The National Health Services Analysis - Essay Example

?Select and critically appraise a policy document that is relevant to your area of practice. Critically analyse the evidence base, for the development of a plan to support the implementation of this aspect of policy in practice. Introduction The National Health Services has established the Slips, Trips and Falls policy in order to impact on all individuals involved in healthcare delivery of healthcare services as part of the general population or as contractors. The policy of the NHS Direct is basically to guarantee that all staff members and contractors within the Trust premises feel that they are being protected from the risks which are associated with slips, trips, and falls. It is a policy which provides a foundation by which the trust is able to secure its prevention via risk assessment and maintenance activities. The Trust also guarantees that slips and trips and falls experienced by staff visitors as well as contractors are reported and then managed by the Trust. The National Health Services white paper has established plans in order to secure savings from their delivery of health services, allowing these savings to be reinvested in the primary care services of the agency. The Department of Health (2012) has declared that the health care system in general is being challenged to improve the quality of their health services while still trying to reduce its cost and financial impact. As such, savings can be secured by changing the practice and the NHS system. Possible savings which nurses can provide to overall services represent millions of pounds a year (Gainsbury, 2009). Such potential must therefore be explored and expanded. Through the NHS Institute for Innovation and Improvement, there are several high impact actions which come from data suggested by nurses and midwives in the UK. Falls prevention is one of these HIAs which seem to call for new processes in management (Power, 2009). The nursing profession is one which has, from the very start been focused on securing quality care for the patients (Fabre, 2009). I am a nurse working fulltime and in the unit where I am assigned to, fall risks are one of the problems identified, and its prevention seems to merit more improvements in the current existing policies on slips, trips, and falls. Slips, trips, and falls prevention and management managed to provide an updated standard in the management and prevention of falls. The policy impacts on all in-patient admissions as well as staff members. As discussed by Andersson, et.al., 2006 there have been identified issues in the planning and implementation of the policy. Andreoli, et.al., (2010) points out that the implementation of policies seem to be removed from reality, especially as many policy-makers and recipients often do not understand or appreciate the processes which are needed in order to make the policy work. Kubler (2001) highlights that fact that the passage of legislation of policy is not necessarily associated with the achievement and accomplishment of policy goals and objectives. In the hospital where I work, the top-down policy implementation process is being implemented. This has allowed for the implementation of the policy from the management level down to the employee level. Based on the data gathered by the NHS, the issue of slips and falls is a significant one and the NHS has understood the importance of prioritizing falls prevention and management (Laurance, 2012). Based on a review of the present data on slips, trips and falls, specific changes were made on its implementation (Laurance, 2012). The goal of preventing and managing falls and its risks is to improve the safety of patients and health professionals who are exposed to risks of falling (NHS, 2010). The policy is mostly related to the assessment of data, the implementation of preventive measures, as well as the implementation of multi-disciplinary working. It also secures guidelines for the staff, giving standards which seek to manage the unit’s prevention strategy, to reduce inpatient falls, and consequently decrease the prevalence of falls and slips (NHS, 2010). Ability to make decisions based on the implementation of specific policy The nature of my position in the hospital does not provide an enlightening role in terms of making decisions relating to managing and implementing the policy. I consider this a significant gap and issue in policy implementation. In general, my contributions to the policy implementation mostly referred to the act of ensuring that there were no physical barriers to falls, risks, and trips. This included keeping floors dry, hiding wires, taping down carpet edges, and keeping hallways well-lit, among others. The goal of these activities was to implement changes in the current applications of the practice. Policy-making does not only refer to a specific decision applied or made at a specific time, but it is mostly understood as the constant interaction between the different structures and institutions involved, including interest groups and ideas (John, 1998). This would indicate that health policy assessment requires the assessment of factors relating to the role of the state, the impact of different actors, the manner or means by which they use power, the stylings of political systems, as well as the tools for participation (Walker and Gilson, 2004). Policy analysis would likely assess the impact of values systems and how these are managed through ideas and argument. Most of the studies on policy assessment have provided a description on the direction of specific policies; but not much research has secured elements relating to actual policy change (Walker and Gilson, 2004). This has impacted on general knowledge on actors as well as processes