Mitigating Patient Falls Among Elderly Patients Final Project
Abstract
The capstone project aims to introduce an educational program that will teach patients and nurses the precautionary measures that should be taken to prevent patient falls effectively. The intervention was selected after realizing that the current interventions used in the practice setting do not incorporate the two, nurses and patients, and there is a knowledge deficiency on patient fall prevention measures, especially among older patients, who are most affected by the problem. The need to be addressed in this project is the high number of patient fall cases reported at RML specialty hospital, a long-term care facility. In general, the selected approach achieved the purpose of reducing fall cases reported among older patients at RML specialty hospitals. By implementing the capstone projects, the essential findings included the knowledge deficiency of elderly patients in the necessary fall prevention measures, despite them being the most affected population. In addition, it was found that the nurses are willing to use every available measure or intervention to prevent patient falls more effectively, thus improving their care quality and patient outcomes. Mitigating Patient Falls Among Elderly Patients Final Project
PLACE YOUR ORDER HERE NOW
Mitigating Patient Falls Among Elderly Patients
Patient falls are a major nursing care quality and safety issue affecting hospitalized patients. Elderly patients are among the populations most affected by patient falls due to the increased risk of falling. Patient falls are associated with increased healthcare cost utilization, chronic pain, loss of confidence in balance, and increased length of hospital stay. Therefore, there is a profound need to address the patient fall problem among elderly hospitalized patients. The target population for this capstone project is the elderly hospitalized patients and the nurses providing care to them. The target setting is RML specialty hospital, a long-term care facility. The intervention introduces an educational program to teach the nurses and patients the necessary precautions to prevent patient falls. Implementing the intervention is vital since it will improve patient outcomes for elderly patients and measure the quality of care. The major elements of the intervention are setting the goal, identifying an intervention strategy, setting a timeline for implementation, and devising a method to monitor the intervention progress. The intervention will be evaluated by comparing the patient fall cases reported before and after the implementation of the intervention. This final project entails the problem statement, literature review, and the intervention, implementation, and evaluation plan in detail. Mitigating Patient Falls Among Elderly Patients Final Project
Problem Statement (PICOT)
Need Statement
Patient falls, especially among older hospitalized patients, are a major patient safety and quality improvement issue that is common in healthcare settings since they are used as one of the measures of nursing care quality. Patient falls are defined as the unintended descent to the floor, which makes the patient sustain minor or major injuries. According to Vaishya and Vaish (2020), falls among elderly hospitalized patients are a major issue since they are mainly associated with an increased hospital stay, loss of independence for the elderly patient, reduced quality of life, and chronic pain. There is a need to prevent falls among the elderly hospitalized patient population in the institution, thus reducing falls-related injuries and other patient issues related to patient falls. The proposed project addresses the patient falls problem among elderly patients at RML specialty hospital-acute center. Addressing the need to prevent patient falls in this setting is vital since it will show improved nursing care quality and patient outcomes/quality of life.
Population and Setting
The target population in the proposed project is the elderly hospitalized patient population. Research shows that elderly hospitalized patients across different departments and units are the population most affected by patient falls (Pitchai et al., 2019). Additionally, geriatric patients lead to minor and major injuries, such as fractures, lacerations, and internal bleeding. These injuries are associated with increased healthcare services utilization, healthcare costs, and poor patient/overall organizational outcomes. Therefore, it is vital to address the need to prevent patient falls among the elderly patient population. Mitigating Patient Falls Among Elderly Patients Final Project
The target healthcare setting is an RML specialty hospital long-term acute care center. Long-term care settings are known to report high numbers of patient fall cases (Shaw et al., 2019). Similarly, the target setting has been reporting increased patient falls, especially among elderly patients, despite the measures to prevent falls among this population. Addressing the patient falls prevention needs in this setting will help improve the overall organizational outcomes/performance, nursing care quality, and quality of life for senior patients. The need, patient population, and setting analysis are based on the assumption.
Intervention Overview
Various evidence-based interventions can be applied to address the identified need. One of the quality improvement interventions to achieve improved outcomes within the target population and setting is an educational program aimed at educating the nurses and the patients on how to effectively prevent patient falls. According to Heng et al. (2020), one of the ways to prevent and mitigate patient falls among geriatric patients is patient education aimed at awareness creation and increasing knowledge on fall prevention. The intervention is appropriate for addressing the target population’s needs and setting since some patients fall due to inappropriate prevention knowledge. Additionally, nurses require staff development and education to inform them of the new evidence-based and best-practice interventions to prevent patient falls. A disadvantage of educational programs is that they may not benefit patients with neurological conditions that limit them from learning. More so, educating the nurses and patients a lot of time. Mitigating Patient Falls Among Elderly Patients Final Project
Comparison of Approaches
Other interventions/approaches can produce the desired outcomes in the target population and setting. One of them is using the patient falls risk assessment tools. Different fall-risk assessment tools are available to assist healthcare providers in assessing patients’ fall risk and therefore plan on preventing and managing falls on occurrence (LeLaurin & Shorr, 2019). Patient falls risk assessment tools encourage Interprofessional care approaches compared to educational programs since the risk assessment results are used by all the care providers in the team to prevent patient falls. Additionally, the intervention fits the target setting and population compared to patient education since most geriatric patients have low educational capacity, and thus a risk assessment can be more effective in preventing patient falls.
Initial Outcome Draft
The expected outcome of implementing the intervention in the proposed project is to reduce the number of reported patient fall cases in the institution. Reducing the number of patient falls reported in the institution will also improve the quality of care, patient safety, and care experience. The outcome can be evaluated by a comparison of the number of patient falls reported before and after the implementation of the proposed intervention.
Time Estimate
The development and implementation of the intervention to address the patient falls need in the institution is estimated to take approximately ten weeks. The potential challenges that may impact the time frame and affect the development and implementation of the intervention include inadequate collaboration from the Interprofessional team and lack of buy-in and support from the leaders and managers of the target institution.
