How to Reduce the Incidence of Falls among Inpatients - Essay Example

?Evidence-based Research: Prevention of Falls Part I: Strategy in the exploration of the area of interest Introduction Inpatients are often at risk of falls. Most inpatients are elderly or are afflicted with a long-term disease which limits their mobility. Their skeletal and muscular system for the most part is often compromised due to some degenerative disease or some long-term illness. Studies claim that about 30% of hospital-based falls lead to major injuries (Stevens, et.al. p. 290). These falls are very much common in about 2% to 17% of patients during their hospital stay and their fall rates are either at 1.4 up to 17.9 falls within 1000 patient days (Schwendimann, p. 1472). Fall-related injuries are seen in about 15% to 50% of patients – these injuries include fractures or lacerations. Moreover, falls often cause fears of falling and it subsequently causes activity restriction and prolonged hospital stay (Schwendiman, p. 1472). Different factors have been considered as possible contributory causes for falls, including, an aging population, rising patient acuity, nurse shortages, an inefficient staff, and similar factors (Hendrich). Measures to prevent falls have been implemented by various hospitals in their clinical setting; however, for the most part, these methods have not been able to significantly reduce the rates of falls. This paper shall explore different ways by which nurses can prevent inpatient falls. It shall answer the question: according to evidence-based practice, what are the efficient nursing interventions which can be applied to prevent inpatient falls. Methods: An extensive literature search was conducted for this paper. First, a manual library search of the school library was carried out – searching medical and nursing journals for published studies in relation to falls and the prevention of falls. This search covered the past five years: January 2006 to December 2010. Relevant studies were set aside for further evaluation. Next, an internet search was carried out through the following databases: Medline, PubMed, Cochrane, Embase, and other nursing journals. The Medline database was used because it presented a reliable database of medical and nursing related peer-reviewed researches from a variety of nursing and medical journals. The Cochrane database was chosen because it has the widest and most extensive database for peer-reviewed medical and nursing-related researches. This database yielded studies which were used for this assessment. Finally, Google scholar was also used because it is one of the fastest databases to search. It stores all academic journals and studies from a wide-range of topics. Moreover, it has search properties which were chosen in order to specify the search process and ensure reliable search results. A Google scholar search was carried out in order to facilitate the search process. The following search words and combinations were entered into the search engines: falls prevention; inpatient falls prevention; elderly falls prevention, and similar combinations. Studies falling within the 5 year period were set aside for further evaluation. Each study were then critically analysed based on the following elements: reliability of authors, peer-review process, publication in a reliable peer-reviewed journal, validity of research methods, reliability of results, and validity of general research process. Results: Based on the search results, there were 10 studies which fulfilled the criteria for this research topic. Various studies presented methods for the prevention of falls. Some of these methods were evaluated depending on effectiveness and impact on clients. In a paper by Schwendiman, et.al., (p. 1472), the authors carried out a serial survey study in order to evaluate in-patient fall rates and injuries before and after the implementation of an interdisciplinary falls prevention program (IFP) in a 300-bed urban public hospital. In the process of research, the authors were able to establish that falls often lead to negative consequences like injuries, prolonged hospitalization, and legal liabilities. The application of the interdisciplinary falls program did not manifest any significant changes in the frequency and consequent injuries of falls (Schwendiman, et.al., p. 1472). The authors recommended more studies in this same line of research to be carried out. In a study by Stenvall, et.al. (p. 167), the authors sought to evaluate whether a postoperative multidisciplinary, intervention program, which includes a systematic assessment and treatment of fall risk factors, active prevention, detection, and treatment of postoperative complications can reduce inpatient falls and fall-related injuries. The study revealed that out of 12 patients in the intervention group, fall frequency registered at 18 times, whereas, 26 patients suffered 60 falls in the control group. All in all, the authors concluded that the application of comprehensive geriatric assessment and rehabilitation can prevent the incidence of falls and injuries, especially among patients with dementia or with a higher risk of falls (Stenvall, et.al., p. 167). Murphy, et.al., (p. 33) also set out to conduct their study on the application of a multifaceted program which seeks to reduce falls in the acute medical unit of a tertiary