Prevent and Reduce Falls in Elderly people Post Hip Replacement through Falls Risk Assessment - Term Paper Example

NURS2006 ASSIGNMENT 3 Clinical Practice Improvement Project Report Student Name, FAN and ID: Project Title: Prevent and Reduce Falls in Elderly people Post Hip Replacement through Falls Risk Assessment Project Aim: To reduce patient falls among elderly people post hip replacement by 25% in 6 months in Australia through effective fall risk assessment Relevance of Clinical Governance to your project Clinical governance plays a role of ensuring that patients receive safe and quality healthcare. This project is relevant to clinical governance in that falls risk assessment is an intervention performed to reduce risk and improve clinical safety by preventing and minimising falls (CSQHC, 2012, p. 5). Falls’ prevention is among the most important goals of clinical governance. Implementation of systems like falls risk assessment interventions is important for prevention and minimisation of falls and costs associated hospitalization (CSQHC, 2012, p. 5). This indicates that the proposed intervention for the project (falls risk assessment) is an important clinical governance issue because it not only ensures safety and quality of the patients at risk of falls but also reduces costs associated with hospitalisation after falls (CSQHC, 2012, p. 5). The relevance of this project to clinical governance is also stipulated within the Nursing and Midwifery Board of Australia (NMBA). According to standards of NMBA (2010) nurses are obligated to play a role in quality improvement activities. NMBA standards require nurses to constantly take part in activities that improve quality of nursing care, such as continuous review and using most recent evidence to review and improve current practices (NMBA, 2010). This project seeks to uphold the NMBA standards by taking part in the quality improvement activity, falls risk assessment. After the implementation of effective falls risk assessment for the targeted population, nurses will be key stakeholders in this quality and safety improvement activity. Additionally, this project will undergo constant review and evaluation in accordance with the most recent evidence. Therefore, the proposed intervention (falls risk assessment in elderly people post hip replacement) is a vital clinical governance issue because it prevents and reduces rates falls and also minimises hospitalisation and consequently lowers costs associated with hospitalization. Evidence that the issue / problem is worth solving: Evidence shows that a third of people aged above 65 years fall each year and this causes many negative health outcomes such as mortality, handicap and reduced quality of life (Child et al, 2012, p. 1). This is in line with Moncada (2011, p. 1270) who found out that falls are among the most common cause of deaths among individuals aged 65 years. Patients who have had hip replacement following hip fracture, especially the elderly have the highest risk of sustaining falls (Colon-Emeric, 2012, p. 1). The major reason for the elderly being high-risk patient in regard to falls is because the prevalence and severity of injuries allied to falls elevates significantly with age (CSQHC, 2012, p. 6). Accordingly, there is need to perform falls risk assessment in elderly patients who have had hip replacement to enable development of fall prevention strategies for such patients (Salpakoski et al, 2014, p. 6). Studies further show that incidence of falls in people who have had hip replacement surgery is much higher than the general population (Hill et al, 2016, p. 1). Specifically, aged people who undergo hip replacement surgery are at higher risk of falls and also they have weaker muscles due to the surgery and this further elevates the risk to falls (Hill et al, 2016, p. 1). In addition, evidence also indicates that after hip replacement surgery, the postoperative pain and weakness affects the ability of person to walk and this further increases the risk to later falls (Mandl, et al, 2013, p. 91). As per Salpakoski et al (2014, p. 6) falls among the elderly people significantly affects the patients physically and psychologically and this can further cause more fractures, worse ambulation and even result to death. Therefore, performing falls risk assessment is critical for all elderly people who have undergone hip replacement surgery because it enables identification of those at risk of falls as well as the risk factors to the falls. This aids in implementation of the suitable falls prevention strategies. Preventing future falls reduces subsequent fractures and also mortality that results from the falls (Swinkels et al, 2009, p. 179). Evidence also shows that falls risk assessment is important in identifying patients who are at risk of falls after being discharged from hospital (Mandl et al, 2013, p. 94). It is thus evidence that carrying out comprehensive falls risk assessment for elderly patients post hip replacement surgery is important in order to develop falls preventative interventions (Mandl et al, 2013, p. 94). Key Stakeholders: Stakeholders in this project will include the management and leaderships in the