Intervention Plan Design: Patient Falls Essay

Develop a 4–6 page holistic intervention plan design to improve the quality of outcomes for 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.

Assessment paper #2 attached below: PICOT on Patient falls. This paper will be built off that paper.

7th edition APA format

Your application of the PICOT approach to developing your problem statement and the research that you conducted and synthesized in your literature review are the foundation and framework that you will need to successfully build your intervention plan. This plan will lay out specific components of the intervention you are planning to address the need you have identified for the target population and setting. Intervention Plan Design: Patient Falls Essay. You will justify your approach to the intervention plan by integrating appropriate theoretical foundations. You will also analyze and address the needs of stakeholders, requirements of regulatory bodies, and ethical and legal considerations. It is important to have a sound intervention plan design in place before trying to work on the details of implementation and evaluation.

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By successfully completing this assessment, you will demonstrate your proficiency in the following course competencies and assessment criteria:

• Competency 1: Lead organizational change to improve the experience of care, population health, and professional work life while decreasing cost of care.

Explain the impact of cultural needs and characteristics of a target population and setting on the development of intervention plan components.

• Competency 2: Evaluate the best available evidence for use in clinical and organizational decision making.
  • Evaluate theoretical nursing models, strategies from other disciplines, and health care technologies relevant to an intervention plan.
  • Analyze the impact of stakeholder needs, health care policy, regulations, and governing bodies relevant to health care practice and specific components of an intervention plan.
• Competency 3: Apply quality improvement methods to impact patient, population, and systems outcomes.
  • Define the major components of an intervention plan for a health promotion, quality improvement, prevention, education, or management need.
• Competency 4: Design patient- and population-centered care to improve health outcomes.
  • Explain the impact of cultural needs and characteristics of a target population and setting on the development of intervention plan components.
• Competency 6: Evaluate the ability of existing and emerging information, communication, and health care technologies to improve safety and quality and to decrease cost.
  • Justify the major components of an intervention by referencing relevant and contemporary evidence from the literature and best practices.
• Competency 7: Defend health policy that improves the experience of care, population health, and professional work life while decreasing cost of care.
  • Analyze relevant ethical and legal issues related to health care practice, organizational change, and specific components of an intervention plan.

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

• Communicate intervention plan in a professional way that helps the audience to understand the proposed intervention and the implications of the plan that must be taken into account.
• Demonstrate completion of hours toward the practicum experience. Intervention Plan Design: Patient Falls Essay.

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.

You intervention plan design will be the second section of your final project submission. The goal for this is to design a holistic plan that should be able to improve the quality of outcomes for your target population and setting. Provide enough detail so that the faculty member assessing your intervention plan design will be able to provide substantive feedback that you will be able to incorporate into the other project components in this course, as well as 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 Guiding Questions: Intervention 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 and the setting and context for this intervention plan.

Reminder: these instructions are an outline. Your heading for this this section should be Intervention Plan Components and not Part 1: Intervention Plan Components.

Part 1: Intervention Plan Components

•  Defines the major components of an intervention plan for a health promotion, quality improvement, prevention, education, or management need, and suggests criteria that could be used to evaluate the success of such a plan.
•  Explains the impact of cultural needs and characteristics of a target population and setting on the development of intervention plan components, and identifies assumptions on which the explanation is based.

Part 2: Theoretical Foundations

•  Evaluates, identifying both strengths and weaknesses of, theoretical nursing models, strategies from other disciplines, and health care technologies relevant to an intervention plan.
•  Justifies the major components of an intervention by referencing relevant and contemporary evidence from the literature and best practices, and impartially considers conflicting data and other perspectives.

Part 3: Stakeholders, Policy, and Regulations

•  Analyzes the impact of stakeholder needs, health care policy, regulations, and governing bodies relevant to health care practice and specific components of an intervention plan, and identifies assumptions on which the analysis is based.

Part 4: Ethical and Legal Implications

• Analyzes relevant ethical and legal issues related to health care practice, organizational change, and specific components of an intervention plan; identifies knowledge gaps, unknowns, missing information, unanswered questions, or areas of uncertainty (where further information could improve the analysis).

