Management of Patient Falls Prevention

Clinical safety is a fundamental element in the delivery of quality healthcare services. Institutions must identify and eliminate risks that could potentially endanger patients as they interact with the healthcare system. Approximately half of hospital falls are avoidable if appropriate measures are instituted promptly (Montejano-Lozoya et al., 2020). A hospital fall is defined as a situation in which a patient unintentionally comes to rest on the ground or a lower level. However, the event must not be triggered by an overwhelming external force such as a push. Ensuring that the incidence of falls within hospitals is reduced is essential for the delivery of quality care.

Description of the Problem

Hospital falls are a devastating problem, especially in institutions that care for elderly patients. Epidemiological findings indicate that these incidents occur at a rate of 3-5/1000 bed-days, and approximately 700,000 to 1 million admitted patients fall annually (Department of Health & Human Services, 2019). It is vital to note that more than a third of hospital falls result in injuries (Department of Health & Human Services, 2019). In some cases, individuals suffer from head trauma or fractures. The prevalence of falls in healthcare institutions is a matter of grave concern because the Centers for Medicaid and Medicare services do not provide additional reimbursement to health institutions to cover costs linked to these events.

Explanation of Causes

Several factors predispose patients to hospital falls. The most common risks include advanced age, history of a recent fall, the male sex, confusion, urinary incontinence, and adverse drug reactions (Morris & O’Riordan, 2017). In addition, near cardiovascular instability in the form of orthostatic hypotension contributes significantly to the frequency of falls. Advanced age is associated with visual, auditory, and mobility challenges that make moving from one point to the next extremely difficult. While individuals without mental illness may be prone to falling, the risk is higher among individuals with psychiatric conditions. In a study conducted by Hajduchová et al. (2019), 50.7% of the patients that suffered a fall had no reported psychological symptoms. However, 34.4% were confused, 20% suffered from dementia, 14.5% were restless, 2.1% were depressed, and 6.4% had anxiety (Hajduchová et al., 2019). The aforementioned illnesses reduce the affected individuals’ ability to care for themselves, making them prone to accidents.

The hospital environment is a critical risk factor to consider when evaluating the causes of falls. The incidence of events rises when patients start rehabilitation and when they first come into contact with new compensation aids (Hajduchová et al., 2019). Problematic hospital equipment such as faulty nurse call buttons or inefficient bed-exit alarms may predispose patients to accidents. Problems with incontinence and evacuation contribute immensely to the frequency of hospital falls. Finally, patients on high-risk medication such as antidepressants and sedatives are at risk of falling. This is because these drugs are often associated with side effects such as dizziness, confusion, or fatigue which make mobility challenging.

Identification of Stakeholders

It is critical to emphasize the need for change to the hospital’s stakeholders. Creating a sense of urgency is essential because it galvanizes support for the proposed solution. The relevant stakeholders are patients, nurses, physicians, hospital administrators, and the board of trustees. The hospital’s support of quality improvement is advantageous given the fact t has dedicated resources for the development of relevant infrastructure.

Discussion of stakeholders

The hospital’s board of trustees and administrators are interested in the project because quality improvement aligns with the institution’s commitments and values. Their interest is primarily in the project’s ability to reduce the costs associated with falls. The board of trustees has the power to allocate resources and manage decision-making within the institution. In addition, they have the power to grant or deny staff time for team meetings, leadership time to monitor progress, and training resources. In addition, they determine access to tangible resources such as communication material and new care equipment. The board of trustees is capable of influencing investors whose financial contributions may be required to facilitate the project’s operations.

The physicians and nurses are interested in the project because it facilitates the improvement of patient wellbeing. For instance, the fact that falls are associated with increased functional impairment, pain, and mortality is a matter of grave concern. Reducing the aforementioned adversities helps improve the quality of care offered at the institution. This group of stakeholders has the power to influence others to get involved with the project. They act as advocates committed to the project’s main goals and objectives. In addition, they can take ownership of the project, given their specific interest in fall prevention. It is worth noting that nurses and physicians will constitute the interdisciplinary implementation team that will ensure outlined targets are achieved.