Literature Review
According to Jia et al. (2019), patient falls among older adults have been a major patient safety issue. Research shows that patient falls among older adults are a significant cause of death globally since the global burden of patient falls is substantial, with the highest incidence and prevalence rates reported among older adults (Vaishya & Vaish, 2020). Falls increase the disease burden, especially among hospitalized older adults and more so adults with chronic self-reported chronic illnesses such as diabetes, stroke, and depression. Fall patients have lower health-related quality of life, increased mortality, and Quality Adjusted Life Years (QALY). Additionally, falls are known to lead to widespread disability and have other social consequences, such as loss of independence. Therefore, falls are a major problem among the elderly adult population, with more than 10% recording multiple falls annually. They will continue to increase the health burden as the populations age if the necessary precautions are not taken to prevent them (Jia et al., 2019)Mitigating Patient Falls Among Elderly Patients Final Project .
The prevalence of patient falls among older adults currently ranges from 27.1%- 34.8% (Lan et al., 2020). Falls among adults in this population are mainly associated with frailty, which increases the risk of patient falls. The majority of patient fall incidences are in nursing homes and other long-term care facilities. However, even elderly adults in the community and those receiving homecare services report falls. Elderly adults at home, especially adults living alone, fall due to inadequate precaution and prevention measures (Cunha et al., 2019).
ORDER HERE NOW
Furthermore, falls among hospitalized patients in long-term care facilities and acute settings increase the healthcare burden on individuals, families, and healthcare systems due to minor and major injuries. The most common injuries sustained by elderly patients after falls include hip, wrist, humerus, and pelvis fractures. As mentioned earlier, sustained injuries lead to increased hospital length of stay, chronic pain, and poor health-related quality of life, among other issues. Additionally, patient falls among older adults increase medical costs since internal and external injuries must be treated. Older adult patients require screenings and surgeries following falls.
The other significant effect of patient falls among elderly hospitalized patients is the cognitive and psychological effects of these patients sustaining head/brain injuries that impact their neurological functions. More so, the psychological impact of patient falls includes increased fear of subsequent falls, anxiety, and confidence in balance (Giovannini et al., 2022)Mitigating Patient Falls Among Elderly Patients Final Project .
Research evidence supports the appropriateness of addressing the patient falls prevention need within the target population and setting due to the increased risk factors related to patient falls. Elderly hospitalized patients have increased risks of patient falls. According to Kiyoshi-Teo et al. (2019), the risk factors related to patient falls include age-related problems such as loss of muscle mass, difficulties in maintaining balance, and postural hypotension. Other risk factors are associated with falls among older patients in long-term care settings. Ha et al. (2021) note that the factors associated with inpatient and outpatient older adults include urinary incontinence, COPD, having more than three comorbidities, alcohol consumption, using psychotropic medications, and mobility impairment.
Furthermore, research shows that various preventive measures have been developed to address the issue of patient falls among hospitalized older adults. These measures are implemented in inpatient and outpatient settings such as homecare settings. The two major types of preventive measures used among older adult populations are exercise and multifactorial interventions. Other interventions, such as fall prevention and self-management education, also exist. The outcomes and applicability of these preventive measures differ due to health conditions and age issues. For instance, some patients may be unable t exercise due to frailty and other health condition limitations. Additionally, patients with neurocognitive deficiencies may not necessarily use the patient education measures due t the inability to learn (Wu et al., 2022)
The literature reviewed above is current, including sources published within the last five years. It is also relevant since it entails studies focusing on only older hospitalized adults. It is also trustworthy and sufficient since most of the studies used are randomized controlled trials and systematic reviews published in reputable journals. However, it is worth noting that locating literature to support the need and the appropriateness to address the need for patient fall prevention in long-term care facilities is challenging since patient fall cases in some care facilities are underreported. Therefore, there is limited information on the prevalence and incidence of patient falls in these populations and healthcare settings, thus providing gaps in literature evidence. Therefore, patient falls among hospitalized elderly patients is a need that is heavily felt, based on the evidence presented in the literature, and thus should be addressed. Mitigating Patient Falls Among Elderly Patients Final Project
Literature Synthesis on the Impact of Healthcare Policy and Technology in Addressing the Need to Prevent Patient Falls in the Target Population and Setting
Health policy significantly impacts the approach to address the patient falls need in the target population and setting. By 2030, the number of people older than 65 will be more than the number of people in other age populations, including those below five. Therefore, healthcare policies have been developed to meet the healthcare needs of aging populations with time. Better health and health care for adults is one of the healthcare policies (Fulmer et al., 2021) that aims at addressing the healthcare needs of aging populations (2019), including putting in place preventive measures to reduce health risks such as patient falls (Singh et al., 2020). Healthcare institutions have institutional policies on the prevention of patient falls, which guide the approach taken to address the issue.
According to Singh et a. (2020), fall prevention management and procedures in healthcare institutions can be categorized into three; Pre-fall policies and procedures, post-fall policies and procedures, and communication between and amongst staff, patients, and family members. The approach selected to prevent patient falls in the target institution will therefore depend on the institutional policy on patient falls prevention and be implemented according to the clinical practice guidelines employed in the institution. Based on the pre-fall policies and procedures on patient falls, the selected approach to education to nurses and patients to help them take necessary precaution to prevent falls should include the definition of falls (Singh et al., 2020) and awareness creation on patient falls risks (Montero-Odasso et al., 2021). Additionally, educational programs on patient falls, especially those focusing on educating older patients, should consider the various patient education needs of the target patient population, including health literacy, language, and the appropriate educational level for the patient population (Fulmer et al., 2021; Singh et al., 2020)Mitigating Patient Falls Among Elderly Patients Final Project .
