plan for the fall prevention intervention depends on effective leadership and management. The nurse leaders or managers in the skilled care rehabilitation centers will be responsible for this task. They would need to establish a quality improvement implementation committee with an interprofessional collaborative view to oversee the implementation of the nurse-led fall prevention package in order to facilitate and manage their work. In order to update them and bring them into line with the evidence-based fall prevention intervention, this committee will review the current organizational policies and SOPs. Interventions for Proposed Clinical Change Project on Patient Falls Essay
Additionally, they will consider the industry norms for quality evaluation of patient falls. On this, they may refer to the JCAHO recommendations and guidelines as well as the toolkits provided by the Agency for Healthcare Research and Quality (AHRQ). The strict adherence to nursing standards of practice will also be enforced by the implementation committee, which is led by the nurse manager. To avoid potential conflicts, they will search for and deal with them. To convey to and persuade the nurses of the importance of putting the recommendations into effect, they will need to be excellent communicators.
In other words, they need to figure out a means to guarantee that the skilled care facilities’ nurses and other allied healthcare workers will buy in as much as possible. Regarding the availability of the resources necessary to successfully implement the fall prevention intervention, management and leadership will also be required. Interprofessional collaboration would be the guiding principle throughout so that all professions could contribute to the implementation’s success.
Implications of the Change Project
The requirement for greater nurse recruitment reflects the consequences of change related to the suggested quality improvement initiatives. To handle hourly rounding without leading to burnout, they will be necessary. Spending on nurse education and training, as well as the purchase and installation of bedside alarm technology, will also have an impact. For successful implementation, there will be high demands on both financial and human resources. Therefore, costs can be managed by carefully deploying the nurse skill mix, conducting on-the-job training within the institution, and purchasing bedside alarms from the lowest but best bidder. Interventions for Proposed Clinical Change Project on Patient Falls Essay
Important Considerations Made
The treatments taken into consideration for this project have a very direct relationship to the determined research issue. Teenage overweight and obesity are the issue, and the suggested fixes are based on recent literature and scientific research. The questionnaire will be used as the tool for gathering data. The data will be analyzed using nonparametric tests like Chi-square and linear regression, which will be used for both descriptive (tables, graphs, percentages) and inferential purposes. The choice of the subjects was justified by prior research that shown the issue to be common among elderly individuals with many comorbidities.
On the other hand, random sampling offers the best validity and dependability. Potential barriers to progress include a lack of resources and reluctance to change. One practical barrier to data collecting is the reluctance of nursing home and other hospital staff to provide truthful responses and figures. The data presented are based on self-reporting by institutions, which is typically underreported for obvious reasons. This is the other practical restriction. It will be necessary to review data from regulatory and certification organizations like the JCAHO and AHRQ in an effort to control the limits. By illuminating the efficacy of the aforementioned initiatives, this change project will fill up any knowledge gaps regarding the issue. Interventions for Proposed Clinical Change Project on Patient Falls Essay
Conclusion
Accidental patient falls are a significant issue that significantly impacts seniors 65 years and older. It is well recognized that this is primarily due to the fact that this population is elderly and has a number of comorbid conditions, such as dementia and other neurodegenerative diseases. However, there are evidence-based therapies that can be utilized to lessen and avoid this fall problem, according to current scientific literature. They were examined in this project paper, together with the accompanying obstacles and difficulties, and how they could be overcome.
References
Agency for Healthcare Research and Quality [AHRQ] (2018). Preventing falls in hospitals. https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html
American Psychological Association [APA] (2022). Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-5-TR), 5th ed. Author.