on health policy-making. Policy-making has also helped explain why some health issues often garner political notice. Even with political will being labeled as critical to decision-makers in providing major interest in various health issues, not much is known about how it actually manifests and how it is managed (Shiffman, 2007). These policies also allow users to identify which stakeholders may support and who may reject change; in effect, strategies can be applied in order to improve the possibilities for reformist groups. Through policy-making, obstacles which compromise implementation can also be identified. Walker and Gilson (2004) discuss that in assessing the impact of nurses and health workers in managing South Africa’s free health care policy, they focused on clearly understanding staff experiences, mostly on personal and professional impact of the policy. Their assessment established that nurses were often asked to implement policies where they were not often consulted, and whose impact on their routines and activities were often ignored (Walker and Gilson, 2004). Features of the policy process including nurses’ values, especially perceptions of patients had major effects on how the free health care policy was secured for the practice. The possibilities of managing gaps in the policy implementation have often been based on communication and a general understanding of policies as indicated by nurses and service users. As a nurse, I was tasked to ensure that these various physical risks for slips and falls were managed. In the process of implementing these activities, I was also tasked with monitoring data on falls, slips, and trips within the unit for three months. As a result, I was able to secure pertinent data relating to decrease of falls, slips, and trips after my assigned activities were implemented. I was eventually able to make an assessment of the falls issue in the healthcare system. I was also able to open up a rich discussion with my colleagues on the problem. These activities provided an outlook of how the agency was seeking to manage the issue and how the different healthcare workers were able to present their ideals in policy implementation. In the process, I have understood my contribution and impact on the prevention and management of the policy in the unit where I am working. Critically explain the strategy for improving quality, service outcomes related to an aspect of the policy including educating and influencing people who influence and make decisions. The specific steps indicated in the training relating to falls prevention and management have managed to increase the competence and knowledge of the nurses and other health professionals (Beauchet, et.al., 2009). As a result, these health professionals have become even more motivated in managing various aspects of the policy. Research-based data on best practice of slips, trips, and falls revealed various interventions depending on targeted patients, health care professionals, safety resources, or all these elements covered equally (Browne, et.al., 2004). Majority of the remedies covered healthcare provider behaviour often referring to the application of a new risk assessment approach, as well as additional equipments. Other interventions were focused on specific healthcare professionals, especially nurses; other studies focused on multi-disciplinary approaches (Browne, et.al., 2004; Boltz, et.al., 2009). Most interventions established covered multi-component remedies with common elements including individual fall risks as well as the education of staff and patients as well as their families. Other studies, including those pertaining to risk assessment were able to establish their own assessment tool; however, not all of these studies were able to evaluate the reliability of these tools (Chapman, et.al., 2011). Studies also suggest the testing of specific equipment, including low beds (Haines, et.al., 2010), bed alarms (Spiva and Hart, 2013), the use of carpets instead of vinyl floorings (Rosen, et.al., 2013). Older studies also suggest equipment check as a standard aspect of falls prevention, and this suggestion has also been adopted by newer studies (Nelson, et.al., 1986). More frequent and regular nursing rounds, including specific toilet schedules for patients were also indicated by studies on fall risks and fall prevention (Callahan, et.al., 2009; Dykes, et.al., 2010). Other studies also suggested the application of different signs indicating patient risks (Edmonson, et.al., 2011). These signs are indicated on rooms, beds, or on patient wrist bands. These signs are also meant to warn the health professionals on cautions which must be taken on the patient, especially in terms of preventing falls and slips (Edmonon, et.al., 2011). An assessment of numerous studies indicates varying improvements observed from patients. Majority of interventions are unique and focused on individual patients and their needs (Gates, et.al., 2008). The units and patient qualities are also diverse across studies, often preventing an adequate comparison of the interventions. The diversity in terms of fall rates was also very much apparent, especially as some improvements were seen in fall rates depending on the conditions of the research and patient setting (Graf, 2008). Successful and effective interventions mostly related to at least some form of fall prevention intervention applied, instead of no prevention risks applied. Authors also admitted that it is not always possible to totally prevent all falls in the acute care settings (Graf, 2008; Haines, et.al., 2006). Based on the complicated and multi-disciplinary nature of various interventions, it is difficult to actually indicate specific remedies or to suggest which elements must be present (Harrington, et.al., 2010). Fall prevention interventions for acute care facilities focus on addressing the identified risk factors during admission. It is therefore important to screen the patients first on their fall risks as well as their functional ability in order to ensure that referrals during the follow-up of falls prevention management would be implemented (Harrington, et.al., 2010). The management of risk factors for falls have a more significant impact on falls prevention. Screening tools are very much significant as they can support routine clinical management and indicate more specific assessments and management of older adults (Harvey, et.al., 2010). All adults admitted to hospitals must be assessed for fall risks, and such screening must be carried out as soon as possible after admission (Harvey, et.al., 2010). The emergency unit has a significant opportunity in the screening of patients. Such screening must be carried out when changes in functional status are seen and when the patient’s environment also changes (Helfrich, et.al., 2009). In terms of balance and mobility issues, ongoing balance and mobility issues must be referred to post-hospital falls prevention and exercise programs after discharge (Hilbe, et.al., 2010). This would include an ongoing liaison with the family physician or nurse practitioner. In assessing balance, mobility, strength, the assessment tool must measure the balance and movement issues as well as muscle weakness (Hilbe, et.al., 2010). The assessment tool must also assess possible adjustments in balance and strength. The prevention and management of falls, slips, and trips in instances where cognitive impairment is assessed would also include a thorough evaluation of the patients (Hill, et.al., 2009). Older adults often present with these issues which often make them vulnerable to falls. Once again, the assessment of the risk must be carried out in order to evaluate the possible cause of potential falls and how changes can be made to reduce the risk (Hill, et.al., 2009). The older adults manifesting with delirium must therefore have such delirium managed first. The participation of caregivers and family members must also be established in order to further understand what and how interventions can work in the management and prevention of fall risks (Hill, et.al., 2010). The management and prevention of falls and fall risks also relates to the use of appropriate footwear (Hill, et.al., 2004). Foot pain and other foot issues must be noted upon their admission to the hospital, followed by the assessment of footwear. The hospital staff must instruct the patients on the importance of wearing proper footwear in order to guarantee their safety (Hill-Rodriguez, et.al., 2009). Encouraging patients to wear properly fitting footwear is an important aspect of fall prevention, including the use of hospital-issued footwear. The primary consideration in implementing this policy is that in general, reducing falls would also reduce harm (Jeske, et.al., 2006). Primary training in the prevention and management of slips, trips, and falls is based on the Development Teams for the various clinical groups. Moreover, training is presented to staff where numerous incidents of falls are apparent on a regular basis (Jorstad, et.al., 2005). Self-awareness and education/information are major variables which are applied in order to ensure efficacy of policies (Kehinde, 2009). It is crucial for individuals who are occupying influential positions to ensure that all the health professionals are informed about the risks in the practice, as well as the means and strategies they can implement in order to manage such risks. In this case, there are numerous falls which are being experienced by patients and even staff members in various health units (Kehinde, 2009). These are however very much preventable falls for as long as staff members are properly informed about the risks they are facing in the practice, as well as the risks which patients are exposed to on a daily basis. The information and education would also indicate that falls and slips are also costing the NHS thousands of pounds, as well as placing a burden on healthcare delivery through occupied beds and which could have been allocated to other patients (Kim, et.al., 2007). Aside from costs to hospitals and healthcare services, losses in relation to hours worked are also related burdens. Lawsuits are also offshoots of falls and slips, and costs of litigation all represent added burdens on patients, as well as various work agencies. Through information, different elements have also been assessed as impacting on falls. These elements relate to aging, nurse shortages, inadequately trained staff, limited resources, as well as previous incidents of falls (Lord, et.al., 2003). Policies and strategies in the prevention of falls have been provided by different hospitals, however, these policies have not adequately decreased fall rates. Cost-saving rates were seen to amount to 16,500 pounds for each year according to the NPSA (2007). Such amount was based on the application of improvements on current practice, including alarm systems, risk, assessment practices, and exercise activities which decreased fall incidents to a certain extent. These numbers represented represent an increased need to improve the current policy on falls prevention. The main decision-makers for this policy must be made aware of the issue and must understand the specific elements of the policy, mostly allowing for training on falls prevention for the nursing staff (Mitchell, et.al., 2010). Processes would include the evaluation of contributory elements to falls, including preventive barriers in policy implementation. In general therefore, the tools in informing the