Implementation Plan Design: Patient Falls.

Develop a 4–6-page plan that will allow your intervention to be implemented in your target population and setting.

Note: Each assessment in this course builds on the work you completed in the previous assessment. Therefore, you must complete the assessments in this course in the order in which they are presented.

Previous Assessment #2 & 3 arm uploaded below. Use these papers to build onto this paper on patient falls.Implementation Plan Design: Patient Falls.

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Even the best intervention plan will not be effective without a sound and reasonable approach to implementing it. The implementation of the same intervention plan can vary drastically between different care settings, based on the culture of the care setting, the resources available, and the stakeholders involved in the project, as well as the specific policies already in place. A successful implementation plan blends contemporary and emerging best practices and technology with an understanding of the on-the-ground realities of a specific care setting and the target population for an intervention. By synthesizing these various considerations it is possible to increase the likely success of the implementation and continued sustainability of an intervention plan.Implementation Plan Design: Patient Falls.

• Competency 1: Lead organizational change to improve the experience of care, population health, and professional work life while decreasing cost of care.
  • Propose existing or new policy considerations that would support the implementation of an intervention plan.
• Competency 2: Evaluate the best available evidence for use in clinical and organizational decision making.
  • Analyze stakeholders, regulatory implications, and potential support that could impact the implementation of an intervention plan.Implementation Plan Design: Patient Falls.
• Competency 3: Apply quality improvement methods to impact patient, population, and systems outcomes.
  • Propose appropriate delivery methods to implement an intervention which will improve the quality of the project.
  • Integrate resources from diverse sources that illustrate support for all aspects of an implementation plan for a planned intervention.
• Competency 4: Design patient- and population-centered care to improve health outcomes.
  • Propose a timeline to implement an intervention plan with reference to specific factors that influence the timing of implementation.
• Competency 5: Integrate interprofessional care to improve safety and quality and to decrease cost of care.
  • Propose strategies for leading, managing, and implementing professional nursing practices to ensure interprofessional collaboration during the implementation of an intervention plan.
  • Evaluate the current and emerging technological options related to the proposed delivery methods.
• Competency 6: Evaluate the ability of existing and emerging information, communication, and health care technologies to improve safety and quality and to decrease cost.
  • Analyze the implications of change associated with proposed strategies for improving the quality and experience of care while controlling costs.Implementation Plan Design: Patient Falls.

Note: You will also be assessed on two additional criteria unaligned to a course competency:

• Communicate implementation plan in a way that clearly illustrates the importance of interprofessional collaboration to create buy-in from the audience.
• Demonstrate completion of hours toward the practicum experience.

See the scoring guide for specific grading criteria related to these additional requirements.

Assessment Instructions

Instructions

Note: The assessments in this course are sequenced in such a way as to help you build specific skills that you will use throughout your program. Complete the assessments in the order in which they are presented.Implementation Plan Design: Patient Falls.

Your implementation plan design will be the third section of your final project submission. The goal for this is to design a plan that will allow your intervention to be implemented in your target population and setting. You should be able to preserve the quality improvement outcomes that you designed for your target population and setting while also ensuring that the intervention does not put undue stress on the health care setting\’s resources or violate any policies or regulations. Provide enough detail so that the faculty member assessing your implementation plan design will be able to provide substantive feedback that you will be able to incorporate into the final draft of your project.

At minimum, be sure to address the bullet points below, as they correspond to the grading criteria. You may also want to read the scoring guide and the Guiding Questions: Implementation Plan Design document (linked in the Resources) to better understand how each criterion will be assessed. In addition to the bullet points below, provide a brief introduction that refreshes the reader\’s memory about your problem statement, as well as the setting and context for which this intervention plan was designed before launching into your implementation plan.Implementation Plan Design: Patient Falls.

Reminder: these instructions are an outline. Your heading for this this section should be Management and Leadership and not Part 1: Management and Leadership.

Part 1: Management and Leadership

•  Proposes strategies for leading, managing, and implementing professional nursing practices to ensure interprofessional collaboration during the implementation of an intervention plan, and impartially considers conflicting data and other perspectives.
•  Analyzes the implications of change associated with proposed strategies for improving the quality and experience of care while controlling costs; identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the analysis).Implementation Plan Design: Patient Falls.

