The capstone change proposal is fall prevention among geriatric patients. Falls are a common occurrence in the healthcare sector because of balance difficulties and general muscle weakness. Many patient falls are attributed to long-term problems such as diabetes, heart disease, and hypotension. Besides, poor vision, depreciating physical fitness, and improper self-medication among geriatric patients are often associated with falls exposing them to a wide range of problems that influence their perspectives towards life. Individuals aged 65 years and over exhibit a greater prevalence of falls that mainly result in injuries. The difficulty of primary nursing care for this unique patient demographic is also increased by combining healthcare needs and complications associated with elderly falls. Over 20% of falls lead to injuries, a move that has compelled health institutions to develop a series of approaches that can be used to reduce the prevalence of falls in the contemporary community.
The project highlights that multifactorial interventions reduce the susceptibility of falling among geriatric patients. The interventions include identifying patients at risk of falls, proper application of fall prevention, and in-service training of the nurses on fall prevention. Identifying patients who are prone to falls in elderly patient’s care will focus on guiding older adults on the indicators of falls to curb the prevalence of falls before they happen. Identifying the indicators of falls would improve the patient’s outcome since they approach with a personalized solution. Many factors must be examined and combined to determine the fall risk status of a patient. They include age, sensory deficits, mobility problems, neurological disorders, history of falls, cognitive impairment, and depression. Some medications also increase patient’s risk of falls. Patient falls are regarded as a risk to the patient’s safety in hospitals. They can result in severe injury or even death and increasethe duration of stay.
Proper application of fall precautions includes; evaluation of the risk of falling through a screening tool, regular cognitive and balance exercises, using assistance device when walking, using nonskid shoes, and removal of clutter and proper lighting(Cheng, Tan, Ning, Li, Gao, Wu, and Hu, 2018). Older adults with cognitive impairment are guided on physical exercises as an intervention to prevent falls. Physical exercise intervention is conducted in a controlled environment to reduce the risk of aggravated muscle contractions. The physical therapist uses a patient-centered approach through effective communication to assess the health conditions and recommend specific exercises. In-service training of nurses is relevant in educating emergency department providers on the compliance of fall prevention guidelines. The training helps develop a safety-conscious culture and helps avert manageable patient falls.
The articles reviewed have different research aims and questions but are geared towards a solution change in fall prevention among geriatric patients. The research questions are based on implementing and preventing falls, analyzing emergency implementation guidelines, and tips to reduce falls in hospitals and home setups. The study by (Vlaeyen, Stas, Leysens, Van der Elst, Janssens, Dejaeger, Milisen, 2017) focuses on implementing fall prevention strategies in residential care facilities. The prevention strategies analyzed include older adults communicating changes in their health to caregivers and increased understanding of falls’ possible symptoms that reduce the likelihood of falls.
The article by (Najafpour, Godarzi, Arab, and Yaseri, 2019) examines the link between fall risk factors and the frequency of falls in a hospital setting. Comparingly, (Heng, Jazayeri, Shaw, Kiegaldie, Hill, and Morris, 2019) and (Morris and O’Riordan, 2017) examine the effects of disseminating information regarding patient falls to the health practitioners as well as patients. The article highlights aggravating fall factors such as unfamiliar settings, dizziness, illnesses, and lack of activity.Besides, (Cheng, Tan, Ning, Li, Gao, Wu, and Hu, 2018) reviews the study that offers multifactorial intervention tips to geriatric patients in managing and preventing falls. Some factors such as noncompliance with stipulated guidelines and inadequate working environment affect the implementation of emergency interventions.
The article by (Davenport, Cameron, Samson, Sri-On, and Liu, 2020) explores the relationship between the failure to comply with the nursing regulations and the frequency and number of falls in an emergency unit setting. The article also analyzes the level of knowledge regarding the guidelines and their practical implementation. (Grossman, Curry, Owens, Barry, Caughey, Davidson, and US Preventive Services Task Force, 2018), aim to find out the suitable fall prevention technique among neurologic patients.
Objectives of the Study
Falls are a global public health problem. Patients, physicians, and the healthcare system are all affected by patient falls and accidents. The evidence-based practice assessment aims to conduct a systematic analysis of the efficacy of fall prevention methods in hospital and residential home care. The process to evaluate fall prevention intervention occurs after the project has been completed. A summative evaluation determines the proposed change project’s success in terms of time, cost, and outcomes. Evaluation of fall prevention is an ongoing process, especially in older adult patients. Although the results are the most important, cost and time are critical elements as well.
To determine the frequency and incidence of falls in hospitals associated with staff and assess the viability of fall prevention techniques targeting the geriatric population. Correspondingly, another objective is to understand the interventions relating to each risk,including health-based risks and environmental risks and their interventions. Health-based hazards include chronic illness-specific to an individual, while environmental risks include improper use of canes (Grossman, Curry, Owens, Barry, Caughey, Davidson, and US Preventive Services Task Force, 2018). The interventions used should match the exposure to the specific type of risk. To determine the efficacy of the intervention techniques in achieving quality improvement and cost savings in the healthcare sector.
Resources needed in the capstone change proposal include; communication, funding, management support, and a conducive environment regarding new policies and regulations. Good communication between nurses and patients is one of the critical elements of successful patient safety programs.The most appropriate communication entails relaying the vision of what’s going to happen, how individuals will be involved, what is expected from them and their team (Dithole, Thupayagale-Tshweneagae, Akpor, and Moleki, 2017). The strategic goals and action plan are communicated to all clinical and administrative staff. Everyone in practice should know the goals and clearly understand their role in implementing strategies to achieve them. Effective communication and team culture cultivation are significant if the strategic planning actions begin moving the practice in a new direction.