Healthcare policies on the use of technology in the prevention of patient falls also exist. Recently, technology-based applications have been introduced in healthcare to obtain superior patient care outcomes and experience via efficiency, access, and reliability. These applications are widely used among older hospitalized patients, especially in acute care settings and long-term care facilities (Oh-Park et al., 2021). Some technologies used to prevent patient falls in healthcare settings include wearable sensors, movement detectors, cross-fall prevention intervention systems, and Modern Technology against fall interventions, among others. The government and other healthcare organizations recommend that healthcare institutions put in place healthcare technology to prevent patient falls (Oh-Park et al., 2021) and ensure that the technology is safe for the patient to use (Singh et al., 2020), and does not cause more harm to the patient while preventing falls (Montero-Odasso et al., 2021)Mitigating Patient Falls Among Elderly Patients Final Project .
Furthermore, communication between and among the Interprofessional team is essential to address patient falls prevention needs. The Interprofessional team that must work together to facilitate the educational program for nurses and patients includes healthcare leaders, doctors, nurses, and various specialists. Communication will enable the team to work together to ensure the program works effectively. For instance, the institution leaders will provide the necessary materials and funds to facilitate the educational program, while the doctors will run the program by playing the educating role.
However, the evaluation and synthesis are based on the assumption that all healthcare institutions, especially long-term care and acute settings, have the necessary institutional policies developed based on the recommended government policies and practice guidelines. However, information on evaluating the application of the available policies and practice guidelines on patient fall prevention is missing, hence deficits in the evaluation.
Intervention Plan
Intervention Plan Components
Generally, the intervention is an educational program that will create awareness and enhance the knowledge of the patients and the nurses on properly taking precautionary measures to prevent patient falls. The major elements of the intervention are setting the goal, identifying an intervention strategy, setting a timeline for implementation, and devising a method to monitor the intervention progress. The project and intervention aim to reduce the number of patient fall cases recorded at RML specialty hospital. There has been an increased number of reported patient fall cases in the institution, which is worrying, given that patient falls are among the nursing care quality indicators. Most patients suffering this fate are elderly in the acute care specialty unit. These patients have poor health-related quality of life, chronic pain, and increased healthcare spending. Additionally, despite the current intervention and falls risk assessment, the number of patient fall cases was still high. Hence, there was a need to set a goal to address the issue,
As mentioned earlier, the intervention strategy selected is an educational program for the nurses and the patients. The previous intervention that has been implemented to address the patient falls need is the fall risk assessment tool. The educational program was selected over the falls-risk assessment tool since patients must also be involved in preventing patient falls for better outcomes. Research shows that patient involvement in fall prevention through patient education programs effectively reduces the number of patient fall cases (Heng et al., 2020)Mitigating Patient Falls Among Elderly Patients Final Project .
The set timeline for implementing the intervention is ten weeks. During this timeline, the patients and the nurses will have sessions to cover the preventive measures for fall prevention. The patients and the nurses will have different sessions since their roles in patient fall prevention are also different. The criteria that will be used to evaluate the plan’s success is comparing the patient falls cases recorded in the institution before and after the educational program. A reduction in the patient fall cases reported will translate to the success of the intervention plan. The patient fall records will be essential for the evaluation.
Impact of Cultural Needs and Characteristics of the Target Population and Setting on the Development of the Intervention Plan Components
Walters et al. (2020) note that consideration of cultural needs and characteristics helps enhance the acceptance of an intervention. The target population includes elderly hospitalized patients at RML specialty hospital and the nurses caring for these patients. The two groups have different cultural characteristics and needs, which should be considered in the intervention plan to enhance acceptance of the intervention. RML mainly cares for patients with complex medical conditions requiring extended hospitalization. More so, the majority of the patients in the institution are elderly. Most cultures believe age is associated with knowledge, respect, and calmness. Some of the target population’s cultural needs include the desire for respect and communication using a language they understand. On the other hand, the nurses’ cultural needs include confidence, achievement, and morality.
These cultural needs significantly impact the development of the intervention plan. For instance, the nurses’ need to have confidence, a sense of achievement, and morality in their work led to the goal of reducing the number of patient falls, which is a measure of nursing care quality. The intervention and timing should also strive to enable them to meet these needs. The selection of the educational intervention was also guided by the target population’s cultural need for respect and decent communication to ensure that they will embrace and accept the intervention. The issue of cultural needs for the target population is based on the assumption that the patients and the nurses share common cultural characteristics and needs.
Theoretical Foundations, Interdisciplinary Strategies, and Healthcare Technology Relevant to the Intervention Plan
Every healthcare intervention plan based on nursing theories and interprofessional strategies supported by healthcare technology will most likely succeed. The theoretical nursing models relevant to the developed intervention plan include the self-regulation theory and King’s theory of goal attainment. The former theory stipulates that patients should be active in their care, while the latter holds that a patient grows and develops to attain certain goals (Hawley-Hague et al., 2021). King’s theory of goal attainment is the nursing model that will most impact the intervention plan components. As mentioned earlier, involving patients in fall prevention is vital in enabling them to take the necessary precautions to prevent falls. Additionally, the goal that will be attained is preventing falls, thus reducing the number of patient falls in the target settings. The strength of using this model as the framework is the higher chances of success due to patient involvement. The weakness is that elderly patients may not follow the process of achieving the goal diligently due to age-related limitations (Park, 2021)Mitigating Patient Falls Among Elderly Patients Final Project .
The interdisciplinary strategies that will impact the intervention plan design are project management planning strategies that include defining success, finalizing a plan before getting started with a project, and setting achievable goals. As seen in the intervention plan elements above, these project management strategies heavily influenced the plan’s development. Project management and planning strategies may consume time, but they promote the success of the intervention’s implementations and outcome achievement.
Healthcare technology also impacts the intervention plan design. For instance, the materials used in implementing the educational program include augmented and visual reality for patient education. Hawley-Hague et al. (2021) note that video conferencing can be used in patient falls prevention programs to enhance education for the nurses and the patients. Although using these technologies may require more resources, they are likely to produce a better educational experience for the target population.