Part 2: Delivery and Technology

•  Proposes appropriate delivery methods to implement an intervention which will improve the quality of the project, and identifies assumptions on which the proposal of delivery methods is based.
•  Evaluates the current and emerging technological options related to the proposed delivery methods; identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the analysis).Implementation Plan Design: Patient Falls.

Part 3: Stakeholders, Policy, and Regulations

•  Analyzes stakeholders, regulatory implications, and potential support that could impact the implementation of an intervention plan, and identifies assumptions on which the analysis is based.
• Proposes existing or new policy considerations that would support the implementation of an intervention plan, and considers how existing or new policy might impair the implementation of an intervention plan.Implementation Plan Design: Patient Falls.

Part 4: Timeline

• Proposes a timeline to implement an intervention plan with reference to specific factors that influence the timing of implementation, and considers factors that could force revision of the timeline.

Address Generally Throughout

• Integrates resources from diverse sources that illustrate support for all aspects of an implementation plan for a planned intervention; impartially considers conflicting data and other perspectives.Implementation Plan Design: Patient Falls.
• Communicates implementation plan in a way that clearly illustrates the importance of interprofessional collaboration to create buy-in from the audience. Grammar, punctuation, spelling, and citations are error-free.

Additional Requirements

• Length of submission: 4–6 pages, double spaced.
• Number of resources: Minimum of 3–6 resources. (Your final project will require 12–18 unique resources.)
• Written communication: Written communication is free of errors that detract from the overall message.
• 7th edition APA formatting: Resources and citations are formatted according to current APA style. Header formatting follows current APA levels.
• Font and font size: Times New Roman, 12 point.

Attached below: Implementation plan design paper criteria & scoring guide, Assessment 2 and Assessment 3.

Intervention Plan Design for Patient Falls

Patient falls especially among elderly patients is a major healthcare service quality concern in the US healthcare system. For this reason, evidence-based quality improvement (QI) strategies need to be implemented to lower the rates of patient falls in this particular patient population. This is what will enable the achievement of the best patient outcomes in this patient population. A particular need in this regard has been identified in the elderly patient population in skilled nursing facilities carrying out in-patient rehabilitation for this elderly population. The limited mobility, joint stiffness, and normal tissue degeneration that occurs with age place these older patients at a higher risk of falling in these facilities and sustaining injuries or even dying (McCarthy, 2016; Kojima et al., 2015).Implementation Plan Design: Patient Falls. Most of the injuries sustained by the elderly in skilled nursing facilities and nursing homes such as fractures of the pelvis or hip fractures/ dislocation are the result of preventable falls (Kenny et al., 2017). The incidence of accidental patient falls in the US hospital system is between 3.3 and 11.5 patient falls per 1,000 hospital stays. And make to make this quality matter even more of a concern to the financial welfare of the organization, the Centers for Medicare and Medicaid Services (CMS) as a rule no longer reimburses for services rendered to victims of hospital falls. This is because they are deemed as preventable and a result of laxity in the quality of care (Fehlberg et al., 2017; Bouldin et al., 2013). This intervention plan design is a follow-up to the PICOT investigation that identified the need for the prevention of falls among the elderly patients at skilled nursing rehabilitation centers. The population of target for the quality improvement was identified as the registered nurses working in these skilled nursing centers which provide the setting. The three-pronged intervention strategy for the reduction of patient falls in this setting was nurse education, doing hourly rounds, and the use of bed alarms (Hill et al., 2016; Goldsack et al., 2015). The comparison was the use of bed alarms alone, while the expected measurable outcome was to decrease the patient falls in the skilled nursing care center to 3.4 falls per 1,000,000 patient days or zero defect (Rastogi, 2018). The timeframe for the intervention was set at six months.Implementation Plan Design: Patient Falls.

Table 1: Summary of the elements of the PICOT statement

Intervention Plan Components

The PICOT investigation above provides enough evidence to support a three-pronged approach to the solution of the problem of patient falls among the elderly patients in a skilled nursing rehabilitation center. The use of a falls prevention bundle in comparison to a single intervention such as the use of bed alarms alone has been found to be more effective. This is the evidence-based finding that informs the use of this approach in this intervention plan design (Guirguis-Blake et al., 2018; Morgan et al., 2016).The components of this patient fall prevention and improvement bundle are (AHRQ, 2018):Implementation Plan Design: Patient Falls.