Finance is one of the most important aspects of a business. Healthcare facilities have to organize their budget and keep track of their hospital expenditures to outplace their revenues and help the organization determine what to spend, where to spend, and when to spend. The change proposal’s financial element entails funding for the proposed change and inquiring from the management about the budgetary concerns regarding implementing the change proposal. The inquiry is a prerequisite in implementing the strategy as it needs a budget to cover the cost of the proposed plan. Funds are required to purchase supplies such as falls prevention equipment, screening tools and initiate educational programs. Financially sustainablehealthcare facilities can sustain highly reliable systems and allocate ongoing resources to quality enhancement.
In addition, support from management is required to achieve a conducive environment that prioritizes the actions needed to reach the proposed goals. Leaders and managers can influence the policies and cultivate a conducive environment that will favor my project’s implementation, thus being critical resources in the implementation process. Leaders focus on setting and upholding standards regarding the implementation strategy and being actively involved in policy setting(Dykes, Khasnabish, Burns, Adkison, Alfieri, Bogaisky, and Adelman, 2021). Management provides guidance and support to staff regarding the policy changes. Time management is also a required resource since the project are subject to time constraints. Implementation of healthcare projects is based on specified periods as they seek to roll out programs and measure the projected outcomes. The project time management is influenced by forecasting as it estimates the time of completion of the project.
Anticipated measurable Outcomes
Measurement is essential to monitoring the intervention process’s viability as it highlights the techniques that are working and the inadequate methods. In addition, outcomesare also in the form of the percentage of patients at risk of falling and fall-related injuries with interventions in place. The North American health care system measures the quality of care through structure measures, process measures, and outcome measures.
Outcome measures and process measures are used to determine the interventions’ viability, while structure measures gauge human resource attributes. Structure measures answer the question of general satisfaction of healthcare prevention techniques among the patients. Outcome measures refer to the effect of interventions on the health of patients. Outcome measures answer whether the team is achieving what it is trying to accomplish and articulates the picture of triumph. The outcome measurement includes reducing falls and reducing the rate of injuries resulting from falls (France, Slayton, Moore,Domenico, Matthews, Steaban, and Choma, 2017). Process measures articulate the methods by which care is provided. The main focus of process measures is the ability to diagnose and treat complications appropriately. Process measures include the increased percentage of educated staffregarding fall prevention strategies and the number of preventable falls.
How the Intervention will be Evaluated
Evaluation of the Intervention will be done through prevalence studies and formative studies. Prevalence studies will include assessment of fall rate and fall prevention from a random selection of geriatric patients. Interviews from the randomly selected patients will encompass the general satisfaction of nursing care to the patients.The evaluation process will also measure the interventions’ effectiveness to mitigate or eliminate fall risk factors through cross-sectional analysis. This is achieved by determining the number of modifiable risk factors eliminated or modified.
Formative studies entail checking records to determine the type of falls, severity of falls, and fall rates. Evaluation of type of falls is subdivided into number and frequency of accidental falls and anticipated falls. Analysis of the severity of falls is done by assessing the type of injury, either low, moderate, severe, death, duration, and extent of damage (Dykes, Khasnabish, Burns, Adkison, Alfieri, Bogaisky, and Adelman, 2021). The formative evaluation also entails checking records to obtain information regarding readmissions. The readmission records monitor the number of repeats falls within 30 days of discharge and delays in the time to the occurrence. Comparatively, it shows the patients’ diagnostic cohorts; thus, nurses know patients prone to falls risk. Evaluation of the outcomes will also incorporate post-fall analysis through post-fall reports conducted within the first 15 minutes after a fall.
Cheng, P., Tan, L., Ning, P., Li, L., Gao, Y., Wu, Y. & Hu, G. (2018). Comparative effectiveness of published interventions for elderly fall prevention: a systematic review and network meta-analysis. International journal of environmental research and public health, 15(3), 498.
Davenport, K., Cameron, A., Samson, M., Sri-On, J., & Liu, S. W. (2020, July 10). Fall Prevention Knowledge, Attitudes, and Behaviors: A Survey of Emergency Providers. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390582/
Dithole, K. S., Thupayagale-Tshweneagae, G., Akpor, O. A., & Moleki, M. M. (2017). Communication skills intervention: promoting effective communication between nurses and mechanically ventilated patients. BMC nursing, 16(1), 1-6.
Dykes, P. C., Khasnabish, S., Burns, Z., Adkison, L. E., Alfieri, L., Bogaisky, M., … & Adelman, J. S. (2021). Development and validation of a fall prevention efficiency scale. Journal of patient safety.
France, D., Slayton, J., Moore, S., Domenico, H., Matthews, J., Steaban, R. L., & Choma, N. (2017). A multicomponent fall prevention strategy reduces falls at an academic medical center. The Joint Commission Journal on Quality and Patient Safety, 43(9), 460-470
Grossman, D. C., Curry, S. J., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., … & US Preventive Services Task Force. (2018). Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. Jama, 319(16), 1696-1704.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A., & Morris, M. E. (2019, September 01). Educating hospital patients to prevent falls: Protocol for a scoping review. Retrieved from https://bmjopen.bmj.com/content/9/9/e030952
Morris, R., & O’Riordan, S. (2017, July). Prevention of falls in hospital. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6297656/
Najafpour, Z., Godarzi, Z., Arab, M., & Yaseri, M. (2019, May 01). Risk Factors for Falls in Hospital In-Patients: A Prospective Nested Case-Control Study. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571495/
Vlaeyen, E., Stas, J., Leysens, G., Van der Elst, E., Janssens, E., Dejaeger, E., … & Milisen, K. (2017). Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators. International journal of nursing studies, 70, 110-121.