care centre. Their study revealed that the application of geriatric awareness, creation of ‘falls tool boxes,’ education for staff and family, and the implementation of structured hourly rounds schedule was able to reduce the incidents of falls in the tertiary care centre. The authors also pointed out the implications of the study associated with the empowerment of nursing staff in relation to the implementation of evidence-based practice and the use of benchmarking procedures to measure patient outcomes (Murphy, et.al., p. 33). In the discussion by Berggren, et.al., (p. 801) the authors conducted their study in a similar vein to the previous studies – to evaluate the application of a multidisciplinary, multifactorial fall-prevention program in the reduction of inpatient falls and injuries one year after discharge. The intervention group included the application of staff education, systematic assessment, treatment of fall risk factors, and vitamin D and calcium supplementation. After a year, the paper revealed that although there was no significant difference in the results for the intervention and the control group, the team which applied comprehensive assessment and rehabilitation was able to reduce inpatient falls and injuries (Berggren, et.al., p. 801). All in all, the study revealed that the prevention of falls is an important part of the everyday life of patients who are prone to falls. In the exploratory study of Huey-Ming and Chang-Yi (p. 42), the authors set out to understand the opinions and observations of recently discharged senior patients in relation to the fall prevention education which the received during their most recent hospitalization. The patients pointed out that the patient education they received during their most recent hospitalization was insufficient and that these patients had the following concerns: need to use electronic beds, bed height affects their fall rates, beds may be too narrow, pathways to the bathroom too disorderly, and no nurses responding to call buttons (Huey-Ming and Chang-Yi, p. 42). They suggest the following measures be taken in order to reduce their fall risks: lower and easy to adjust beds, dry bath floors, better lighting, wider doorway for patient rooms, clean and clear pathways, pull bars to walls, free of charge walkers as needed, bedside commodes and urinals, repetition of directions to avoid falls, fast response to call buttons, and more physical therapy opportunities (Huey-Ming and Chang-Yi, p. 42). In the study by Dykes, et.al., (p. 1912) the authors set out to investigate whether a fall prevention tool kit (FPTK) through health information technology (HIT) can reduce patients falls in hospitals. The study covered two groups – one intervention and one control studied during the 6-month intervention period. The study revealed that the FPTK was effective with patients aged 65 years and above during their 1000 days intervention period. In effect, the authors set forth that applying an FPTK compared with usual care is a more effective remedy in hospital units because it was able to significantly reduce falls (Dykes, et.al., p. 1912). Gates, et.al., (p. 130) carried out their study in order to assess the effectiveness of multifactorial assessment and intervention programmes in the prevention of falls and injuries among older adults recruited to trials in primary care, community, or emergency care settings. The study was carried out as a systematic review of randomised and quasi-randomised controlled trials, and meta-analysis. The result of their study revealed that multifactorial fall prevention programmes in primary care and in emergency settings are effective programmes in helping reduce the number of fallers and the rate of fall-related injuries (Gates, et.al., p. 130). Therefore, the implementation of such programmes is an effective intervention in the reduction of falls and fall-related injuries both in and out of the hospital. These results from previous studies were also highlighted in the study by Gray (p. 247) which assessed falls prevention in the protection of hospice patients. The study set forth that in order to keep patients safe, adequate assessment, prevention, and intervention tools must be implemented. The study also emphasized that the procedures like strengthening exercises, reduction or elimination of medications which cause dizziness, imbalance and confusion are appropriate interventions in the prevention of falls. This study also points out the importance of enforcing pragmatic interventions which help reduce the risk of falls and, at the same time, provide hospice comfort. Part II The study by Stenvall, et.al. (pp. 167-175) is well written, concise, and grammatically correct. It also avoids the use of jargons which are too technical for ordinary readers to understand. The research is also organized and laid out well with its logical progression from one thought to another and from one portion of the research process to another. The researchers’ qualifications and their position indicate that they have the undergraduate and postgraduate degrees in nursing and advanced nursing practice. Their current positions also put them in the line of work which is appropriate for practice in the current topic. Their positions gave them more than adequate insight into the practical applications of nursing theories and nursing processes. The