Intervention Plan Design Components Justification
The intervention plan design components are deemed necessary in reducing the number of patient falls reported at RML specialty hospital. The components of the intervention plan design include the timeframe, the intervention strategy, the goal, and the progress monitoring plan. The ten-week time frame is adequate for delivering the educational program and evaluating the outcomes. According to LeLaurin and Shorr (2019), educational programs on awareness creation and improving patient fall prevention knowledge are among the most effective strategies. A recent review showed that a ten-week time frame is adequate for an educational program on patient fall prevention, especially for elderly patients (Cattaneo et al.., 2019). However, there are conflicting views on using educational programs to prevent falls among elderly patients. Bet et al. (2019) note that instead of educational programs, which need time and may be ineffective due to elderly patients’ educational limitations related to age, other preventive measures, such as wearable sensors, should be used for fall prevention in these populations. Mitigating Patient Falls Among Elderly Patients Final Project
Stakeholders, Policy, and Regulations’ Impact on the Intervention Plan Design
The relevant stakeholders in implementing the proposed intervention include the institution’s leaders, nurses, physicians, patients, and unit managers. Each of these stakeholders may have different needs regarding the intervention, thus negatively impacting the intervention plan design. The stakeholders’ roles, needs, and priorities will be clarified to avoid confusion and enhance maximum cooperation. The institutional and government policies on educational health promotion programs may also impact the implementation of the intervention by providing directions and specifications for implementation. For instance, policies on patient education stipulate that patients’ health literacy should be first assessed and provided with education that fits their learning needs (Heng et al., 2020). Such policies will impact the timeframe and intervention delivery. The analysis assumes that the policies and regulations are well laid out and understood before implementing the intervention. Another assumption is that all the stakeholders know their roles concerning the educational program and show interest in participating.
Ethical and Legal Implications of the Intervention Plan
Different legal and ethical issues impact the development of an intervention plan design. The ethical issues in the educational program include an authoritarian progression on the patient’s autonomy and implementing education in the patient’s best interests. To avoid these issues, the patients and nurses were consulted on the best ways to deliver the educational program, thus ensuring that it is based on the patients’ and nurses’ best interests and avoiding authoritarian progression. Legal issues such as negligence were considered in developing the educational content for the nurses. For example, since patients may have an increased risk for falls based on the current medications, nurses should assess the risks of patient falls before administering these medications. Failure to do that would be a legal issue of negligence. Therefore, awareness creation on such issues was included in the proposed educational program. A major area of uncertainty in the implementation plan design is the sustainability of the outcomes of educational programs on patient prevention, especially for the patients. Further information would help inform the programs to make the outcomes sustainable.
Implementation Plan
Leadership and Management Considerations
Leadership and management are important aspects in the implementation of an intervention. The intervention plan design should carefully devise the leadership and managing strategies to implement the intervention and enhance interprofessional collaboration and professional nursing practices, thus promoting implementation success and sustainability. The leadership strategies that will be used to promote interprofessional collaboration include delegation to empower the team, encouraging two-way communication, and defining/articulating a clear vision.
According to Folkman et al. (2019), leaders should enhance interprofessional collaboration by working with the interprofessional team through empowerment and power delegation. Thus the team members readily play their roles and participate effectively. Additionally, two-way communication ensures that the team works effectively and that each member’s contribution is considered. The definition and communication of a clear vision will ensure that the interprofessional team is on the same page and working towards achieving similar goals.
The strategies to manage the interprofessional team include applying best practices, utilizing the team members’ capabilities, and collectively defining a timeline to achieve the set goals. These management strategies will enhance interprofessional collaboration during the implementation of the intervention. According to Labrague et al. (2022), team managers must identify the nursing best practices relevant to the intervention being implemented, thus enhancing the acceptance and success of the intervention implementation. Each team member has capabilities based on their specialty and roles concerning the intervention.
Managers should utilize these capabilities to maximize performance and enhance goal achievement. More so, collectively defining a timeline for achieving the set goals will enhance interprofessional collaboration since the team members will feel their contribution is valued. Other perspectives in leading and managing interprofessional teams during the intervention’s implementation include using the authoritative leadership approach to lead the team since there has to be one leader in charge of the team (Flaherty & Bartels, 2019).
Change Implications Associated with the Proposed Strategies
The proposed management and leadership strategies are meant to lead change regarding the quality and experience of care while controlling costs. First and foremost, team empowerment and two-way communication will enhance the effective prevention of patient falls in the institution, thus improving the quality of care. Patient falls are one of the measures of nursing care quality since they are associated with poor health-related quality of life, chronic pain, and loss of independence for the patient. Therefore, achieving the goal of reducing patient fall cases in the institution through the proposed leadership strategies will improve the quality of care. Secondly, the proposed leadership and management strategies will change the institution’s care experience by using best practices and utilizing the interprofessional team members’ capabilities. Each team member will therefore be expected to play their role in preventing patient falls, thus improving patient care experience by having a safer care environment.
Furthermore, patient falls increase the cost of care due to the need for surgeries and other treatments sustained from the injuries (Hoffmann et al., 2019)Mitigating Patient Falls Among Elderly Patients Final Project . Falls also increase hospitals’ operating costs since patients need care after the fall. Therefore, the changes resulting from leading and managing the interprofessional team using the best practice professional nursing practices will considerably decrease care costs for the institution and the individual. A major knowledge gap is a sustainability of maintaining, leading, and managing the interprofessional team created during the intervention plan implementation after the completion of the implementation. Research shows that some teams fail to continue working together sustainably after achieving the goal (Labrague et al., 2022).
