How to Improve and Reduce the Number of Falls in Hospital - Research Proposal Example

Clinical Practice Improvement Project Report

Student Name, FAN and ID:

Student name:

FAN:

ID:

Project Title:

How to improve and reduce the number of falls in hospital

Project Aim:

The project intends to find ways of minimizing the frequency of patient falls to improve the quality of nursing care in acute care setting. It focuses on identifying the tools for risk assessment and practices among the nurses which can reduce the instances, as well as risks of the patient, falls while undergoing treatment in hospitals. It will identify-evidence-based methods for improving the quality of care through prevention of falls by examining successful practices for use by the nurses after reviewing the available literature.

Relevance of Clinical Governance to your project

In this project, the clinical governance plays a critical as it will aid in the improvement of the quality services offered and safeguarding high standards of care by establishing excellence in clinical care. Acting as an umbrella that contains the activities that improve and sustain the standards of patient care, it will assist in familiarizing with the quality and safety improvement activities such as prevention of patient fall in hospital. Through its five themes of patient, information and staff focus, leadership and quality improvement, they will assist in considering the best practices that end patient fall problems in the healthcare setting.

Evidence that the issue / problem is worth solving:

Patient falls in hospitals are devastating. There are several costs associated with falling some of which include distress, injury, pain, loss of confidence, increase in morbidity as well as mortality. Apart from having adverse effects on the patient, it also affects the family members of the patient. The careers of the fallen patients may get affected and even the quality of life they lead after discharge from the hospital. Falls have an adverse impact on the wider health system.

Falls are common incident cases reported in acute and community hospitals as well as in mental health hospitals. Falls among the old patients is prevalent in community hospitals where they stay long, and this rises the chances of each of them falling while undergoing treatment (May 2015 p. 4-6). In addition to that, those having psychological health problems are prone to risks of falling because of multiple medical comorbidities and medications. The increased incidences of falls have resulted to their categorization depending on the harm they cause to the falling patients. The categorizations are no harm, low, moderate, severe and death (May 2015 p. 4-6). Falls with not harm results to no physical injuries to the patients but the confidence of the hospital gets affected. The patients do not show any noticeable bruising. A low harm necessitates first aid, slight cure as well as extra medication. Moderate harm can result in the admission of outpatient for surgery or to the inpatients; it can lead longer stay in the hospital. An occurrence of severe harm has permanent harm to the patient such as brain damage or disability (May 2015 p. 4-6). Some falls can result to direct death of the patient. All these categories indicate that falls have serious effects on the patient whenever they occur and hence necessitating the establishment of ways that can help in minimizing the incidences.

Patient falls are a standard metric of the quality of the nursing care. Some of the falls result from the unfamiliar environment, surgery, treatments, medications, acute illness and bed rest (Dykes et al. 2009 p. 299–304). Patient falls is a serious issue in many hospitals which result to massive liabilities to the hospitals as well as to the nurses on duty. For instance, in the United States, the Medicare does not offer reimbursement to the hospitalization costs arising from fall injuries (Dykes et al. 2009 p. 299–304).

Falls are widespread in hospitalized patients and poses a serious threat to their safety. One primary cited cause of falls in hospitals are accidents and thus complicating many of the hospitals stays (Bouldin et al. 2013 p. 13–17). Evidence indicates many of the falls arise because of inadequate assessment, communication, not following the designed protocols, under-staffing, and lack of orientation, leadership and supervision. For example, in the united states, the chances of fall tends to be high the more a patient stays in hospitals. Falls varies according to unit type. Those with the highest number of falls are neurology, neurosurgery, and medicine units while intensive care units have low levels. Other factors contributing to falls are mental status, the severity of illness and age. On estimation, patients falling stay in hospitals for additional 6 to 12 days (Bouldin et al. 2013 p. 13–17). They, therefore, incur extra costs and stay in the hospital.

From the above-identified consequences resulting from falls, it is important to devise ways through which the medical practitioners can use to minimize the levels of patients falls in hospitals to stay away from liabilities, affect the health condition of their patients and impact the reputation of their healthcare system.

Key Stakeholders:

The key stakeholders in this project are the ministry of health, nursing, physician, pharmacists, therapists and surgeons associations and patients.