hospitals, the doctors, and the nurses and other stakeholders such as physiotherapist. The management is a major stakeholder in this project because they will be directly involved in the implementation of this project in the hospital. The management has the responsibility of catering for the costs of this project as well as ensuring that adequate resources are provided for throughout this project. Doctors are also key stakeholders in this project because they are the healthcare providers who will be in charge making diagnosis and prescribing the course of treatment for the population (elderly people post hip replacement) involved in this project. Nurses will also be key stakeholders in this project. This is because they are the primary caretakers of the patients and hence they will be solely involved in performing falls risk assessment. In addition, since nurses are actively involved in patient’s care, they will provide useful information regarding falls risk among the study population throughout the project. CPI Tool: PDSA (Plan, Do, Study, Act) The planning and implementation of this project will be done the PDSA tool. PDSA tool compromises of four phases namely, Plan, Do, Study and Act. PDSA tool is valuable in implementation of quality improvement projects since it operates in a cycle and hence the quality improvement process is continuous (WHO, 2009, p. 2). PDSA tool will be used in developing falls risk assessment tool to be used in assessment of old people who have undergone hip replacement surgery. Plan This project is going to assess if falls risk assessment prevents and reduces falls among elderly people post hip replacement. The first goal in planning phase will be to reduce falls among elderly people post hip replacement will have reduced by 25% within 6 months. The second goal will be to educate all newly hired nurses on falls risk assessment by the end of 3 months. This will be achieved by performing falls risk assessment to reduce falls among elderly people post hip replacement; performing post-intervention audit a month after the launch of fall risk assessment project and carrying out second post-intervention audit and obtain the number of falls between the two months. Do This will involve implementing the change (falls risk assessment among elderly post hip replacement) by performing the following tasks: Evaluating the cost of the project and solicit for the funds and resources from the appropriate department; Assigning of roles to every team member involved in the project; Minimizing resistance to implementation of the change by educating staff members as well as the management regarding the significance of the change; Assessing where the units and wards where falls risk assessment is mostly needed within the hospitals; Training nurses on how to carry out effective falls risk assessment; Implementing the change by making falls risk assessment among the elderly post hip replacement, a part of the day-to-day operation of the system; Evaluating nurses compliance to falls risk assessment on elderly post hip replacement patients and evaluating the rate of falls among the elderly post hip replacement patients after this application of the intervention Study This phase will consist of: collecting the results from the previous audits and compare against baseline findings; examining the results after implementing the intervention and comparing with pre and post interventions audits data and studying and comparing the number of falls among the elderly post hip replacement before the project and after the implementation of the project Act This is the final phase and in this project it will encompass: Performing the falls prevention strategy by performing falls risk assessment on all elderly post hip replacement patients: Poster presentation on effective falls risk assessment held at the monthly unit based council meeting: Poster presentation on falls risk assessment knowledge held at the weekly staff meeting for further knowledge improvement and additional training on falls risk assessment and more rigorous falls risk assessment on the project population will be conducted basing on the collected data Summary of proposed interventions: Application and approval of funds The first activity will include applying for funds from the management in conjunction with the accounting department in order to have funds approved to carry out the project successfully. Even though this project will not have high costs, it will be necessary to purchase and stock falls risk assessment equipments. In addition, it will be necessary to buy materials for training the staff members who will be involved in the project. For example, there will be brochures handout for each nurse during training session. Training the nurses and other stakeholders As aforementioned, it will be necessary to train nurses who will be performing falls risk assessment as well as all stakeholders who will be involved in this project. This will take some time as it will be necessary to ensure that everyone involved in this project has the necessary skills. Training will involve educating nurses how to handle the assessment appliances as well as on how to practically perform