Significance of Falls Risk Assessment as a Falls Prevention Strategy in Older People - Case Study Example

NURS2006 ASSIGNMENT 3 Clinical Practice Improvement Project Report Student Name, FAN and ID: Type your assignment into the white spaces in the template and the rows will expand as much as you need them to.ie Alex Smith smit0000 ID 1234567 Project Title: Significance of falls risk assessment as a falls prevention strategy in older people Project Aim: To reduce the rate of falls in Canterbury Hospital, Campise NWS, Australia by 25% for the elderly in-patients in 6 months using Fall Risk Assessment as the falls prevention strategy Relevance of Clinical Governance to your project This project is relevant to clinical governance because it focuses on preventing harm and ensuring patient safety. The project will be helpful in risk management in regard to minimizing risks to patients by performing fall risk assessment to the older people and implementing systems to minimize the risks and hence prevent falls. Clinical governance requires health organizations to put in place systems for ensuring that the incident of patient falls is reduced as well as harm from falls. Therefore, this project proposes fall risk assessment as the best practice-based intervention to prevent falls of the patients while in the hospital. All elderly patients on presentation, after being admitted and if clinically indicated will undergo fall risk assessment and the necessary preventative measures implemented to any person who is at risk of falls. In addition, healthcare providers especially the nurses who will participate in this project will get an opportunity to develop their skills which is vital in nursing profession. In addition, falls have impact high costs to the consumers and Australia at large. AIHW (2013, p. 1) indicates that falls cost the Australian community more than $806 million annually in direct healthcare system costs. This is supported by Morello et al (2015) who explain that falls rate within acute hospital setting are very high and evidently result to longer hospital patient stays as well as increased hospital costs. The resource burden of falls within hospitals is significant for the Australian hospital system (Morello et al, 2015, 368). Falls are also significant source of harm within hospitals and consist of approximately 40 percent of all reported patient incidents. As a result, falls also result to extra hospital costs due to their impact on hospital length of stay and resource utilization. Evidence indicates that falls among in-patients are extremely prevalent where 3.6 percent of all admitted patients experience falls and third of these falls result to injuries (Morello et al, 2015, p. 368). Consequently, falls are a major burden on hospital resources due to the resultant increases in hospital length of stay and costs, where patients who sustain falls during their admission have almost twice the length of stay and costs as compared to the in-patients who do not experience falls (Morello et al, 2015, p. 367). This study also indicated that more than 50 percent of the additional costs allied to fall injuries are attributable to the falls and not the ensuing injuries (Morello et al, 2015, 369). Therefore, since clinical governance also aims to decrease healthcare costs, the healthcare costs associated with falls indicate the relevance of this project to clinical governance. Prevention of falls is one of the key pillars of clinical governance in order to ensure there is delivery of safe and quality healthcare. Evidence that the issue / problem is worth solving: Fall rate is extremely high among the elderly and falls cause significant harm in this population. Commonwealth of Australia (2009, p. 1) shows that the incidence rate of falls in older people in Australia is 35%; this indicates the high rate of falls in this population. Evidence indicates that falls among the older population are the leading cause of injuries and ensuing injuries and they also result to high rate of mortality and morbidity. In addition, falls are among the main contributors to immobility in the older population as well as early place in nursing home institutions (Goodwin et al, 2014, p. 2). Studies also show that falls among the elderly place a significant burden to the healthcare system (Phelan et al, 2015, p. 282). Falls also result to significant injuries, disability, reduced quality of life and even death among the elderly. Falls have been shown to be the leading cause of injuries in older people and also are the major cause of their hospitalization. According to Commonwealth of Australia (2009, p. 1) falls have several precipitating causes and predisposing factors which makes diagnosis, treatment and prevention of falls difficult clinically. Additionally, evidence has shown that falls in older people have multi-factorial, interacting predisposing and precipitating causes such as poor vision or gait disorder and this makes them very susceptible to falls Commonwealth of Australia, 2009, p. 1). Fall risk assessment has been shown to be an effective tool in falls prevention (Phelan et al (2015, 284). A comprehensive fall risk assessment consists of: falls history, medication review, physical evaluation, functional assessment and also environmental assessment. A comprehensive fall risk assessment has the ability to identify factors that contribute to falls, for example medications that can contribute to falls and as a result the medications can be reviewed (Milos et al, 2014). Identification of risk factors to falls can be effective in preventing falls. Consequently, the