title of the study is also clear, accurate, and unambiguous. The words used were clear and concise as befitting the elements which needed to be set forth at the beginning of the research. The title was also encompassing enough to cover the essential elements of the research topic. The direction of the research and the outcomes were also set forth in the title. By reading the title, the reader already has an idea of what to expect from the research. The abstract was also able to provide a clear outline of the study by detailing the research problem or question that the research seeks of answer. It also provides other details like sample, methodology, findings, and conclusion. These details are summarized in short and precise sentences which simplify a long and verbose research text. The purpose of the study was clearly set forth by the authors. They clearly identified that the purpose of their research is to ‘evaluate if a postoperative multidisciplinary, multifactorial intervention program could reduce inpatient falls and fall-related injuries in patients with femoral neck fractures.’ The purpose of the research is identified in measurable terms and outcomes. It describes the population as well as the intervention which the population is set to undergo. For the most part, the study also has a logical consistency as it follows the steps of the research process logically and in an orderly fashion. One step or part of the research logically leads to another step and part of the research, and so on and so forth. The transition from each thought or each sentence to the next is also natural and logical. The links for each thought and portion of the research is also clear. There are no out of place or illogical statements interspersed in the research text. The review of related literature is logically organized. It is incorporated in the introduction; but it flows logically in the presentation of the research background and framework. It is logically organized as it discusses the previous studies which were carried out on the current subject matter. The critical analysis of the literature is however not clearly presented. The authors only skim over the critical assessment of the literature. Since there is no clear analysis of the literature, there is no clear balanced critical analysis of such literature. Majority of the literature is recent in origin; some are however older than five years from the research’s publication. All the studies chosen are primary sources and of an empirical nature. The conceptual framework was identified in the text. The basis of falls and the intervention which is to be carried out on the patient is also identified. The framework which supports the current study alongside the essential details which surround the current research topic is detailed by the authors. The framework they chose to help support their research topic was appropriately chosen. The aims and objectives, as well as the research question have been identified by the authors. They are clearly stated within the research text, more particularly, in the introduction portion of the text. These aims flow naturally from the literature review. These aims, objectives, as well as hypothesis came from a natural progression of thought from some of the studies chosen in the literature review. The target population has been clearly identified and the process by which the population was selected was also specified. The sample population was randomly selected and is of a sufficient number for this study. The inclusion and exclusion criteria were also specified by the authors. The authors also specified the ethical processes which they were able to follow in the text. The participants were fully informed about the nature of the research and about the level of their participation in the research. All the technical terms, theories, and concepts mentioned in this study were also clearly defined. The impact of the research on their physiology and disease was also discussed. After the participants were informed, those agreeing to be participants signed the consent form. In so doing, the participants were adequately protected from harm. This study was also ethically approved by the ethical committee. The research design chosen for this research, as well as the data-gathering instrument was described and identified by the authors. The instrument chosen was appropriate and was developed based on the research topic raised in conjunction with the possible outcome. Reliability and validity testing were carried out and the results of such were also discussed. Other authors were also called in to carry out such reliability testing in order to free the testing process from bias. Several applicable and appropriate statistical tools were used for the study. The student’s T-test, Pearson’s x2 test, and the Mann-Whitney U tests were used at various appropriate areas in the research analysis. The findings are significant in the sense that they provide a clear measure of the effectiveness of applying a certain process in the reduction of falls. The findings serve as basis and support for the support (or lack thereof) for the use of multifactorial remedies in reducing falls. All the findings in the text are linked to the literature review – either to support or not to support some of the findings therein. The hypothesis was supported by the findings