falls risk assessment. Training will be conducted by experienced and skilled professionals on falls risk assessment on the elderly. The training team will consist of professionals such as doctors, specialist nurses as well as physiotherapists Data collection on rate of falls Data will need to be collected on the rate of falls. Collection of data will be performed prior to the implementation of the project and after the project’s implementation. The collection of data will be done using an open-ended questionnaire as well as through interviewing and obtaining data from the hospital records. Persons responsible for data collection will be trained on how to effectively collect data. The collected data will be analysed and then used for the specific purposes throughout the project. Barriers to implementation and sustaining change: There are various barriers that may impact negatively on the implementation process of the project. The implementation process requires financial resources in order to facilitate training and development of the key stakeholders. Lack of adequate financial resources is one of the barriers to the implementation process. Managerial support is an important aspect during the implementation of any strategy aimed at improving on the quality of care (Russo, Barnett, Cheng, Richards, Graves & Hall, 2015, p. 4). The lack of managerial support is a barrier as some of the management staff members do not fully understand the problem and its effects. Some of the stakeholders such as nurses who are directly involved in the provision of care to the patients will be required to change their methods of operation. This therefore presents a change management problem as the nurses are used to the old practice. Resistance to change is therefore a barrier that may affect the implementation process. Resistance by the organizational employees as well as other stakeholders is very common during implementation of changes in organizations. In addition, implementation of this program maybe hindered by lack of enough supervisory staff available to train the project stakeholders regarding this project and also failing to sufficiently involve all healthcare providers in this project (IMPAQ International, 2014, p. 11). Evaluation of the project: Data will be collected pre and post project and then compared. This will involve collected data on the rate of falls among the elderly post hip replacement patients before and after implementation of the project and then comparing the data. A reduction on the rate of falls after the implementation of this project will indicate efficacy of the falls risk assessment in reducing and preventing falls. However, if there is no reduction on the rate of falls among the study population, it will imply that the project was not effective in reducing the falls. Interviews will also be used to collect feedback regarding the efficacy of the project. Patients will be interviewed to find out if they are experiencing lesser falls after falls risk assessment. Their feedback will be documented for analysis to find out if they experienced reduced falls after implementation of the project Nurses will also be audited to examine if they are adhering to the fall prevention intervention (falls risk assessment) Reference List Nursing and Midwifery Board of Australia (NMBA) (2010), Available at: http://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Codes-Guidelines.aspx Child S, Goodwin V, Garside R, Boddy K & Stein K, 2012, Factors influencing the implementation of fall-prevention programmes: a systematic review and synthesis of qualitative studies, Implement Sci, vol. 7, no. 91. 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. IMPAQ International, 2014, Advances in the Prevention and Control of HAIs, Columbia, IMPAQ International. Russo P, Barnett A, Cheng A, Richards M, Graves N & Hall L, 2015, Differences in identifying healthcare associated infections using clinical vignettes and the influence of respondent characteristics: a cross-sectional survey of Australian infection prevention staff. Antimicrobial Resistance and Infection Control, vol. 54, no.29. 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> Moncada L, 2011, Management of Falls in Older Persons: A Prescription for Prevention, Am Fam Physician,vol. 84, no. 11, pp:1267-1276. Russo P, Barnett A, Cheng A, Richards M, Graves N & Hall L, 2015, Differences in identifying healthcare associated infections using clinical vignettes and the influence of respondent characteristics: a cross-sectional survey of Australian infection prevention staff. Antimicrobial Resistance and Infection Control, vol. 54, no.29. 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. 