policy-makers can include elements like raising awareness, identification of needs, identification of gaps in the implementation, policy monitoring, and mobilization of support (Myers, 2003). Secondary prevention of slips, trips, and falls Secondary prevention processes would be based on the type of injury suffered by the patient. In cases of hip fracture which is the common type of injury suffered by older adults, hip protectors are advised (Coussement, et.al., 2009). Hip protectors which therefore directs energy away from the point of impact is effecting in decreasing the impact of possible falls on the injured femur (Lord, 2007). These protectors may come in the form of pads or shields which are then fitted in the pockets in specially designed underwear in order to reduce the impact of falls. They are not meant to prevent falls, but they do reduce the impact of these falls (Lord, 2007). Such hip protectors have been known to reduce the impact of falls on numerous adults at risk of falls, especially among nursing home residents. Ensuring the safety of floors is also an important element in the secondary prevention of falls. Flooring material which secures firm walking surface has been developed under laboratory conditions (Drahota, et.al., 2011). These floors are meant to prevent falls as well as decrease the impact of the fall through energy absorbing materials. Multifactorial falls risk assessment is a means by which better efficacy in the prevention programs can be achieved. Such program proved to be an effective element in a review discussing sixty randomized controlled trials (Chang, et.al., 2004). Practice guidelines also emphasize multifactorial community and institutional prevention activities. The prevention process can focus first on fall-related injuries among older adults, mostly living independently or in nursing homes (Moller, et.al., 2003). Community interventions can include behavioral instructions and training on the management of specific risk factors, including gait or balance issues; moreover, exercise can also improve muscle strength (Moller, et.al., 2003). Medication adjustments may also necessary for some patients, especially those taking medicines which can drowsiness or dizziness. In a systematic review of health and environmental intervention programs among community dwelling adults and among older patients having a history of falls, studies indicate that multifactorial elements include behavioral and environmental aspects (Stevens and Olson, 2000). In effect, exercises to manage strength and balance help reach improved patient outcomes, including environmental modifications, health education, medication review and risk factor reduction (Stevens and Olson, 2000). In another study, the elements of successful multidisciplinary remedies include exercise activities which help manage gait and balance training, as well as those which instruct on the efficient application of assistive tools provided by occupational therapists (Stevens and Olson, 2000). Evaluation and management of postural hypotension, as well as the removal or modification of environmental hazards form part of the secondary prevention processes for falls Falls are often seen in residential care facilities. For these incidents, applying multifactorial remedies have also seen success in falls prevention. Sufficient resources have been secured in the delivery of services for these programs (Shoba, 2005). Multifactorial interventions include the application of comprehensive and individualized assessment measures with specific safety recommendations focusing on environmental and personal safety, mostly on managing room lighting, flooring, and footwear, and also the use of wheelchairs, exercises, balance, transfer and ambulation, and other comprehensive programs (Shoba, 2005). In a randomized trial of nursing homes which covered 500 residents, the evaluation secure intensive and diverse interventions for environmental modifications, including wheel locks for beds, improvements in lighting, modification of floor plans, and better attention given to patient needs. There is also a need to secure interventions which would help institutionalize fall prevention in nursing homes, especially alongside programs designed to manage high-risk patients (Stevens, 2000). More specific and systematic remedies include gait training and instruction on the use of assistive tools, the modification of medication, exercise training focusing on balance training, management of environmental hazards, treatment of cardiovascular diseases, including cardiac arrhythmias (Al-Faisal, 2000). Conclusion The policy Slips, Trips, and Falls Prevention as secured by the NHS provides efficient suggestions and standards on the prevention and management of falls, slips, and trips. These policies also provide guidelines for health workers in terms of assessing the fall risk. In the current setting, some improvements have been seen in the incidents of falls in the unit where I am working. However, these policies need a more engaged participation from all healthcare professionals. There remains a gap between policy and implementation. This has always been a problem with most policies. However, various recommendations must be drawn from evidence-based practice which provides strong and effective guidelines on fall prevention and management, both in the primary and secondary setting. References Al-Faisal, W., 2006. Falls prevention for older persons Eastern Mediterranean Regional Review [online]. Available at: http://www.who.int/ageing/projects/EMRO.pdf [Accessed 04 April 2013]. Andersson, A., Kamwendo, K., and Seiger, A., 2006. How to identify potential fallers in a stroke unit: validity indexes of four test methods. 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