Address Generally Throughout

•  Communicates intervention plan in a professional way that helps the audience to understand the proposed intervention and the implications of the plan that must be taken into account. Grammar, punctuation, spelling, and citations are error-free. Intervention Plan Design: Patient Falls Essay.
• Demonstrates completion of hours toward the practicum experience and provides a clear and concise description of the focus of the clinical hours and alignment to the capstone project.

Additional Requirements

• Length of submission: 4–6 pages, double spaced.
• Number of resources: Minimum of 5–10 resources. (You may use resources previously cited in your literature review to contribute to this number. 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.

Intervention Plan Design

Need Statement

The high incidence of patient falls among the elderly is a quality improvement need. In hospital settings, the elderly are at an increased risk of patient falls. As individuals advance in age, the possibility of accumulating health problems and subsequent medications increases. Similarly, their risk of falling also increases. Aging is also associated with numerous changes in gait, including decreased limb strength and gait velocity. Ultimately, these factors place older adults at a high risk of patient falls. As indicators of frailty and immobility, and chronic health impairment among older persons, falls significantly diminish functioning by limiting activity for older persons, causing injury, and loss of mobility. According to Kenny et al. (2017), most injuries among seniors result from falls. These include hip and forearm fractures, pelvis, and humerus.

Addressing patient falls is incredibly crucial, given their imminent health burden. Patient falls are linked to high rates of morbidity and mortality. McCarthy (2016) highlight that falls is the leading cause of death resulting from injury among the elderly above the age of 65 in the United States. One in every four US citizens dies from fall-related causes. Also, fall-related injuries are highly prevalent among the elderly. Mainly, hip and wrist fractures, pelvis, and osteoporosis are among the factors that increase vulnerability to patient falls. Intervention Plan Design: Patient Falls Essay.Other severe injuries resulting from patient falls are laceration, joint dislocation, disabling tissue injury, and sprain. Notably, even falls that do not result in physical injury have negative impacts such as self-imposed activity limitations, anxiety, and trauma.

Additionally, patient falls lengthen hospital stays and increase healthcare costs. The Centers for Disease Prevention and Control (2020) asserts that the cost of treating patient falls approximates to $67.7 billion annually. As patient falls are linked to subsequent hospital readmissions, addressing the issue is incredibly crucial.

Population and Setting

Nursing staff in a skilled nursing facility comprise the target population for a quality improvement program targeting patient falls. Nursing staff practicing in these facilities are well trained and specialized in providing round-the clock-assistance to the elderly on the activities of daily living (ADLs). It is incredibly crucial to address patient falls within this population as these nursing staff care for individuals at a high risk of patient falls. They, therefore, play a fundamental role in falls prevention among the elderly, especially residents of skilled medical facilities.

This project targets skilled nursing facilities as the setting. Skilled nursing facilities are a type of nursing home acknowledged by Medicare and Medicaid to meet the long-term health needs of the elderly. The setting is crucial in addressing patient falls among the elderly as skilled nursing facilities house seniors who have limited potential to function independently and who require assistance with daily living activities. Frailty is acknowledged as a significant risk factor for patient falls (Kojima et al., 2015).  As a result, skilled nursing facilities are likely to record a higher incidence of patient falls as they contain frail adults.

Intervention Overview

Several interventions are effective in addressing patient falls. These are hourly rounding, coupled with nursing staff education and the use of bed alarms. Research has demonstrated that the integration of hourly rounding protocols in nursing practice is an efficient evidence-based strategy for patient falls (Goldsack et al., 2015).  Hourly rounding reduces the occurrence of falls and can be used in tandem with other fall prevention interventions to enhance patient safety. Staff education is another intervention to minimize the occurrence of falls among seniors in skilled nursing facilities. Staff training promotes a culture of safety in the organization (Hill et al., 2016). Staff participating in the education program should be those who interact with patients daily, and this has broader experience in patient behavior and falls prevention. These two interventions should be combined with the use of bed alarms for effective falls prevention.  Intervention Plan Design: Patient Falls Essay.The above interventions align well the target population, project setting, and the identified need.