The patients and their kin are interested in the project because of its potential to alleviate suffering and improve the quality of care. The injuries associated with hospital falls are often painful and increase the cost of care at healthcare institutions. In addition, the fear of falling fills patients and their relatives with anxiety and may limit patient autonomy. These stakeholders have the power to influence the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores which determine Medicaid and Medicare reimbursement rates. A low score often means that the institution will receive limited funding from the government to facilitate the provision of care. This group of stakeholders can influence other patients seeking healthcare services. A decline in consumer satisfaction is likely to negatively impact the institution’s bottom line.

Explanation of the Project

The project is designed to establish a culture where safety is prioritized, and fall events are reduced. The Kotter Change model will facilitate the identification of specific restraining and driving forces that will facilitate procedural improvements. It is essential to inform the hospital management of the urgency of the fall prevention project and ask for assistance to facilitate the implementation of changes. The plan involves the formation of an interdisciplinary team that will outline a vision of how to address the challenge. In addition, it will plan, evaluate, test the changes and study the outcomes. The final objective is the empowerment of nurses and other health professionals to become active participants in fall prevention initiatives.

Proposed Solution

The proposed solution involves the integration of a clinical nurse leader to create an interdisciplinary team tasked with reducing the fall rate in the hospital’s surgical ward. The project includes three essential components that define its structure. These are a quality improvement model, a risk evaluation strategy, and standardized intentional rounding. The team will comprise the unit manager, registered nurses, unit assistants, patient care technicians, and hospitalists. It is worth noting that the department uses a face-to-face hand-off communication process, and the physicians carry out multidisciplinary rounds and intentional rounding to plan specific aspects of daily patient care.

Evidence Summary

Patient falls are a serious factor to consider in the hospital setup. Individuals at the highest risk of experiencing this adverse event are adults between the ages of 64 and 75 years (Ruby, 2017). Falls can be prevented by applying a multifaceted solution that includes the installation of an interdisciplinary team, the implementation of intentional rounding, and the application of an assessment tool. Intentional rounding involves a well-thought-out program where the nursing staff carries out two hourly checks using a standard protocol (Sims et al., 2018). The nursing staff is tasked with assessing the patient’s level of pain, their position, personal needs, and possessions (Langley et al., 2017). It is vital to note that adhering to a specific, intentional rounding schedule that ensures that the patient’s items are within reach and the room is free of hazards minimizes falls (Sims et al., 2018). Observing each of the steps outlined in a rounding protocol ensures that all the patient’s needs are met, which minimizes the risk of falls.

Adopting an interdisciplinary approach that includes a team of specialized nurses is important in fall prevention strategies. The interdisciplinary team is a valuable resource for the education of nurses and caregivers on the most effective fall-prevention techniques (Avanecean et al., 2017). Assessment tools such as the Thomas Risk Assessment Tool have helped reduce falls significantly (Chang et al., 2017). Effective implementation of the aforementioned solutions will facilitate the reduction of hospital falls.

Safeguarding against falls in hospitals is essential to the provision of quality services. It should be noted that between 20 to 30% of the incidences can be avoided through the implementation of evidence-based interventions in a program that includes an interdisciplinary team approach, risk assessment, and intentional rounding (Morris &O’Riordan, 2017). In addition, encouraging a culture of vigilance and safety consciousness through the provision of continuous feedback is essential.

It is essential to employ a multidisciplinary approach when embarking on a quality improvement program aimed at reducing hospital falls. For instance, a quality improvement project conducted at an academic hospital in the Midwest involved a multidisciplinary team of nurses, physicians, pharmacists, occupational therapists, and social workers (Dhillon et al., 2019). The team’s efforts resulted in a decrease in the fall rate from 4.22/1000 patient days to 2.24/1000 patient days (Dhillon et al., 2019). Hajduchová et al. (2019) note that the Morse Fall Scale, which rapidly assesses the patient’s likelihood of falling, is highly effective. Therefore, nurses should use the tool to identify high-risk patients and dedicate more time to monitoring their activities. Additional evaluation techniques, such as a nurse-led fall-prevention toolkit that connects evidence-based prevention initiatives to specific risk factors, can significantly reduce the incidence of falls (Dykes et al., 2020). Ensuring that patients admitted to health institutions avoid falls is essential for their overall wellbeing.