Fehlberg, E.A., Lucero, R.J., Weaver, M.T., McDaniel, A.M., Chandler, M., Richey, P.A., Mion, L.C., & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in Aging, 1(3), 1-7. http://dx.doi.org/10.1093/geroni/igx036
Gavaller, M., Gavaller, M., & Oh, H. (2019). Impact of bed alarm removal and implementation of hourly rounding to reduce falls. Journal of the American Medical Directors Association, 20(3), B19. https://doi.org/10.1016/j.jamda.2019.01.080
Guirguis-Blake, J., Michael, Y., Perdue, L., Coppola, E., & Beil, T. (2018). Interventions to prevent falls in older adults. JAMA, 319(16), 1705. https://doi.org/10.1001/jama.2017.21962
Kenny, R., Romero-Ortuno, R., & Kumar, P. (2017). Falls in older adults. Medicine, 45(1), 28-33. https://doi.org/10.1016/j.mpmed.2016.10.007
Mileski, M., Brooks, M., Topinka, J.B., Hamilton, G., Land, C., & Mitchell, T., Mosley, B., & McClay, R. (2019). Alarming and/or alerting device effectiveness in reducing falls in long-term care (LTC) facilities? A systematic review. Healthcare, 7(1), 51. Interventions for Proposed Clinical Change Project on Patient Falls Essay
Recommendations and Conclusions: Falls in the Elderly
This project on patient falls has demonstrated just how this is a major clinical practice issue for nurses. This is especially so for those nurses working in nursing homes and other elderly rehabilitation care facilities. By using evidence-based strategies backed up by research evidence (Melnyk & Fineout-Overholt, 2019), the rate of 3.3 to 11.5 falls per 1,000 hospital stays must be reduced (AHRQ, 2018). According to Venema et al. (2019), the national average for these accidental patient falls in the United States is about 3.44 falls per 1,000 patient stays. This paper takes the position that at least the measures recommended here should be able to reduce the falls rate to below this national average. Therefore, the purpose of this paper is to offer recommendations and conclusions on the clinical practice problem of patient falls among elderly patients. Interventions for Proposed Clinical Change Project on Patient Falls Essay
Recommendations and Implications for Clinical Practice
Among senior elderly individuals 65 years of age and older, falls are a clinical practice issue that affects patient safety (AHRQ, 2018; Guirguis-Blake et al., 2018). This is a very serious safety concern with enormous consequences for both the patient and the provider. The nurses’ lack of understanding regarding adequate risk evaluation and necessary actions afterwards is one of its reasons. The other two factors are the elderly patient population’s vulnerability and a general paucity in terms of numbers of nursing staff in most settings. The outcomes for patients are significantly impacted by this falls issue. They may suffer factures, a concussion, significant intracerebral bleeding, or only bruises if they are lucky. The consequences for the elderly patients are quite undesirable and include prolonged hospital stays and costs as well as death in the most serious cases.
Recommendations
The recommendations that this paper addresses concerning the prevention of patient falls among the elderly are:
- Having a bi-annual (twice-a-year) training program for all the nurses working in a particular setting with elderly patients. This training will focus on falls risk assessment by using assessment tools such as the Morse Falls Scale, the Berg Balance Scale (BBS), the Sit to Stand Test (STST), Romberg Test (Tandem Stand Test), or the Dynamic Gait Index (DGI) amongst other tools (Falcão et al., 2019; Ghahramani, 2016). In a study, it was shown by using the Morse Fall Scale that 45% of the participants were at higher risk of falls (Falcão et al., 2019). The training/ retraining will also equip the nurses with the necessary evidence-based interventions to apply and prevent falls in those identified to be at a higher risk of falls. These interventions are given below.
- Creating a safe environment for the elderly patients always. This is an environment that is devoid of slippery floors, stairs down which cognitively impaired elderly patients can fall, or beds without side rails. According to Falcão et al. (2019) and Smith et al. (2017), the elderly in the hospital or residential care facility must have contact with an environment defined by quality flooring and lighting. Interventions for Proposed Clinical Change Project on Patient Falls Essay
- There should also be purposeful hourly rounds conducted by the nurses on every shift (AHRQ, 2018; Gavaller et al., 2019; Guirguis-Blake et al., 2018; Kenny et al., 2017). These must be consistent as they are aimed at identifying potential risks in every patient before a falls incident occurs. For instance, it is during these hourly rounds that the nurses might discover that a certain patient was struggling to reach a glass of water that was placed far from their bed.