significance of falls risk assessment is that it helps in identifying risk factors to falls and then the appropriate interventions are used to prevent falls. As Goodwin (2014, p. 2) shows, in order to implement the appropriate fall prevention interventions, performing a comprehensive fall risk assessment is imperative in order to establish an individual’s risk or susceptibility to falls and then implement personalized tailored interventions for falls prevention. Milos et al (2014, p. 3) also explains that falls risk assessment has been effective in reducing the high rate of falls among the elderly through identification of all risk factors and consequent implementation of the suitable interventions. Key Stakeholders: Stakeholders in this project include the management, nurses, physicians, pharmacists, elderly patients and their parents. The management is a major stakeholder in this project because they are the ones who will sanction this project and the management will also provide resources and funds to oversee conducting of the project. Physicians will also play a critical role in this project. The role of physicians will be to identify patients at risk of fall and refer them for assessment. This is because physicians have the sole responsibility of diagnosing and prescribing the appropriate assessment tests for patients. Nurses will also play extremely important role in this project. They will be the primary healthcare providers because they will be actively involved in the project’s activities. For example, it is the nurses who will be performing fall risk assessment and also implementing all interventions prescribed by physicians after the results of falls risk assessment. Pharmacists will also be critical in this project. For example, pharmacists are the ones who will be involved in providing all the prescribed medications and medical equipment to the elderly patients after fall risk assessments. The older persons and their persons are also important stakeholders in this project. In this regard, they will be provided with information about the project and informed about all activities that will be carried out throughout the project. CPI Tool: The Plan Do Study Act (PDSA) The Plan Do Study Act (PDSA) tool will be used in implementing change in this project. The PDSA cycle is used in testing changes by creating of a plan to evaluate the change (Plan), conducting the test (Do), observing and learning from the outcomes (Study), and establishing the adjustments that should be made to the test (Act) (Taylor et al, 2013, p. 1). Plan The plan of this project is to reduce the rate of falls in Canterbury Hospital, Campise NWS, Australia, by 25% for the elderly in-patients in 6 months using Fall Risk Assessment as the falls prevention strategy. The project plans to achieve this object by devotedly performing effective falls risk assessment to older patients. The second plan is to perform post-project audit in order to determine the success rate of falls risk assessment in preventing falls. Do Several activities will be performed in this stage. The first step will be to estimate the project’s expenditure and solicit for the funds. This phase will also include seeking for the required resources. This phase will also include evaluating the patients at high risk of falls and assessing the hospital’s areas that are likely to be high risk areas in regard to falls in order to determine where fall risk assessment is needed most. This phase will also involve training all the project stakeholders on the entire project’s activities and how to conduct the project. For example, nurses will receive training on how to perform effective fall risk assessment and also on how to handle all the projects equipment. Finally, this phase will involve educating the staff members and also the elderly patients about the study in order to ensure that there is no resistance to change. Study This phase will consist evaluating the entire study to find out if the project was effective in reducing the rate of falls in the hospital. Therefore, the hospital records and statistics on the rate of falls before and after the project will be studied in order to evaluate if the fall rate has reduced or not. This phase will also involve observing if the healthcare providers are conforming to the required fall risk assessment tool. Act The phase will entail making adjustments where necessary. For instance, if the study phase establishes that nurses are not adhering to the fall risk assessment intervention, it will be necessary to educate them on significance of adhering to the intervention. Additionally, if the rate of falls is discovered not to have reduced, other fall prevention strategies will be used to prevent falls among the elderly and then the PDSA cycle will be reviewed again. Summary of proposed interventions: Getting approval from the management Approval will be sought from the hospital’s management regarding the project. All information regarding the project will be provided to the management in order for the mangers to have adequate information about this project. Informed consent will also be sought from all patients before they participate in the project. Applying for the funds This project will require relatively big amount of money to buy the required equipments and also to train all the project stakeholders. Therefore, the projected project budget will be presented to the hospital management and other partnering organizations in order for them to provide funds and resources for efficient conduct of the project. Training the all project stakeholders All project stakeholders