and the strengths and limitations of the study were also discussed. Furthermore, recommendations for the research were also made. Finally, all the books, journals, and other media used in the study were all accurately referenced. Part III. Strategy for implementing evidence A. Aim/Objective: to reduce the incidence of falls among inpatients B. Tools: educational materials, conference room, visual aids, DVD source materials outlining strategies to prevent falls. C. Personnel: nursing staff, nursing administrator, physical therapists, occupational therapists, transport aide, attending physician D. Strategy 1. Assess fall risk factors 2. Prevent falls by teaching patients how to properly and safely move about; teaching family and caregivers on preventive measures they can implement to reduce risk of patient falling 3. Treat causes of falls (medicines which may cause dizziness); muscle and skeletal weakness; and blurry vision 4. Detection of fall risks (physical environment, physiological make-up) 5. Treat postoperative complications (dizziness, pain, discomfort, etc) which contribute to fall risks E. Tasks/procedure 1. Assess fall risk factors. In this task, it is important to determine the physical environment of the patient and determine if there are objects there which may increase his risk of falls. 2. Prevent falls by teaching patient how to safely move about. This process can be carried out with the aid of the occupational therapist. The occupational therapist can teach the patient how to safely sit up on his bed, how to get up from his bed, how to stand up, and how to walk without falling or injuring himself. 3. Treat causes of falls. Treating the causes of falls may entail shifting to other medication which would not induce drowsiness or dizziness or blurry vision. It may also involve the conduct of muscle strengthening exercises with the help of the physical therapist. 4. Detection of fall risks. This may entail the cleaning and clearing of the patient’s physical environment, installation of pull bars, or the improvement and increase of lighting. 5. Treatment of postoperative complications. This would entail the administration of pain medications, medication to reduce nausea and dizziness, and medication which would reduce muscle stiffness and discomfort. Recommendations for future research After considering the above discussion, recommendations for future research on the different common causes of falls among inpatients can be carried out. There are various causes of falls among inpatients – some of them may be attributed to the patient, and the others may be attributed to the medical staff. There is a need to consider these causes and determine which factors and elements would most likely cause falls among inpatients. In the implementation of changes in the prevention of falls, change may be achieved in my area of practice through the cooperation and collaboration of medical personnel. There are however bound to be barriers in carrying out these solutions. These barriers include: resistance of staff to implement change; resistance of staff members to cooperate and coordinate with each other; lack or failure of communication; shortage of staff; and inadequate assessment processes. In order to address these barriers would include: gradual introduction of change; increase of collaborative activities with staff members; trainings which enhance coordination and cooperation of medical staff; hiring on more staff to fill in deficiency; and implementation of a strict assessment process by posting a checklist at each nurses’ station, as well as in the chart of each patient. Works Cited Dykes, P., Carroll, D., Hurley, A., Lipsitz, S., Benoit, A., Chang, F., Metzer, S., Tsurikova, R., Zuyov, R., & Middleton, B. “Fall Prevention in Acute Care Hospitals: A Randomized Trial”. JAMA. (2010), volume 304, number 17: pp. 1912-1918 Gates, S., Fisher, J., Cooke, M., Carter, Y., & Lamb, S. “Multifactorial assessment and targeted intervention for preventing falls and injuries among older people in community and emergency care settings: systematic review and meta-analysis”. BMJ. (2008), volume 336, number 7636: pp. 130–133. Gray, J. “Protecting Hospice Patients: A New Look at Falls Prevention”. Am J. Hosp Palliat Care. (2007), volume 24, number 3, pp. 242-247 Hendrich, A. “Inpatient Falls: Lessons from the Field”. PSQH (2006). 18 February 2011 from Huey-Ming, T. & Chang-Yi, Y. “Perspectives of Recently Discharged Patients on Hospital Fall- Prevention Programs”. J Nurs Care Qual, volume 24, number 1, pp. 42–49 Murphy, T., Labonte, P., Klock, M., Houser, L. “Falls Prevention for Elders in Acute Care: An Evidence-Based Nursing Practice Initiative”. Critical Care Nursing Quarterly, volume 31, number 1, pp. 33–39 Schwendimann, R., Buhler, H., De Geest, S., & Milisen, K. “Falls and consequent injuries in hospitalized patients: effects of an interdisciplinary falls prevention program”. (2006) BMC Health Services Research, volume 1472, pp. 6963-6969 Stenvall, M., Olofsson, B., Lundstrom, M., Englund, U., Borssen, B., Svensson, O., Nyberg, L., & Gustafson, Y. (2007) A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporosis. (2007), volume 18, number 2: pp. 167–175. Stevens, J., Corso, P., Finkelstein, E., & Miller, T. (2006) The costs of fatal and non-fatal falls among older adults. Inj Prev, volume 12, pp. 290-295 Read More