Proposed Clinical Change Project on Patient Falls Discussion

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. Proposed Clinical Change Project on Patient Falls Discussion

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.

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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. Proposed Clinical Change Project on Patient Falls Discussion

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. Proposed Clinical Change Project on Patient Falls Discussion

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.

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. Proposed Clinical Change Project on Patient Falls Discussion

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.

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. Proposed Clinical Change Project on Patient Falls Discussion

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.

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. Proposed Clinical Change Project on Patient Falls Discussion

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.

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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), 5^th 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.  Proposed Clinical Change Project on Patient Falls Discussion