The Importance of Falls Risk Assessment in Elderly people Post Hip Replacement - Literature review Example

Investigation of a CG or CPI Issue The importance of Falls Risk Assessment in Elderly people Post Hip Replacement Introduction Falls risk assessment involves one pillar of clinical governance namely: clinical risk, which focuses on reducing risk and improving overall clinical safety. Preventing patient falls and harm is one of the objectives of clinical governance it is necessary to implement systems for prevention of patient falls, reducing incidence of patient falls as well as reduction of harm from falls (CSQHC, 2012, p. 5). Falls risk assessment involves comprehensive and systematic process of identifying an individual’s risk factor for falling and hence it involves governance for safety and quality of the patients at risk of falling (CSQHC, 2012, p. 5). As a result, falls risk assessment facilitates development of care place that identifies risk factors for falls. In Australia, the safety and quality healthcare commission requires healthcare organizations to set up and maintain systems for preventing falls and this includes screening or assessment of patients’ risk for falls as well as implementing multifactorial falls prevention strategies (CSQHC, 2012, p. 5). Therefore, this ensures that patients’ risk for falls is identified promptly and the necessary action taken. The focus of this paper is on the importance of falls risk assessment in elderly people post hip replacement. The significance of this topic is that whereas falls can occur at all ages, the incidence and severity of injuries allied to falls increases considerably with age (CSQHC, 2012, p. 6). In addition, the ambulatory dysfunction and functional impairment that result after hip fracture and resulting hip replacement surgery further elevates the fall risk among the elderly people (Colon-Emeric, 2012, p. 6). Hip fracture patients, especially the elderly are among the most frail and high-risk patients in hospitals (Colon-Emeric, 2012, p. 1). Elderly patients who have undergone hip replacement surgery after hip fracture are at risk of many complications, including risk for falls. It is therefore important to identify elderly patients after hip replacement, who are at high risk for falls in order to develop fall prevention strategies for the patients (Salpakoski et al, 2014, p. 6). Evidence shows that incidence of falls after post hip replacement procedures is higher as compared to the general community population and these findings encompass a higher rate of hip fracture (Hill et al, 2016, p. 1). Elderly people who undergo hip replacement have increased risk of falls and have decreased muscle strength after the surgical procedure which further increases their risk to falls (Hill et al, 2016, p. 1). Risk for falls is related to poor walking ability and this implies that postoperative period when pain and weakness can impact an individual’s walking ability and hence increased risk for falls (Mandl, et al, 2013, p. 91). Therefore, falls risk assessment in elderly people post hip replacement is an important clinical governance issue because falls risk assessment helps in reducing falls risk and improving overall clinical safety of elderly people post hip replacement. Literature Critique The study by Hill (2016) recruited 534 study participants and this sample is good, which has a high likelihood of achieving saturation. The inclusion/exclusion criterion of the study by Hill (2016) provides a detailed selection method. However, the study used a single private tertiary hospital in Perth, Western Australia and hence this makes generalization of the findings beyond this specific hospital difficult. Data after hospital discharge was collected through telephone calls. This is a good choice since data was collected without any bias from researchers. The overall rigor of methodology used in Hill (2016) is excellent because most of the rigor elements of rigor were present. Study by Colon-Emeric (2012) involved review of previous studies. Adequate previous studies were reviewed and but the article does not indicate search engines used in locating reviewed studies. There was not framework or theory to guide this study. Generally, the overall rigor of methodology is medium because most of the possible rigor elements were missing. In Mandl et al (2013), retrospective cohort study was used. The sample was adequate and hence the study achieved saturation. The inclusion/exclusion criteria provide a detailed selection method of the study participants. The data was obtained through interviewing and chart review was used in obtaining missing data. Independent interviewers obtained the data and this made the degree of research corroboration high. The overall rigor of methodology used in Mandl et al (2013) is outstanding because most of the rigor elements of rigor were present. Study by Swinkels et al (2009) had 117 participants and hence sample size was adequate which means the study achieved saturation.  