1. The performance of hourly rounds to check on the condition of all the patients, including whether they are comfortable in bed or not (Linehan & Linehan, 2018; Shin & Park, 2018; Daniels, 2016; Leone & Adams, 2015)
2. Nurse education and training to address knowledge gaps on the standardized assessment of risk factors for falls, as well as patient education (Heng et al., 2020; AHRQ, 2018)

• The use of bed alarms as a technological adjunct to the fall prevention bundle (Mileski et al., 2019)

Hourly Rounding

The concept of hourly rounding in this intervention plan/ bundle is to identify a potential fall before it happens. It is a purposeful round that is planned and documented. During the round, the nurse checks for the so-called 5Ps namely position, personal needs, pain, potty, and periphery (Daniels, 2016). During these rounds, patients who report pain are given pain-relieving interventions. Pain is one of the reasons that may make the elderly patient attempt to get up so as to get the attention of the nurse. Immobile patients are also positioned properly during these rounds. The patients are also assisted with toileting and other personal needs. Lastly, the rounds give the nurses the opportunity to place within reach any items that the patient may want to use (Linehan & Linehan, 2018; Shin & Park, 2018; Leone & Adams, 2015).Implementation Plan Design: Patient Falls.

Nurse Education and Training/ Patient Education

Training nurses and educating them on how to recognize and prevent imminent patient falls is a very important part of the falls prevention bundle (AHRQ, 2018). This training addresses knowledge gaps and gives the opportunity for the nurses to have grey areas addressed. It is in this same sense that the nurses who have been trained should also educate their patients on the dangers of getting out of bed without assistance, especially if the particular elderly patient is a fall risk (Heng et al., 2020).Implementation Plan Design: Patient Falls.

The Use of Bedside Alarms

Bedside alarms are a technological solution to the notification system that nurses can rely on. The alarm is set to sound after a particular time lapse following the departure of a patient from their bed.Usually, the nurse is required to set he alarm to sound just seconds after the patient attempts to leave their bed. This could be 3-5 seconds, giving no time for the patient to fall. Education on the consequences of ignoring the alarm by the nurses is paramount (Mileski et al., 2019). This is the role that technology plays in the reduction of patient falls.Implementation Plan Design: Patient Falls.

The criteria that can be used to assess for the success of the above fall prevention bundle is a tangible, verifiable, quantifiable, and numerical reduction in the frequency of patient falls after the six months of intervention. This calls for the documentation of the baseline fall statistics before implementation of the bundle, followed by monthly monitoring to assess progress and lastly the final value after the six months.Implementation Plan Design: Patient Falls.

Impact of Cultural Needs and Characteristics of the Target Population and Setting on the Development of the Intervention Plan Components

In order for the intervention plan above to be successful, the characteristics of the target population of registered nurses working in skilled nursing rehabilitation centers and the setting of the intervention must be taken into account. Also to be taken into account are the cultural needs of the target population. What could be considered as the most important cultural need for the nurses impacting the plan is the provision of a conducive working environment that is defined by empowerment and psychological safety to facilitate delivery of quality nursing care. The characteristics of registered nurses in skilled nursing rehabilitation centersthat impacted the plan include that:Implementation Plan Design: Patient Falls.

• They are lifelong learners and are therefore ready to learn (education and training on identification of fall risk and prevention of the same).
• They are patient advocates by default and therefore receptive to the idea of preventing harm to patients (fall prevention).
• They are governed by nursing standards of practice that require that they assess patients (as for the risk of falls), make nursing diagnoses (such as risk of fall due to old age), make a nursing care plan (including hourly rounds, pain management, turning and positioning, reassurance and so on), implement the care plan, and evaluate the success of the plan.Implementation Plan Design: Patient Falls.
• They are governed by bioethical principles that include not harming the patient by omission or commission – nonmaleficence or primum non nocere.

The characteristics of the skilled care centerimpacting the intervention plan include being a temporary home for the inpatients during rehabilitation and being a care center designed for old people with mobility problems. These characteristics favor the above plan. The assumptions on which the above explanation is made are that there will be no nurse turnover for the six months of the plan implementation and that the skilled care center will also be in operation for the entire duration.