Appropriate Method of Delivery to Implement the Intervention
According to Heng et al. (2020), the mode of delivery in patient falls education programs considerably influences the project outcomes. Selecting the appropriate delivery method for implementing an intervention plan improves knowledge and self-perception of fall risk. It, therefore, empowers the patients to play their part in preventing falls effectively. The proposed appropriate delivery methods to improve project outcomes in the patient falls prevention intervention plan include face-to-face discussions on safety measures, posters, handouts, and videotapes. These methods are most appropriate for implementing the intervention plan since the target population entails elderly hospitalized patients. Due to their special learning needs and limitations, these delivery methods will ensure that the content of the preventive measures on patient falls is understood. The proposed methods will improve the quality of the project by promoting the likelihood of success. When the patients and the nurses understand the educational content delivered, they will most likely play their roles in patient falls prevention effectively, thus producing positive project outcomes. The proposal of these delivery methods is based on the assumption that the necessary materials to deliver the educational content using these delivery methods are readily available for use.
Technological Options Related to the Proposed Delivery Methods
Technology is an essential part of any implementation plan design. The current and emerging technological options related to the proposed methods of delivery include simulations, videoconferencing, training through virtual reality, and fall prevention assistive devices such as wristbands, wearable sensors, and bed alarms. These technological options will help to make the delivery methods more effective by simplifying educational content delivery. More so, technological options such as simulations will help educate the nurses and the patients by presenting complex experiences and simplifying them to some real-life experiences they can relate to. Therefore, supporting the intervention delivery methods using technology will most likely help develop positive project outcomes. One of the areas of uncertainty while using technological modalities in patient education is their perception of the experience and effectiveness of the education delivered to elderly patients. Further information on the elderly patients’ experience in patient education using technology would inform the analysis.
Stakeholders, Regulatory Implications, and Support that Would Impact the Implementation of the Intervention Plan
Various considerations may considerably impact the implementation of the proposed intervention plan. Stakeholders, regulatory implications, and support are among these considerations. The relevant stakeholders in introducing the educational program on patient fall prevention include the nurses, patients and their families, doctors, institutional leaders, unit managers, orthopedic and surgical specialists, and other healthcare providers. Each of these stakeholders has different needs concerning the program. Failure to identify stakeholder needs/priorities and strategize on addressing them may affect the intervention implementation negatively (Baris & Seren Interpeler, 2019). Therefore, engaging each relevant stakeholder and strategizing on addressing their needs is vital.
Various regulatory implications may impact the implementation of the intervention plan. For instance, the institutional and governmental regulations relating to patient education and the care of geriatric patients would support or limit the intervention plan. For instance, if the target setting has a regulation on the method of delivery for patient education among different health populations, the regulation should be followed, despite it not being in the initial implementation plan.
Furthermore, support from the institutional leaders and managers is vital for implementing the proposed intervention. Financial and human resources support, buy-in, and acceptance of the intervention are the basic forms of support required for an intervention to be implemented successfully. Institutional leaders and managers provide the go-ahead for the project team to implement proposed interventions. Additionally, the leaders and institutional management provide the financial and human resource support required for any intervention in their institution. It is, therefore, vital to seek their buy-in and support before implementing the intervention, thus promoting success.
Support and buy-in can be obtained by providing the leaders and the institutional managers with a written proposal of the project, highlighting its advantage and the importance of implementing the project on patient care experience, outcomes, and cost reduction. The proposal should also outline the intervention implementation plan and design. In addition, the project implementers can meet with the leaders to clarify the proposed intervention, thus gaining their support and buy-in. The analysis is based on the assumptions that all the relevant stakeholders are ready to participate, the regulatory implications are clear, and the project team has identified methods of acquiring necessary support and buy-in.
Policy Considerations Supporting the Implementation Plan Design
New and existing policies in the institution may support or impair the implementation plan design. The institution has a patient falls prevention and management policy that all care providers observe. The policy will support the implementation of the proposed intervention since the intervention is aimed at preventing patient falls. However, new policies limiting patient education among elderly patients may impair the implementation plan design by discouraging the intervention delivery methods. For instance, an institution may develop a policy discouraging patient education among elderly patients due to perceived ineffectiveness compared to other interventions.
Proposed Implementation Timeline
The proposed intervention will be implemented within ten weeks. Ten weeks are an appropriate timeframe, considering the educational content’s preparation, getting the program’s facilitators, and holding the educational sessions. However, factors such as delays due to inadequate finances may lead to a revision in the timeframe, whereby more time will be required.
Evaluation Plan
Outcomes that are the Goal of the Intervention Plan
The desired outcome of implementing the educational program on patient fall prevention is reducing the number of patient falls reported in the institution. Thus, patients’ improved health-related quality of life, reduced healthcare costs, and chronic pain, among other effects of patient falls. The other outcome is increased patient fall prevention knowledge for both the patients and the nurses. The outcomes establish a framework that can be used to improve the quality, safety, and experience of care since it is a general measure of care quality and patient safety and can also be used to determine care experience. Mitigating Patient Falls Among Elderly Patients Final Project
Alternative outcomes of the intervention include reducing the risk of falls for patients at a higher risk of falls and preventing additional harm to hospitalized patients. An advantage of reducing the risk of falls is the emphasis on taking precautionary measures, while the disadvantage is that it is difficult to measure the outcome. The advantage of preventing additional harm to hospitalized patients as an outcome is that it is a general goal that can be used in different populations, while the disadvantage is that it is not easily quantifiable.
Evaluation Plan
The degree to which the outcomes were achieved will be measured and evaluated using the number of patient fall cases reported in the institution. The number of patient fall cases reported after the implementation of the intervention will be compared with the number of patient fall cases reported before the intervention was implemented. The required data to fully evaluate the outcomes include patient falls reports and records from the patients and the nursing units/departments of focus. The technology and tools to collect data include questionnaires, dashboards, and Electronic Health Records (EHR). The questionnaires will be used to collect data that will be used to evaluate the outcome of increased knowledge. In contrast, the dashboard and HER will collect data to evaluate the reduction in the number of patient falls recorded in the institution.