A self-administered baseline questionnaire regarding falls was used to obtain data and this ensured collection of detailed and exhaustive data. Use of questionnaires also reduced bias during data collection. The study participants came from a diverse community dwelling and hence this made generalization of study results possible. However, the inclusion/exclusion criterion of the study does not provide a detailed selection method. Generally, overall rigor of methodology used in Swinkels et al (2009) is outstanding because most of the rigor elements of rigor were present. The study by Salpakoski et al (2014) was a prospective follow-up study with a sample of 81 community-dwelling hip fracture patients. This sample was relatively adequate and hence saturation was comparatively adequately achieved. A self-administered questionnaire was used to obtain data and this ensured collection of detailed and exhaustive data and also reduced bias during data collection. The inclusion/exclusion criterion of the study provides a detailed selection method. Additionally, study participants came from a diverse community dwelling and hence this made generalization of study results possible. Accordingly the representative sample is medium to high quality and this makes transferability and external validity on the high side. Overall rigor of methodology used in the study is exceptional because most of the rigor elements of the methodology were present. Findings Findings from the studies show that older patients who undergo hip replacement have higher risk of falls (Hill, 2016, p. 1). Falls among the elderly result to significant physical and psychological costs to the patients and may further result to more fractures, deteriorated ambulation or functional status and even death (Colon-Emeric, 2012, p. 8 & Salpakoski et al, 2014, p. 6). As a result, it is important to perform fall risk assessment to all elderly post hip replacement patients in order to identify their risk of falls and risk factors and hence implement appropriate interventions to prevent the falls. Fracture prevention lowers subsequent fracture rates as well as mortality and prevention is only possible if those at risk for falls are identified promptly through falls risk assessment (Swinkels et al, 2009, p. 179). (Mandl et al, 2013, p. 94) also found out that fall risk assessment helps in identifying older patients who are risk for post-discharge falls after hip replacement. These findings indicate that falls after hip replacement surgery can be reduced by performing comprehensive fall risk assessment by developing preventative interventions and also changing the underlying risk factors for falls (Mandl et al, 2013, p. 94). Fall risk assessment is important for identification of patients who may be at risk of falls in order to use fall prevention interventions. Swinkels et al (2009, p. 179) found out that identification of those at risk of falls is the first step in preventing falls. Consequently, fall risk assessment assists nurses in identifying patients at high risk for falls in order to initiate the required interventions (Mandl et al, 2013, p. 94). This is line with Swinkels et al (2009, p. 179) who established that fall risk assessment in this population is important in preventing and reducing falls by ensuring that the suitable interventions are implemented. References Colon-Emeric C, 2012, Postoperative management of hip fractures: interventions associated with improved outcomes, BoneKEy Reports, vol. 1, no, 241. http://www.nature.com/bonekeyreports/2012/121212/bonekey2012241/full/bonekey2012241.html Commission on Safety and Quality in Health Care, 2012, Safety and Quality Improvement Guide Standard 10: Preventing Falls and Harm from Falls, Sydney,ACSQHC. Hill A, Ross-Adjie G, McPhail S, Monterosso L, Bulsara M, Etherton-Beer C, Powell S & Hardisty G, 2016, Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study, MJ Open, vol. 6, no. 7. < http://bmjopen.bmj.com/content/6/7/e011139.full> Mandl L, Lyman S, Quinlan P, Bailey T, Katz J & Magid S, 2013, Falls Among Patients Who had Elective Orthopaedic Surgery: A Decade of Experience From a Musculoskeletal Specialty Hospital, Journal of orthopaedic & sports physical therapy, vol. 43, no. 2. < http://www.jospt.org/doi/pdf/10.2519/jospt.2013.4349> Swinkels A, Newman J & Allain T, 2009, A prospective observational study of falling before and after knee replacement surgery, Age Ageing, vol. 38, no. 2, pp. 175-181. < http://ageing.oxfordjournals.org/content/38/2/175.full> Salpakoski A, Törmäkangas T, Edgren J, Sihvonen S, Pekkonen M, Heinonen A, Pesola M, Kallinen M, Rantanen T & Sipila, 2014, Walking Recovery after a Hip Fracture: A Prospective Follow-Up Study among Community-Dwelling over 60-Year Old Men and Women, BioMed Research International, Volume 2014 (2014), Article ID 289549. < https://www.hindawi.com/journals/bmri/2014/289549/> Read More