Theoretical Foundations

The PICOT model is used to generate evidence for best practice. After the successful dissemination of the recommendations of the PICO clinical inquiry, what remains is translation into practice (White et al., 2016). This is where the above intervention plan comes in. In this case, the theoretical nursing model on which this intervention plan will be based is the Roger’s Diffusion of Innovation Theory (Pashaeypoor et al., 2016). One of the strengths of this theoretical model is that the innovators who are 2.5% of the organization’s human resource act as agents for change influencing the search for evidence and adoption of the recommendations for best practice (in this case it is doing hourly rounds, staff education and training, patient education, and making use of bedside alarms). The other strength is that early adopters (13.5%) and early majority (34%) will also quickly embrace the practice change to reduce patient falls. Together with the innovators, these two groups of nurses at the skilled nursing center forms a critical mass for effective change adoption (50%) s a QI initiative. On the other hand, the weakness of the model is that the late majority (34%) and the laggards (16%) will slow down adoption by being sceptical of the evidence-based intervention pan.Implementation Plan Design: Patient Falls.

The strategy from other disciplines in this case will be drawn from the goods manufacturing sector in which Six Sigma quality paradigm governs QIs. For this, the strategy will be to have “zero defects”. This means having virtually zero falls or a ratio of 3.4 falls per million hospital stays (Rastogi, 2018). Finally, the healthcare technology relevant to the intervention plan is artificial intelligence or AI in the form of intelligent bedside alarms (Mileski et al., 2019).

The relevant contemporary evidence for the intervention plan as outlined above comes from several authoritative peer-reviewed studies on the effectiveness of a falls prevention bundle in the reduction of patient falls as a QI initiative. These studies are by Linehan & Linehan (2018), Shin & Park (2018), Daniels (2016), and Leone & Adams (2015) for hourly rounds.For staff training and education as well as patent education the study evidence is from Heng et al. (2020) and the evidence-based toolkit for falls prevention by the AHRQ (2018). The conflicting data, however, is provided by the study by Gavaller et al. (2019) who found that bedside alarms in themselves are ineffective as a prevention strategy for patient falls. This apparent ineffectiveness is however mitigated by including it in a bundle instead of using it alone (as in this case).

Stakeholders, Policy, and Regulations

The impact of stakeholder needs, healthcare policy, regulations, and governing bodies on the intervention plan is immense. The patients as stakeholders expect to receive quality care. Falls cannot guarantee this. The hospital/ organization as another stakeholder also needs a good rating and classification by the Joint Commission on Accreditation of Healthcare Organizations or JCAHO. Healthcare policy such as the rule by the CMS of not reimbursing for services rendered to hospital fall victims has a major impact on the intervention since the hospitals stand to lose money through care and even possible litigation. Lastly, governing bodies such as state boards of nursing expect nurses to provide the highest quality of care devoid of negligence. The assumption on which the above analysis is made is that the organization values its reputation and that nurses at the centers are professional and qualified.Implementation Plan Design: Patient Falls.

Ethical and Legal Implications

The ethical issues related to practice is that nurses must observe the bioethical principle of nonmaleficence or primum non nocere (Santhirapala&Moonesinghe, 2016). This means they should never harm to befall a patient, such as in the case of injuries resulting from a fall. Legally, then nurse owes the patient a duty of care. When breached as in the case in which the patient falls and gets injured, the nurse can be sued for Civil Negligence under Tort Law (Walker, 2011). Organizational change may also be inspired if the organization is sued along with the nurse on vicarious liability grounds. The unknowns or missing information in this case is the state of the working environment in the skilled centers for the nurses. An environment of victimization and intimidation by nurse managers will make the nurses effuse to report cases of patient falls.Implementation Plan Design: Patient Falls.

Conclusion

Patient falls as a quality issue in healthcare has drawn significant attention. The falls are responsible for preventable morbidity and mortality. Any organization that values its reputation and ratings will implement evidence-based QI initiatives to curb this issue. This is the content of this paper, with regard to prevention of falls in a skilled nursing rehabilitation center for older patients.   Implementation Plan Design: Patient Falls.