The data collected from these tools and technology strategies will be analyzed using a t-test non-parametric test. The evaluation plan will therefore illustrate the impact of the intervention if an improvement in knowledge of patient falls is noted. Additionally, a reduction in the number of patient falls cases reported in the institution, especially among elderly patients, will demonstrate the impact of the intervention. The analysis assumes that the target population, nurses, and the patients in the institution will cooperate in data collection. Additionally, the needed records from the EHR and dashboard metrics will be available and readily accessible.
Discussion and Reflection
Advocacy
Nurses play a significant role in leading change and driving improvements in the quality and experience of care. One of the major responsibilities of the nurse is advocating for change that affects the patient and how care is delivered to the patient. First and foremost, nurses have been trained to be leaders in Interprofessional teams and professional practice. They can use their knowledge and skills to advocate for change among the Interprofessional team by showing the team the importance of making the proposed change. Additionally, they liaise with other leaders in the team to enhance change. According to Fliedner et al. (2021), nurses are best suited to present the needs of the patients to the Interprofessional team and the institutional leaders and managers to lead change to address the needs. They also push for changes in professional practices that will help address the patient’s needs.
Secondly, nurses advocate by driving improvement in the quality and experiences of care in professional practice and Interprofessional teams. Since nurses are the care providers who spend the most time with the patient, they are best suited to understand their needs and know the best ways of addressing them. Therefore, they provide suggestions on the changes that can be made in professional nursing practices, including the improvements needed. Bedwell et al. (2019) note that nurses drive improvement in these professional practices by creating awareness of the need for change and how the improvement will lead to better care outcomes. They also coordinate the Interprofessional team in improvement interventions, thus driving faster and more efficient improvement. The derived change helps the institution provide better quality and care experience. The analysis is based on the assumption that the nurses in the institution are provided with the necessary support and platforms to enable them to raise their advocacy voice and liaise with the other members of the Interprofessional team, as well as the institutional leaders, to drive change and improvement. Mitigating Patient Falls Among Elderly Patients Final Project
Effect of the Intervention Plan on Nursing and Interprofessional Collaboration
The intervention plan on educating nurses and patients on taking the necessary precautionary measures to prevent patient falls will significantly improve the nursing profession and practice. One of how the intervention will improve the nursing profession is through using the intervention, based on its effectiveness, in other practice settings and health populations to enhance patient outcomes. Additionally, the intervention helps emphasize nurses’ role in patient falls prevention. The educational program aims to enhance nurses’ knowledge of the precautionary measures they can take to prevent patient falls. The intervention will also help the nurses to implement evidence-based practices on patient falls prevention, which will be learned in the program. Therefore, implementing the intervention will improve the profession by using best-practice and current measures to prevent patient falls.
The intervention plan implementation will also improve Interprofessional collaboration in achieving the desired outcomes regarding patient falls in the target population and setting. According to Shaw et al. (2023), interprofessional interventions such as educational programs on patient falls improve interprofessional collaboration by providing a platform for the interprofessional team to work together. The implementation team will include stakeholders from different professionals, thus enabling them to work together to achieve the desired outcomes.
The healthcare field, in general, will gain from implementing the plan/project. As mentioned, the project aims to incorporate an educational program for patients and nurses into the current interventions. Ideally, educational programs on patient fall prevention mainly focus on either of the two individually. Therefore, implementing the proposed intervention will increase knowledge of the effectiveness of educational programs focusing on nurses and patients. The additional information required to improve an understanding of this analysis is the effectiveness of the mixed intervention, which is not readily available in the literature. Mitigating Patient Falls Among Elderly Patients Final Project
Current Project Improvement
The current intervention can be improved to impact the target population more and leverage emerging technology and care models to improve outcomes and safety. The intervention can be revised to reach a broader impact on the target population by extending the implementation to elderly patients’ in-home care and outpatient settings. Research shows that there is still a high incidence of patient falls among patients in-home care and outpatient settings (Ha et al., 2021). Therefore, extending the focus to include elderly adults in these settings would improve outcomes and safety among a broader population.
Additionally, the intervention can use emerging technology to enhance performance related to the intervention outcomes by educating the target population using patient education modalities such as virtual reality and videoconferencing. Thus, patients from home care and outpatient settings would also reduce the risk of falling and increase their knowledge of patient falls prevention, thus reducing fall incidence. The underlying assumptions of the proposed improvements include that the intervention can also be implemented in the mentioned settings and the emerging technological modalities are available for use.
Reflection on Leading Change and Improvement
Completing the project has significantly impacted my ability to lead change in personal practice and the current care setting. First and foremost, I have appreciated the importance of identifying patient safety needs in a particular setting and developing an intervention that can be used to address the need. Secondly, I have gained confidence in working with the interprofessional team to address patient needs by delegating roles of the intervention implementation according to the professionals’ specialty. Most importantly, I can now approach institutional leaders to seek their support and buy-in in implementing interventions that will help address needs and achieve better patient and organizational outcomes.
Furthermore, the project has adequately prepared me to take leadership positions in similar projects and interventions in the future. The experience gained in leading the project and working with other professionals to enhance outcomes improvement will be useful in leading change and improvement interventions. My personal development goals include improving team leadership and management, communication, and interprofessional skills. Mitigating Patient Falls Among Elderly Patients Final Project
Implementation into Personal Practice
The completed intervention, implementation, and evaluation plans can be transferred into my practice to drive quality improvement in other contexts. For instance, the same educational program intervention can be transferred to the care of patients with chronic illnesses, such as diabetes, to enable them to manage their conditions more effectively. Additionally, the evaluation plan can be applied in different contexts to enhance learning and improvement of similar future interventions. However, conflicting evidence shows that diabetes outcomes can be improved using Diabetes Self-Management Education, compared to regular educational programs suggested in this project (Navaneethan et al., 2021).
Conclusion
The intervention planning, implementation, and evaluation of the educational program to educate nurses and patients on the necessary precautions to prevent falls in the institution have been explored above. The various considerations surrounding the implementation have also been discussed. The reflection on the capstone and the lessons learned were also included. Generally, the project has helped me appreciate the role of advocacy in nursing. Additionally, it has improved my skills and confidence in leading and managing change and improvement in different care settings and contexts.