Comparison Approaches

Another alternative to the interventions discussed above is the use of bed alarms only for falls prevention. While the use of bed alarms are effective in decreasing falls by notifying healthcare personnel when high-risk patients try to leave their bed without nursing assistance, the approach is not highly effective when used solely. It should be combined with other fall prevention bundles to be highly effective.

Initial Outcome Draft

The main aim of the project is to reduce the incidence of patient falls among the elderly residing in skilled nursing facilities. It is incredibly reflective of the project’s intention, which is to decrease falls’ incidence among the elderly populations. This outcome further illustrates what the project intends to achieve by establishing a framework for patient safety and quality improvement in healthcare settings. Preventing patient falls improves patient safety and is an indicator of high-quality patient care.

Time Estimate

Implementing a falls prevention bundle encompassing hourly rounding, staff education, and use of bed alarms is estimated to take six months to one year. During this period, staff will be educated on the importance of falls prevention among the elderly as well as the benefits of hourly rounding. Education will also comprise a prompt response to patient bed alarms. While the time frame is realistic, several potential challenges are likely to be encountered during this period. These include time constraints, staff shortages in the facility, and budgetary limitations.

Literature Review

According to the CDC, residents in skilled nursing facilities who frequently fall sustain injuries with a higher potential to cause permanent disability and reduce the patient’s quality of life. Falls in these facilities result from person-centered and environmental factors such as effects of aging or gait imbalance, underlying medical conditions, side effects of drugs, low lighting, wet floors, and inaccessibility of personal items prompting patients to reach them without assistance. Intervention Plan Design: Patient Falls Essay.While various interventions have been proven to be effective, a falls prevention bundle is found to be more successful in preventing falls, compared to the use of a single intervention (Guirguis-Blake et al., 2018). Successful prevention of patient falls requires healthcare professionals to manage underlying risk factors for patients and modify risks within the environment that contribute to patient falls. Given the complexity of these factors, a combination of interventions is necessary.

The process of hourly rounding has been identified as a successful evidence-based approach to reduce patient falls. It encompasses purposefully checking in on every patient every hour and recording the contact. A purposeful hourly rounding comprises checking the 5Ps of the patient. These are pain, position, personal needs, periphery, and potty (Daniels, 2016). When assessing for pain, nurses should determine the patient’s pain level and administer medication when necessary. They must also ensure that patients are placed in a comfortable position and reposition immobile patients to prevent the occurrence of pressure ulcers. Additionally, nurses must assist the patient with personal needs such as hydration, nutrition, and using the toilet while ascertaining that their individual items are within reach.

Linehan and Lihehan (2018) assert that hourly rounding decreases the occurrence of patient falls and light usage while enhancing the perceptions of patients on nurse responsiveness. It is, therefore, a vital tool in improving care outcomes and improving patient safety. Notably, the concept of hourly rounding has been met with some form of resistance from nurses, with opponents most citing increased documentation, over-regulation of nursing activities, and loss of adequate time as major concerns behind intentional hourly rounding. However, evidence-based research has highlighted that hourly rounding improves efficiency, decreases documentation, and significantly improves patient safety. It is, therefore, a quality improvement strategy that increases patient safety as well as satisfaction.

Attending nurses and patient care technicians are responsible for purposeful hourly rounding (Shin & Park, 2018). Although hourly rounding is a standard of care, the frequency of the strategy should be dependent on patients’ needs. Stable patients can be allowed to rest, with less hourly rounding while patients requiring nursing attention should be rounded after every hour. During hourly rounding, the nurses should ask questions and document their interactions with patients to determine the patient’s health needs that should be prioritized. Notably, hourly rounding significantly improves nurse responsiveness as nurses promptly attend to acknowledged patient needs.

