Assessment, Implementation, and Review Essay

The program is about reduction of fall rate among the elderly among inpatients in a hospital setting (educational and hourly rounding protocol).  This is because falls are among the most common adverse incidents within hospital settings. According to Cameron et al (2018) in acute care setting, the rate of fall ranges about 5% while in rehabilitation setting the rate of fall has been recorded to be about 46%. The fall rate is particularly high among hospitalized older adults. Injuries that result from falls can be serious and result in chronic pain, decreased quality of life, emotional distress, disability, prolonged length of hospital stay, increased healthcare costs, functional impairment, and even death (Alshammari et al, 2018). This justifies the significance of implementing a program to reduce fall rates in a hospital setting. Reducing falls in a hospital needs a workforce that is well-informed regarding fall prevention strategies. The integration of fall risk assessment strategies into an hourly rounding approach has been shown to be effective in fall prevention among the geriatric population. Assessment, Implementation, and Review Essay

Program Description

An educational program on fall prevention integrating Hourly rounding is a strategy to preventive care where a nurse leader antedates an adverse event and thus implements strategies to prevent the occurrence of the adverse event. Structured rounding by nurses has been proposed to reduce patient falls in the project and also improve patient safety and satisfaction (Cameron et al, 2018). The hourly rounding will include pain assessment, as well as the assessment of positioning, potty, and nearness to personal items. This is because evidence indicates that inpatient falls occur when patients try to perform the aforementioned aspects. Therefore, attending the safety, comfort, as well as environmental needs of patients will prevent occurrence of adverse events such as falls (Alshammari et al, 2018). All the nursing staff will be training and educated on the expectations from the hourly rounding approach. Nurses will also be advised to ensure that patients do not require anything prior to them exiting the room and that the patient is informed about the expectations of the hourly rounding. Moreover, a fall risk assessment will also be performed during each hourly rounding.Assessment, Implementation, and Review Essay

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All nurses from all medical wards will be enrolled in the training and the training will be conducted as per the guidelines issued by the NICE around the prevention of falls in the geriatric population. A consultant geriatrician specializing in falls, ward managers, as well as senior nurses will be actively involved in developing the fall training program. The training and education will be delivered by the geriatrician, with special knowledge on falls. Every education session will last for 1-hour and it will include discussion regarding falls, how to perform fall risk-assessment, risk factors to falls, and also complications associated with in-patient falls. In addition, nurses will be educated regarding hourly rounding and an emphasis will be put to ensure that each nurse adheres to the hourly rounding in order to ensure all needs of patients are met (Alshammari et al, 2018). Each training session will end with formal teaching on how to perform fall risk assessment and the risk factors for falls. At the end of each session, each nurse will be given a printed pamphlet containing information about the key learning points.

Plan to Implement the Knowledge

The Lowa model will be used to implement the knowledge regarding prevention and reduction of fall. The first step involved the selection of the topic for the evidence-based practice, depending on factors such as the urgency of the problem, impact of the practice, commitment of the staff, as well as the multidisciplinary characteristic of the problem (Newell & Burnard 2016). Falls among the geriatric population is a very significant problem in healthcare setting and therefore this indicates the significance of addressing the issue.

The second step is to form a team to develop, implement and assess the change. The team will include various interprofessional namely nurses, a physician, a pharmacist, occupational therapist, geriatrician, and ward managers. The management will play the role of providing the appropriate resources to ensure the smooth implementation of the project (Berwick, 2015).

The team will then brainstorm all the available evidence to guide the program implementation (Pravikoff, et al, 2015). For the project, evidence will be retrieved from reliable databases such as Web of Science, PubMed, Cochrane, and Cinahl.

The next phase involves grading the evidence which involves the team evaluating the quality of evidence in order to ensure that only the latest and quality evidence is integrated into the project’s implementation (Pravikoff, et al, 2015). In this program, the grading of the evidence will be done according to the efficacy, suitability, and practicability of the evidence.

After grading the evidence, the team will meet and decide what should be recommended for practice depending on the benefits and risks to the patients and the quality of care. The evidence that will be selected will be based on its relevance to practice, applicability, efficacy, significance, and suitability in reducing falls in a hospital setting. Moreover, a collaborative approach will be adopted, where the perspectives of all stakeholders, including the patients, will be taken into account (Berwick, 2015).Assessment, Implementation, and Review Essay

The phase of implementing the evidence will involve championing the adoption of the evidence among the healthcare providers. Champions and change agents will be selected to convince other nurses to implement the recommended changes during training such as ensuring hourly rounding and always performing fall risk assessment (Nutbeam, 2018). The last step is evaluating the impact of the change.

Evaluation

The purpose of the evaluation is to examine the significance and impact of the implemented evidence in improving practice (Nutbeam, 2018). For this project, the evaluation will be done by collecting the baseline data on the fall rate within the hospital in the target ward prior to the implementation of the project. The other set of data on the rate of falls in the target unit will be collected after the proposed changes are implemented (hourly rounding, fall-risk assessment, and other approaches that nurses were educated on, during the training). The baseline data will be compared with the post-project data to determine if the program was effective in reducing the fall rate within the target unit and target population (geriatric).

If the project is not launched successfully, change champions will be used to raise awareness regarding the project using both informal and formal educational approaches and they will also act as a resource to mentor and support nurses (Shaw et al, 2013). Secondly, the change champions will act as persuasive practice leaders, who will work with peers and other interprofessional groups to convincingly advocate for the proposed change in the program by using the best practice guidelines. Finally change agents and champions will be used to tailor the proposed program to the organizational context (Shaw et al, 2013).

Conclusion

The proposed program is about the reduction of falls among the inpatient geriatric population. The program will involve an educational program to nurses about fall preventative strategies such as performing fall risk assessment for the hospitalized older patients and using hourly rounding protocol for this group of patients. The rationale for this program is because the rate of falls among the hospitalized older adult is very high and leads to adverse effects such as chronic pain, decreased quality of life, emotional distress, disability, prolonged length of hospital stay, increased healthcare costs, functional impairment, and even death. The project will be implemented using the Lowa model. In order to evaluate the efficacy of the project, the baseline data will be compared with the post-project data. Finally, change agents and champions will be used to facilitate successful launching of the program.Assessment, Implementation, and Review Essay

References

Alshammari, S, Matar A, Fahad K, Ahmed A & Faroq A. (2018). Falls among the elderly and their relationship with their health problems and surrounding environmental factors in Riyadh. J Family Community Med. 25(1), 29–34.

Cameron I, Dyer S, Murray G, Hill K, Cumming R & Kerse N. (2018). Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev. 2018(9): CD005465.

Newell R &, Burnard P. (2016). Research for evidence-based practice. Oxford: Blackwell Publishing Ltd.

Nutbeam D. (2018). Evaluating health promotion: progress, problems, and solutions. Health Promot Int. 13(1): 27–44

Pravikoff, D. S., Tanner, A. B., & Pierce, S. T. (2015). The readiness of U.S. nurses for evidence-based practice. American Journal of Nursing. 105(9). 40–51.

Shaw E, Howward J, West D, Crabtree B, Nease J, Tutt B & Paul N. (2013). The Role of the Champion in Primary Care Change Efforts. J Am Board Fam Med. 25(5), 676–685. Assessment, Implementation, and Review Essay