References
Baris, V. K., & Seren Intepeler, S. (2019). Views of key stakeholders on the causes of patient falls and prevention interventions: A qualitative study using the international classification of functioning, disability, and health. Journal of Clinical Nursing, 28(3-4), 615–628. https://doi.org/10.1111/jocn.14656
Bedwell, J. R., Pandian, V., Roberson, D. W., McGrath, B. A., Cameron, T. S., & Brenner, M. J. (2019). Multidisciplinary Tracheostomy Care: How Collaboratives Drive Quality Improvement. Otolaryngologic Clinics of North America, 52(1), 135–147. https://doi.org/10.1016/j.otc.2018.08.006
Bet, P., Castro, P. C., & Ponti, M. A. (2019). Fall detection and fall risk assessment in older person using wearable sensors: A systematic review. International Journal Of Medical Informatics, 130, 103946. https://doi.org/10.1016/j.ijmedinf.2019.08.006
Cattaneo, D., Gervasoni, E., Pupillo, E., Bianchi, E., Aprile, I., Imbimbo, I., Russo, R., Cruciani, A., Turolla, A., Jonsdottir, J., Agostini, M., Beghi, E., & NEUROFALL Group (2019)Mitigating Patient Falls Among Elderly Patients Final Project . Educational and Exercise Intervention to Prevent Falls and Improve Participation in Subjects With Neurological Conditions: The NEUROFALL Randomized Controlled Trial. Frontiers in Neurology, 10, 865. https://doi.org/10.3389/fneur.2019.00865
Cunha, L. F. C. D., Baixinho, C. L., & Henriques, M. A. (2019). Preventing falls in hospitalized elderly: design and validation of a team intervention. Journal of the School of Nursing, 53, e3479. https://doi.org/10.1590/S1980-220X2018031803479
Flaherty, E., & Bartels, S. J. (2019). Addressing the Community-Based Geriatric Healthcare Workforce Shortage by Leveraging the Potential of Interprofessional Teams. Journal of the American Geriatrics Society, 67(S2), S400–S408. https://doi.org/10.1111/jgs.15924
Fliedner, M., Halfens, R. J. G., King, C. R., Eychmueller, S., Lohrmann, C., & Schols, J. M. G. A. (2021). Roles and Responsibilities of Nurses in Advance Care Planning in Palliative Care in the Acute Care Setting: A Scoping Review. Journal of Hospice and Palliative Nursing: JHPN: The Official Journal of the Hospice and Palliative Nurses Association, 23(1), 59–68. https://doi.org/10.1097/NJH.0000000000000715
Folkman, A. K., Tveit, B., & Sverdrup, S. (2019). Leadership in interprofessional collaboration in health care. Journal of Multidisciplinary Healthcare, 97-107. https://doi.org/10.2147/JMDH.S189199
Fulmer, T., Reuben, D. B., Auerbach, J., Fick, D. M., Galambos, C., & Johnson, K. S. (2021). Actualizing Better Health And Health Care For Older Adults: Commentary describes six vital directions to improve the care and quality of life for all older Americans. Health Affairs, 40(2), 219-225. https://doi.org/10.1377/hlthaff.2020.01470
Giovannini, S., Brau, F., Galluzzo, V., Santagada, D. A., Loreti, C., Biscotti, L., Laudisio, A., Zuccalà, G., & Bernabei, R. (2022). Falls among older adults: Screening, identification, rehabilitation, and management. Applied Sciences (Basel, Switzerland), 12(15), 7934. https://doi.org/10.3390/app12157934
Ha, V.-A. T., Nguyen, T. N., Nguyen, T. X., Nguyen, H. T. T., Nguyen, T. T. H., Nguyen, A. T., Pham, T., & Vu, H. T. T. (2021). Prevalence and factors associated with falls among older outpatients. International Journal of Environmental Research and Public Health, 18(8), 4041. https://doi.org/10.3390/ijerph18084041
Hawley-Hague, H., Tacconi, C., Mellone, S., Martinez, E., Chiari, L., Helbostad, J., & Todd, C. (2021). One-to-One and Group-Based Teleconferencing for Falls Rehabilitation: Usability, Acceptability, and Feasibility Study. JMIR Rehabilitation and Assistive Technologies, 8(1), e19690. https://doi.org/10.2196/19690
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: a scoping review. BMC geriatrics, 20(1), 140. https://doi.org/10.1186/s12877-020-01515-w
Hoffman, G. J., Liu, H., Alexander, N. B., Tinetti, M., Braun, T. M., & Min, L. C. (2019). Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older. JAMA Network Open, 2(5), e194276. https://doi.org/10.1001/jamanetworkopen.2019.4276
Jia, H., Lubetkin, E. I., DeMichele, K., Stark, D. S., Zack, M. M., & Thompson, W. W. (2019). Prevalence, risk factors, and burden of disease for falls and balance or walking problems among older adults in the US. Preventive Medicine, 126, 105737. https://doi.org/10.1016/j.ypmed.2019.05.025
Kiyoshi-Teo, H., Northrup-Snyder, K., Cohen, D. J., Dieckmann, N., Stoyles, S., Winters-Stone, K., & Eckstrom, E. (2019). Older hospital inpatients’ fall risk factors, perceptions, and daily activities to prevent falling. Geriatric Nursing, 40(3), 290–295. https://doi.org/10.1016/j.gerinurse.2018.11.005
Labrague, L. J., Al Sabei, S., Al Rawajfah, O., AbuAlRub, R., & Burney, I. (2022). Interprofessional collaboration as a mediator in the relationship between nurse work environment, patient safety outcomes, and job satisfaction among nurses. Journal of Nursing Management, 30(1), 268–278. https://doi.org/10.1111/jonm.13491