The proposed solution includes three essential components that define its structure. These are a quality improvement model, a risk evaluation strategy, and standardized intentional rounding. The team will comprise the unit manager, registered nurses, unit assistants, patient care technicians, and hospitalists. It is worth noting that the project will be conducted in the hospital’s surgical department. Through leadership rounding in patient rooms, the multidisciplinary team will observe the effectiveness with which the hospital’s staff communicates fall prevention initiatives to the patients and their relatives. Conducting risk assessments and implementing policy changes are critical steps that will ensure patients receive the best care while hospitalized in healthcare institutions.

Plan of Action

The quality improvement model will incorporate elements of the Institute for Healthcare Improvement (IHI) model to find the leading causes of falls within the surgical unit. The hospital has experienced a high rate of falls in recent weeks. The first step is the identification of the problem and project. This will be accomplished by accessing the hospital’s adverse event reporting system, which highlights areas of concern such as hospital falls. The next step is the identification of a preceptor and obtaining organizational approval through an Alternative clinical activity process at WGU. After permission is granted, I will develop solutions based on current evidence. These include guidelines aimed at reducing patient falls through a quality improvement model, a risk evaluation strategy, and standardized intentional rounding. This will be followed by conducting a literature review from the institution’s database and relevant websites. The keywords that will be used at the WGU library include patient falls, rounding, risk assessment, and Kotter’s theory. The process will start with the identification of resources that quantify and define fall risks, after which resources identifying potential evidence-based solutions will be recorded. These include the improvement of handoff communication when managing high-risk patients, effective fall risk evaluation, and comprehensive communication to the hospital’s staff about fall prevention.

It is critical to secure a change theory because it will guide the project’s implementation. Kotter’s theory of change will be applied because it is instrumental in informing change initiatives in healthcare facilities. The deliverable steps involve creating a quality improvement model and a risk evaluation strategy. This policy, which will be developed outside the hospital, will inform practitioners of the steps to take to avoid falls. After securing a change theory, a presentation will be made to the preceptor by phone meeting to review the problem and proposed plan.

Timeline

The fall prevention project is scheduled to run for five weeks, during which time it is expected that the number of patient falls will reduce significantly. Given the severity of the Covid-19 pandemic, the initiatives will focus on the use of remote access technology to avoid interpersonal contact.

Timeline Actions
Week 1 Initial phone call with preceptor to identify the problem by accessing the hospital’s adverse event reporting system and obtaining organizational approvals.
Week 2 Discussion with preceptor to propose a solution to the high frequency of fall rates in the institution.
Week 3 Conduct an evidence-based literature review on websites and the hospital database with a focus on keywords such as patient falls, rounding, risk assessment, and Kotter’s theory.
Week 4 Select a change theory relevant to the project.
Week 5 Develop the hospital fall reduction guideline that incorporates a quality improvement model, a risk evaluation strategy, and standardized intentional rounding.
Weeks 6 Final phone meeting with instructor/preceptor to present the guideline.

Required Resources and Personnel

There are a variety of resources required for the successful implementation of the project. There is a need for staff time for meetings and training, leadership time to ensure that the project is effectively monitored and supported, communication materials, and new care products. In addition, funding to facilitate education programs and information technology support is critical. The project will also make use of resources that are already in place, such as the hospital data system, which is crucial for reporting fall rates, and continuous medical education programs that can be used to emphasize fall prevention.

Proposed Change Theory

Kotter’s theory of change is instrumental in informing change initiatives in healthcare institutions. Kotter’s model offers a step-by-step guide on the requirements for implementing change in an organization (Aziz, 2017). The first step in Kotter’s model is the creation of urgency, which will be accomplished by highlighting the negative effects of falls on the hospital’s stakeholders. The second step involves forming a powerful coalition that will include nurses who understand the value of patient safety and organizational leaders who are focused on reducing institutional costs. The next step involves creating a vision for change that the leaders in the interdisciplinary team will implement.