CPI Tool:

The CPI tool for preventing falls in Hospitals for this project is Morse Fall Scale, relevant in identifying falls risk factors. It is essential for the identification of the risk factors for the falls among the inpatients (Baek et al 2014 p. 2434-41). The obtained score after the assessment is beneficial in predicting future falls and determining risks factors to aid in planning care to address such factors. The tool may be used by the nurses and can work in conjunction with clinical assessment and review of medications to know whether the patient is prone to falls. With the results, then it is possible to plan.

Morse Fall Scale is a simple to use consisting six variables of the score. It has a predictive validity and interater reliability and can use in acute care settings (Baek et al 2014 p. 2434-41). After determining the fall risk factors, it will easy to determine the most appropriate intervention to reduce the risk.

Summary of proposed interventions:

The following are some of the interventions proposed to remedy incidences of patient falls. The management of the hospital organizations should raise the awareness on the need to prevent falls that result in patient injuries. The management can do this by communicating safety information to both the clinical as well as the non-clinical staff at every level. There is a need to establish an interdisciplinary falls prevention team within the hospitals that will assure that the organization has adequate infrastructure and capacity to prevent the risks that can lead to falls. The team should comprise the major health care stakeholders among them being the nurses, physicians, patient advocacy, quality and risk management, the environmental services and other related stakeholders (Miake-Lye, et al 2013 p. 390-6).

There is a need to introduce standardized and validated tools that can identify risk factors for falls. Such tools should be integrated into the electronic medical record. Apart from that, there is a need to carry out an individualized assessment of falls and injury risk based on the age, gender, cognitive level and the level of patient functioning. The staffs using such tools should undergo training to facilitate reliability among the raters (Miake-Lye, et al 2013 p. 390-6).

The officers in charge of the patients should create a personalized plan care based on risks associated with fall and injury to determine mediations relevant to the particular patient or setting. It is the fact that each patient has a varying extent of risk of fall and thus each plan should assess the risks unique to a particular patient and possible mitigation interventions.

Only the standardized practices and interventions deemed as effective should be used. The post-fall management should be conducted to inform on the areas requiring improvement efforts and to reassess the patient risk of fall. Above all, there should be a well-developed communication amongst the medical professionals and between the patients. In this way, the patients can know when to press their call buttons when they want to get out of bed for assistance and how the hospital workers should respond to bed alarms (Williams, Szekendi and Thomas, 2014 p. 19-29).

A supportive senior administrative leadership is necessary for the implementation of the above-identified strategies. Evidence from the available literature indicates that an ongoing support from both the top-level administration is of high relevance to support the patient fall prevention program (Williams, Szekendi and Thomas, 2014 p. 19-29).

Barriers to implementation and sustaining change:

Despite the availability of the interventions that can remedy the instances of patient fall, some barriers prevent their implementation. Some of the obstacles include the following. There is lack of balance between fall prevention and other priorities accorded to the patient. Even though falls among the patients is disastrous as it can result in the prolonged recovery process, the medical practitioners are forced to focus their attention elsewhere naturally because patients are not in the hospitals because of falls alone (Ganz et al 2013 p. 390-6).

There is lack of balance between the fall prevention and the need to mobilize patients. The patient does not transfer to ambulate to maintain their strength to avoid the complications resulting from bed rest. There are many activities required to protect the patient from harm one of them being fall prevention. There is, therefore, lack of fall prevention reinforcement while at the same time maintaining enthusiasm for other priorities among them being infection control (Ganz et al 2013 p. 390-6).

An interdisciplinary coordination in fall prevention lacks in hospitals. There is no cooperation amongst the nurses, pharmacists, physicians, therapists, patients and families necessary in the prevention of falls. Through coordination and collaboration among the stakeholders there can proper propagation of the right information of the patient fall risk to the right people and the right time. In addition to that, there is no customization of fall prevention and therefore it becomes difficult to address the distinctive needs of Each (Miake-Lye, et al 2013 p. 390-6).

Evaluation of the project:

The methods for evaluating the effectiveness of the intervention strategies proposed in the project will be interviewing the patient and employee stakeholders, reviewing the patients’ health record data stored electronically and abstract information from meeting minutes (Isome et al 2011, p. 1-9). Evaluation of this project is necessary as it will identify the possible barriers hindering the implementation of the proposed strategies. In addition to that, it will determine the facilitators to the implementation for further emphasis.