ORDER HERE
Lan, X., Li, H., Wang, Z., & Chen, Y. (2020). Frailty as a predictor of future falls in hospitalized patients: A systematic review and meta-analysis. Geriatric Nursing, 41(2), 69–74. https://doi.org/10.1016/j.gerinurse.2019.01.004
LeLaurin, J. H., & Shorr, R. I. (2019). Preventing falls in hospitalized patients: state of the science. Clinics in Geriatric Medicine, 35(2), 273–283. https://doi.org/10.1016/j.cger.2019.01.007 Mitigating Patient Falls Among Elderly Patients Final Project
Montero-Odasso, M. M., Kamkar, N., Pieruccini-Faria, F., Osman, A., Sarquis-Adamson, Y., Close, J., Hogan, D. B., Hunter, S. W., Kenny, R. A., Lipsitz, L. A., Lord, S. R., Madden, K. M., Petrovic, M., Ryg, J., Speechley, M., Sultana, M., Tan, M. P., van der Velde, N., Verghese, J., Masud, T. and Task Force on Global Guidelines for Falls in Older Adults (2021). Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review. JAMA Network Open, 4(12), e2138911. https://doi.org/10.1001/jamanetworkopen.2021.38911
Navaneethan, S. D., Zoungas, S., Caramori, M. L., Chan, J. C. N., Heerspink, H. J. L., Hurst, C., Liew, A., Michos, E. D., Olowu, W. A., Sadusky, T., Tandon, N., Tuttle, K. R., Wanner, C., Wilkens, K. G., Lytvyn, L., Craig, J. C., Tunnicliffe, D. J., Howell, M., Tonelli, M., Cheung, M., & Khunti, K. (2021). Diabetes Management in Chronic Kidney Disease: Synopsis of the 2020 KDIGO Clinical Practice Guideline. Annals of Internal Medicine, 174(3), 385–394. https://doi.org/10.7326/M20-5938
Oh-Park, M., Doan, T., Dohle, C., Vermiglio-Kohn, V., & Abdou, A. (2021). Technology Utilization in Fall Prevention. American Journal of Physical Medicine & Rehabilitation, 100(1), 92–99. https://doi.org/10.1097/PHM.0000000000001554
Park B. M. (2021). Development and Effect of a Fall Prevention Program Based on King’s Theory of Goal Attainment in Long-Term Care Hospitals: An Experimental Study. Healthcare (Basel, Switzerland), 9(6), 715. https://doi.org/10.3390/healthcare9060715
Pitchai, P., Dedhia, H. B., Bhandari, N., Krishnan, D., D’Souza, N. R. J., & Bellara, J. M. (2019). Prevalence, risk factors, circumstances for falls and level of functional independence among the geriatric population – A descriptive study. Indian Journal of Public Health, 63(1), 21–26. https://doi.org/10.4103/ijph.IJPH_332_17
Shaw, B. H., Borrel, D., Sabbaghan, K., Kum, C., Yang, Y., Robinovitch, S. N., & Claydon, V. E. (2019). Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents. BMC Geriatrics, 19(1), 80. https://doi.org/10.1186/s12877-019-1082-6
Shaw, L., Kiegaldie, D., Heng, H., & Morris, M. E. (2023). Interprofessional education to implement patient falls education in hospitals: Lessons learned. Nursing Open, 10(1), 36-47. https://doi.org/10.1002/nop2.1276
Singh, H., Flett, H. M., Silver, M. P., Craven, B. C., Jaglal, S. B., & Musselman, K. E. (2020). Current fall prevention and management policies and procedures in Canadian spinal cord injury rehabilitation. BMC Health Services Research, 20(1), 299. https://doi.org/10.1186/s12913-020-05168-8
Skivington, K., Matthews, L., Simpson, S. A., Craig, P., Baird, J., Blazeby, J. M., Boyd, K. A., Craig, N., French, D. P., McIntosh, E., Petticrew, M., Rycroft-Malone, J., White, M., & Moore, L. (2021). A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ (Clinical Research ed.), 374, n2061. https://doi.org/10.1136/bmj.n2061 Mitigating Patient Falls Among Elderly Patients Final Project
Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L., Khan, P. A., Sibley, K. M., Robson, R., MacDonald, H., Riva, J. J., Thavorn, K., Wilson, C., Holroyd-Leduc, J., Kerr, G. D., Feldman, F., Majumdar, S. R., Jaglal, S. B., Hui, W., & Straus, S. E. (2019). Quality improvement strategies to prevent falls in older adults: a systematic review and network meta-analysis. Age and Ageing, 48(3), 337–346. https://doi.org/10.1093/ageing/afy219
Vaishya, R., & Vaish, A. (2020). Falls in Older Adults are Serious. Indian Journal of Orthopaedics, 54(1), 69–74. https://doi.org/10.1007/s43465-019-00037-x
Walters, K. L., Johnson-Jennings, M., Stroud, S., Rasmus, S., Charles, B., John, S., Allen, J., Kaholokula, J. K., Look, M. A., de Silva, M., Lowe, J., Baldwin, J. A., Lawrence, G., Brooks, J., Noonan, C. W., Belcourt, A., Quintana, E., Semmens, E. O., & Boulafentis, J. (2020). Growing from Our Roots: Strategies for Developing Culturally Grounded Health Promotion Interventions in American Indian, Alaska Native, and Native Hawaiian Communities. Prevention Science: The Official Journal of the Society for Prevention Research, 21(Suppl 1), 54–64. https://doi.org/10.1007/s11121-018-0952-z
Wu, Y., Gu, Y., Rao, X., Cheng, M., Chen, P., & He, L. (2022). Clinical effects of outpatient health education on fall prevention and self-health management of elderly patients with chronic diseases. Evidence-Based Complementary and Alternative Medicine, 2022, 1–9. https://doi.org/10.1155/2022/6265388 Mitigating Patient Falls Among Elderly Patients Final Project