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. World Health Organisation (WHO), 2009, WHO Guidelines on Hand Hygiene in Health Care: a Summary NURS2006 Assignment 3 - CPI paper Marking Rubric PERFORMANCE STANDARD CATEGORY & WEIGHTING Excellent Work Good Work Passing Work Unsatisfactory work Project Aim and Evidence the issue is worth solving 20% Aim succinct & clearly defined. All evidence relevant & rigorous. Shows a very high level of insight & relevance to the issue. (17-20)  Aim well defined. Some irrelevant information but most evidence relevant & rigorous. Shows a very good level of insight & relevance to the issue. (13-16.5)  Aim stated with some ambiguity. Some evidence relevant and rigorous, Acceptable level of insight. Quite a lot of irrelevant information is present. May be overlong/ too brief (10-12.5)  Aim not clearly stated Most evidence is not relevant or rigorous. Poor level of insight & relevance to the issue. Significant amount of irrelevant/ missing information. (0–9.5)  Relevance of Clinical Governance to your project 10% Succinct and highly relevant discussion of the relevant pillar of clinical governance related to the chosen clinical issue. (9-10)  Succinct and mostly relevant discussion of the relevant pillar of clinical governance related to the chosen clinical issue. (7-8.5)  Adequate discussion of the relevant pillar of clinical governance related to the chosen clinical issue. Some parts not relevant Overlong / too brief, may be missing relevant information. (5-6.5)  Inadequate discussion of the relevant pillar of clinical governance related to the chosen clinical issue. Overlong / too brief, may be missing a significant amount of relevant information (0-4.5)  Key Stakeholders 5% Identifies most relevant key stakeholders. Discusses clearly how they could be involved in the project. Succinctly and expertly written. Very high level of insight into the role of stakeholders. (4.5 - 5)  Identifies some relevant key stakeholders and adequately discusses how they could be involved in the project. Very well written. Good level of insight into the role of stakeholders. (3.5-4.25)  Identifies a few relevant key stakeholders. Mentions briefly how they could be involved. Quite well written but contains some irrelevant information, or minor information is missing. Adequate level of insight into the stakeholder role. (2.5 – 3.25- )  Contains irrelevant information, or major information is missing. Inappropriate or no key stakeholders are identified Poor insight into the stakeholder role. (0-2)  Clinical Practice Improvement Tool 20% Describes a relevant CPI tool Very clearly discusses how it could be used to address the aim and implement the interventions. Succinctly and expertly written with no omissions of relevant information. (17-20)  Describes a relevant CPI tool Discusses quite clearly how the tool could be used to address the aim and implement the interventions. Well written but may contain some irrelevant information, or some minor information is missing (13-16.5)  Describes a relevant CPI tool and adequately discusses how the tool could be used to address the aim and implement the interventions. Not succinct, contains irrelevant information, significant information is missing (10-12.5)  A relevant CPI tool is not identified. There is no adequate discussion of how the tool could be used to meet the aim or implement the interventions. Contains irrelevant information or some major information is missing. (0–9.5)  Summary of proposed interventions 20% All relevant interventions are discussed very well. Project outline is very clear and the relevance to clinical practice is very high. (17-20)  Most relevant interventions discussed quite well. Project outline is clear & relevance to clinical practice is good. Contains some irrelevant information, minor information may be missing. (13-16.5)  Acceptable level of relevant interventions discussed. Project outline mostly clear, although it may be unclear how the project would actually be implemented in clinical practice due to irrelevant/missing info (10-12.5)  Some elements missing or incomplete. May contain large amounts of irrelevant information. Project poorly described and it is unclear what the project actually entails or its relevance to clinical practice. (0–9.5)  Barriers to Implementation 15% Identifies most potential barriers to implementation & clinical change. Discusses in depth how these barriers could be overcome or minimised. (13-15)  Identifies some potential barriers to implementation & clinical change. Discusses how these barriers could be overcome or minimised. (10-12.5)  Identifies a few potential barriers to implementation & clinical change. Discusses how barriers could be overcome or minimised. Minor omissions and/or some irrelevant information present (7.5-9.5)  Relevant barriers not identified. Poor or no discussion about how they could be overcome or minimised. Major omissions, much of the information provided is irrelevant / unrelated to the CPI goal. (0-7)  Evaluation of the project 10% Succinct discussion of an excellent and achievable plan for how the intervention/s could be evaluated. (9-10)  Succinct discussion of a very good and mostly achievable plan for how the intervention/s could be evaluated. (7-8.5)  Discussion of an adequate plan for how the intervention/s could be evaluated. Some parts not relevant or achievable Overlong / too brief, may be missing relevant information. (5-6.5)  Plan absent or not well described. Most or all of the plan is not relevant or achievable Overlong / too brief, may be missing a significant amount of relevant information (0-4.5)  Name of Marker Grade Overall Comments Read More