According to Leone and Adams (2015), structured, purposeful hourly rounding is linked to positive outcomes such as patients’ confidence in their care, improved satisfaction, reduced use of call bells, and decreased incidence of patient falls. However, several barriers to purposeful hourly rounding have been identified. Time constraints, competing priorities, and increased workloads have been noted to interfere with the process of hourly rounding. Most staff also perceive that increased documentation associated with hourly rounding is irrelevant. Lack of sufficient staff engagement thus hinders the successful execution of hourly rounding.

As an intervention to prevent patient falls among the elderly, purposeful hourly rounding should be used together with other strategies such as staff education and use of bed alarms, in the form of a bundle (Morgan et al., 2016). Intervention Plan Design: Patient Falls Essay.  Ensuring that nurse staff are engaged in falls prevention programs in skilled nursing facilities requires the health organization to provide a comprehensive educational program and training on falls prevention among the elderly. Educating both clinical and non-clinical staff, is an integral approach that allows the organization to reach all professionals, including night shift and weekend nurses. Fall prevention training should also be extended to disciplines beyond nursing staff, such as medical residents, nurse assistants, technicians, and rehabilitation specialists. Education ensures that staff are aware of the crucial roles they play in fall prevention. Staff roles relating to fall prevention will be accurately defined.

According to Heng et al. (2020), the majority of falls prevention programs focus on patient education. These processes focus on educating hospitalized patients as well as those in nursing homes. The authors, however, note that staff education on fall prevention is equally essential as patient education. Various education modalities can be used during staff education, such as face to face meetings, handouts, fall prevention posters, and handouts. Notably, combining these approaches is more effective than using single education provision modalities. Staff education allows nurses to classify patients at high risk of falls and execute patient-centered strategies aimed at falls prevention. Group training education sessions on falls prevention among nursing staff in skilled nursing facilities are effective in enabling nurses to remember and understand the presented information. Fall prevention education for resident care nurses is mostly done by a fall prevention expert, a specialized individual with adequate knowledge on fall prevention acquired through education, training, and experience. Physical therapists also play a crucial role in educating nurse staff on mobility optimization, which is an essential component of falls prevention programs. Self-efficacy has been noted as a critical aspect that allows nurses to transition from education to practice.

Use of bed alarms is another intervention used in combination with hourly rounding and staff education in the identified fall prevention bundle among seniors in skilled medical facilities. Bed alarm systems work to minimize patient falls by notifying healthcare personnel when high-risk patients endeavor to leave their beds or chairs. Among hospitalized patients, most falls result from patients ambulating from the bed, chair, or toilet without adequate assistance from nurses. Alarm systems designed on patients’ bed or chairs have the potential to minimize the potential for physical restraints that contribute to patient falls. Doubts exist on the reliability of bed alarms in preventing patient falls. While the approach is effective in improving nursing responsiveness, the strategy is not effective when used alone. Gavaller et al. (2019) highlight that bed and chair alarms among patients in the long term and acute care settings have been proven ineffective strategies for fall prevention and have satisfied the criteria as a physical restraint according to the Centers for Medicare and Medicaid (CMS).

A study conducted by Mileski et al. (2019) revealed that the use of bed alarms alone as a strategy for preventing falls is inadequate as an intervention. For alarms to be effective in preventing patient falls, they must be used as a component of a comprehensive bundle executed for residents at a high risk of patient falls. The above authors assert that no single intervention is effective in fall prevention. In all healthcare facilities, patient falls are reduced by a multifaceted comprehensive and prolonged approach that focuses on maintaining patient safety and improving the quality of care. Overall, the use of bed alarms is useful in long-term healthcare facilities while utilized as a component of a comprehensive care plan. Intervention Plan Design: Patient Falls Essay.

An example of health policy related to patient falls is the CMS No-Pay Policy for hospital-acquired patient falls. In 2008, the Centers for Medicare and Medicaid (CMS) stopped compensating healthcare organizations for costs linked to patient falls (Fehlberg et al., 2017). This policy increased the likelihood of nurses to implement strategies for fall prevention within healthcare facilities. This policy will impact how the skilled nursing facility will address fall prevention among residents in the organization. As the CMS no longer reimburses costs related to patient falls, the nursing resident facility will have to implement approaches to fall prevention, among them purposeful hourly rounding, staff education, and use of bed alarms. These interventions will be used together to in form of a comprehensive bundle aimed at improving patient safety and enhancing the quality of health outcomes among the elderly populations. These interventions will be made at the individual and organizational level and will directly influence nurses’ delivery of patient care.