- Procuring and installing innovative technology in terms of sensitive and intelligent bedside alarms (Gavaller et al., 2019; Mileski et al., 2019). These would receive input from motion sensors and sound at the nursing station; indicating the patient’s bed or room number to alert nurses when a patient attempts to get up. They can then take corrective action to forestall the impending fall.
- Applying cognitive therapy to restore some cognitive functions in the elderly patients to help them avoid falls. Interventions such as visual art therapy or VAT can be used to achieve this. It makes use of art and artistic techniques like sketching, clay modelling, drawing, collage, and sculpting amongst others (Masika et al., 2020). Nurses have to do this frequently.
ORDER HERE
Implications for Clinical Practice
The implications for clinical practice of the above recommendations are far-reaching. To begin with, there will be shorter hospital stays and quicker recovery times. This will save the patients and their kin unnecessary expenditure on healthcare costs. Additionally, mortality rates will fall and the organization’s reporting will indicate better performance. Nurses will experience better job satisfaction with a reduced staff turnover. Last but not least, there will be no loss of revenue due to the 2008 Centers for Medicare and Medicaid Services (CMS) directive that there will be no reimbursement for care given to falls patients (Fehlberg et al., 2017). Reduction of falls will therefore be a cost-effective measure for the organization. Interventions for Proposed Clinical Change Project on Patient Falls Essay
Summary of Study and Limitations
This study focused on addressing the clinical practice issue of accidental falls among elderly patients. It has been established that the reported falls rate in the United States ranges between 3.3 and 11.5 falls per 1,000 hospital stays. However, the national benchmark is pegged at 3.44 falls per 1,000 patient stays. Through a literature review, it has been established that indeed there are enough evidence-based interventions backed by scholarly evidence for efficacy that can be used to prevent these falls. These include conducting purposeful hourly rounds, installing intelligent bedside alarms, undergoing regular training and retraining, and performing cognitive therapy using measures such as visual art therapy. The limitations include that some of the evidence is more than five years old and may require review; and also some of the scholarly evidence was not high on the hierarchy of evidence.
The directions for future research that may be suggested include the use of higher random samples in studies on falls, controlling for cognitive impairment as a confounding variable, and the conducting of more systematic reviews and meta-analyses. Systematic reviews and meta-analyses confer the highest possible levels of evidence. On theoretical constructs, these will remain the same with no change. These are the theory of Human Caring by Jean Watson, and the Self-Care Deficit Theory (SCDT) by Dorothea Orem. Interventions for Proposed Clinical Change Project on Patient Falls Essay
The suggestions for public policy and/or changes in practice are several. One is that organizations should focus on staff motivation and retention by giving incentives. The other is that the appropriate staffing models must be adopted for nurses (who must be adequate in number). Last but not least, the nurse leaders must be transformational leaders that inspire, motivate, and empower their subordinates to deliver.
Implications/ Relevance of the Theoretical Framework to the Practice Issue
In applying the Self-Care Deficit Theory (SCDT) by Dorothea Orem, it is taken into account that the elderly patients suffering falls are experiencing a care deficit. This means that they cannot prevent themselves from these falls and so the nurses have to fill the care deficit. Also, in applying the theory of Human Caring by Jean Watson and its ten caritas factors; the nurse is able to offer holistic care through selflessness, compassion, and empathy.
Conclusion
Patient falls are a significant clinical practice problem for nurses working with the elderly. Luckily, there is enough scholarly evidence that supports the efficacy of a number of interventions. These can be used in practice settings to reduce and prevent the occurrence of accidental patient falls. They include hourly rounding, bedside alarms, and periodic training/ retraining of nurses. In all, this project has established that patient falls among the elderly are preventable. Interventions for Proposed Clinical Change Project on Patient Falls Essay