will be trained about the project. Professionals will be called to train the stakeholders especially the nurses who will be carrying out the fall risk assessment. This will be important in order to ensure that nurses have the required skills to perform fall risk assessment. In addition, all project stakeholders will be trained on how to handle the project’s equipment. Educating the patients All the project participants (the elderly persons and their families) will be educated about the project. This will involve revealing all details to the participants and explaining to them the important of the project to fall prevention. In addition, informed consent will be sought from the elderly patients in order to seek their permission to be involved in this project. Assessing the success of the project Finally, it will be important to evaluate the project’s success by examining if it has been successful in preventing falls. This will be performed by analyzing the rate of falls before and after the completing of the project. Barriers to implementation and sustaining change: Barriers to change implementation in this project include lack of supporting staff. This means that some staff members may resist the change and fail to support the project in any way. This barrier can be overcome by using change champions (Koh et al, 2007, p. 4). Change champions can include the team leaders among staff members who can be engaged as change champions to support and encourage staff members to put into practice the recommended project’s interventions (fall risk assessment) (Koh et al, 2008, p. 4). In addition, a “fall specialist” can be engaged for prescribing interventions according to the identified risk factors and also monitor if nurses are performing fall risk assessment appropriately, educate high-risk patients and their families on fall prevention strategies and also perform post-fall assessments (Koh et al, 2008, p. 4). Lack of adequate resources to effectively conduct the project is also another barrier. This barrier can be overcome by soliciting funds and resources from other non-governmental organizations. Another barrier would be lack of familiarity with the re and hence nurses might even forget to perform fall risk assessment to the appropriate patients. This barrier can be overcome by use of reminders and identification systems. Some of the reminders may encompass compulsory fall risk assessment tool integrated within nursing assessment notes (Koh et al, 2008, p. 4). This will prompt nurses to conduct fall risk assessment to every elderly person during admission and also at each shift change. Other reminders may include posters on fall prevention in the hospital especially the wards. The identification systems can also e used in alerting nurses the patients that should be assessed for risk of fall (Koh et al, 2008, p. 4). Lack of motivation can also be a barrier in this project. Audit and feedback will be performed to motivate staff members. Evaluation of the project: Audit and feedback: Audit and feedback strategies will be employed with summative data on incidence of falls and adherence to performing fall risk assessment. The results will be reviewed on monthly intervals to determine if falls risk assessment has been effective in reducing the rate of falls in older persons in the hospital. Evaluation of the hospital records before and after the implementation of the project. Records of all elderly patients admitted in the hospital before the project will be collected to know the fall rate at that time. After the project is completed data on fall rate will also be obtained from the hospital records. A decrease in the rate of falls after project’s completion will indicate the effectiveness of the project while no change while indicate that the project has not been effective in preventing falls. Interviewing of the elderly persons. These patients will be interviewed to find out if they are experiencing a decrease in number of falls and whether fall risk assessment is always performed and appropriate prevention interventions implemented. Nurses will be also be observed during the project to see if they are adhering to the recommended fall risk assessment tool Reference List AIHW, 2013, Fall rate in Australia, Australia: 2009-10, AIHW. Commonwealth of Australia, 2009, Preventing Falls and Harm From Falls in Older People Best Practice Guidelines for Australian Community Care, Commonwealth of Australia. Goodwin V, Abbott R, Whear R, Bethel A, Jo T & Stein K, 2014, Multiple component interventions for preventing falls and fall-related injuries among older people: systematic review and meta-analysis, vol. 14, no. 15, pp: 1-8. Koh S, Manias E, Alison H, Donath S & Johson L, 2007, Nurses' perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals, BMC Health Services Research, vol. 8, no.105. Morello R, Barker A, Watts J, Haines T & Hill K et al, 2015, The extra resource burden of in-hospital falls: a cost of falls study, vol. 203, no. 9, pp: 367-378. Milos V, Bondesson A, Magnusson M, Jakobsson U, Westerlund T &Midlov P, 2014, Fall risk-increasing drugs and falls: a cross-sectional study among elderly patients in primary care, BMC Geriatr, vol. 14, no. 40. Phelan E, Mahoney J, Voit J & Stevens J, 2015, Assessment and Management of Fall Risk in Primary Care Settings, Med Clin North Am, vol. 99, no.2, pp: 281–293. Taylor M, Chris M, Nicolay C, Darxi A, Bell D & Reed J, 2013, Systematic review of the application of the plan–do–study–act method to improve quality in healthcare, MJ Qual Saf , vol. 1, no. 18. 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