Kotter’s model emphasizes the need to communicate the team’s vision. It is necessary to explain why the hospital’s adoption of the proposed project will ensure improved customer experiences for all the institution’s clients. It is imperative to build on the change by sustaining efforts aimed at ensuring patient safety is prioritized. The final step is to make the change stick by enshrining it in the institution’s core as part of organizational culture.

Barriers to Implementation

There are various potential barriers to the implementation of the project. For instance, the lack of time and the limited personnel is likely to hinder training initiatives and participation in meetings. In addition, the lack of resources to implement education programs and acquire communication material is a possible impediment. It is essential to note that other factors such as patient complexity, the belief that falls are unavoidable and environmental factors are likely to make implementation challenging.

References

Avanecean, D., Calliste, D., Contreras, T., Lim, Y., & Fitzpatrick, A. (2017). Effectiveness of patient-centered interventions on falls in the acute care setting compared to usual care: A systematic review. JBI Database of Systematic Reviews and Implementation Reports, 15(12), 3006–3048. Web.

Aziz, A. M. (2017). A change management approach to improving safety and preventing needle stick injuries. Journal of Infection Prevention, 18(5), 257–262. Web.

Chang, Y. W., Chang, Y. H., Pan, Y. L., Kao, T. W., & Kao, S. (2017). Validation and reliability of falls risk for hospitalized older people (FRHOP). Medicine (United States), 96(31), 1–5. Web.

Department of Health & Human Services. (2019). Falls . Patient Safety Network. Web.

Dhillon, B., Hallman, I., Ali, N., Ali, M., Landt, K., Hayes, M., & Shever, L. L. (2019). Utilizing a multidisciplinary team approach to reduce falls in the inpatient psychiatric unit. International Journal of Current Research, 11(4), 2781–2784. Web.

Dykes, P. C., Burns, Z., Adelman, J., Benneyan, J., Bogaisky, M., Carter, E., Ergai, A., Lindros, M. E., Lipsitz, S. R., Scanlan, M., Shaykevich, S., & Bates, D. W. (2020). Evaluation of a patient-centered fall-prevention tool kit to reduce falls and injuries: A nonrandomized controlled trial. JAMA Network Open, 3(11), 1–10. Web.

Hajduchová, H., Brabcová, I., Tóthová, V., Bártlová, S., Doseděl, M., Malý, J., & Vlček, J. (2019). Factors associated with falls in hospitals: Outcomes for nursing care. Kontakt, 21(2), 114–120. Web.

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(140), 1–12. Web.

Langley, S., Ormandy, P., & Wray, J. (2017). Does intentional rounding practice improve patient safety and experience? Nursing Times, 113(8), 36–40. Web.

Montejano-Lozoya, R., Miguel-Montoya, I., Gea-Caballero, V., Mármol-López, M. I., Ruíz-Hontangas, A., & Ortí-Lucas, R. (2020). Impact of nurses’ intervention in the prevention of falls in hospitalized patients. International Journal of Environmental Research and Public Health, 17(17), 1–13. Web.

Morris, R., & O’Riordan, S. (2017). Prevention of falls in hospital. Clinical Medicine, Journal of the Royal College of Physicians of London, 17(4), 360–362. Web.

Ruby, C. Z. (2017). Preventing in-patient falls: The nurse’s pivotal role. Nursing, 47(3), 25–30. Web.

Sims, S., Leamy, M., Davies, N., Schnitzler, K., Levenson, R., Mayer, F., Grant, R., Brearley, S., Gourlay, S., Ross, F., & Harris, R. (2018). Realist synthesis of intentional rounding in hospital wards: Exploring the evidence of what works, for whom, in what circumstances and why. BMJ Quality and Safety, 27(9), 743–752. Web.

Slade, S. C., Carey, D. L., Hill, A. M., & Morris, M. E. (2017). Effects of falls prevention interventions on falls outcomes for hospitalised adults: Protocol for a systematic review with meta-Analysis. BMJ Open, 7(11), 1–6. Web.

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