References

Daniels, J. (2016). Purposeful and timely nursing rounds: a best practice implementation project. JBI Database Of Systematic Reviews And Implementation Reports, 14(1), 248-267. https://doi.org/10.11124/jbisrir-2016-2537

Fehlberg, E. A., Lucero, R. J., Weaver, M. T., McDaniel, A. M., Chandler, M., Richey, P. A., … & Shorr, R. I. (2017). Impact of the CMS no-pay policy on hospital-acquired fall prevention related practice patterns. Innovation in aging, 1(3), 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

Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls. Nursing, 45(2), 25-30. https://doi.org/10.1097/01.nurse.0000459798.79840.95

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

Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC geriatrics, 20, 1-12.

Hill, A., Waldron, N., Francis-Coad, J., Haines, T., Etherton-Beer, C., & Flicker, L. et al. (2016). ‘It promoted a positive culture around falls prevention’: staff response to a patient education programme—a qualitative evaluation. BMJ Open, 6(12), e013414. https://doi.org/10.1136/bmjopen-2016-013414. Intervention Plan Design: Patient Falls Essay.

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

Kojima, G., Kendrick, D., Skelton, D., Morris, R., Gawler, S., & Iliffe, S. (2015). Frailty predicts short-term incidence of future falls among British community-dwelling older people: a prospective cohort study nested within a randomized controlled trial. BMC Geriatrics, 15(1). https://doi.org/10.1186/s12877-015-0152-7

Leone, R., & Adams, R. (2015). Safety Standards: Implementing Fall Prevention Interventions and Sustaining Lower Fall Rates by Promoting the Culture of Safety on an Inpatient Rehabilitation Unit. Rehabilitation Nursing, 41(1), 26-32. https://doi.org/10.1002/rnj.250

Linehan, J., & Linehan, J. (2018). Fall Prevention in Long Term Care Using Purposeful Hourly Rounding. Journal Of The American Medical Directors Association, 19(3), B17. https://doi.org/10.1016/j.jamda.2017.12.056

McCarthy, M. (2016). Falls are leading cause of injury deaths among older people, US study finds. BMJ, i5190. https://doi.org/10.1136/bmj.i5190

Mileski, M., Brooks, M., Topinka, J., Hamilton, G., Land, C., & Mitchell, T. et al. (2019). Alarming and/or Alerting Device Effectiveness in Reducing Falls in Long-Term Care (LTC) Facilities? A Systematic Review. Healthcare, 7(1), 51.https://doi.org/10.3390/healthcare7010051

Morgan, L., Flynn, L., Robertson, E., New, S., Forde-Johnston, C., & McCulloch, P. (2016). Intentional Rounding: a staff-led quality improvement intervention in the prevention of patient falls. Journal Of Clinical Nursing, 26(1-2), 115-124. https://doi.org/10.1111/jocn.13401

Shin, N., & Park, J. (2018). The Effect of Intentional Nursing Rounds Based on the Care Model on Patients’ Perceived Nursing Quality and their Satisfaction with Nursing Services. Asian Nursing Research, 12(3), 203-208.  Intervention Plan Design: Patient Falls Essay.https://doi.org/10.1016/j.anr.2018.08.003

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). 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 inmates 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).  Intervention Plan Design: Patient Falls Essay.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.

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):

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.Intervention Plan Design: Patient Falls Essay.  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).

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).

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.

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.

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.  Intervention Plan Design: Patient Falls Essay.The characteristics of registered nurses in skilled nursing rehabilitation centers that impacted the plan include that:

• 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.
• 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 center impacting 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.

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).Intervention Plan Design: Patient Falls Essay.  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.

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.

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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.  Intervention Plan Design: Patient Falls Essay.

References

Agency for Healthcare Research and Quality [AHRQ] (2018). Preventing falls in hospitals. https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html

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