Capstone Change Proposal: Falls and Fall-Related Injuries

Benchmark – Capstone Change Proposal
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Benchmark – Capstone Change Proposal
Background
Elderly people residing in nursing homes face a high risk for falls and fall related injuries. For instance, of the 1.6 million residents in America’s nursing facilities, nearly half report fall-related injuries: about a third of these residents fall two or more times annually. Fall-related injuries adversely impact frail older residents by significantly lowering their quality of life as well as ability to function. Nearly a tenth of all elderly residents who fall in nursing homes end up with a serious injury like hip fracture, which increases their risk of death. Moreover, residents who fall but do not succumb to fall-related injuries end up developing a heightened fear of falling, which also limits their ability to function through self-imposed restriction of activity. Falls are a critical health indicator in long-term nursing facilities and also have potential negative consequences for the institutions. For instance, falls and fall-related injuries are tied to increased paperwork for staff, poor patient satisfaction scores, additional care demands by fallers, high insurance premiums, and civil law suits against the nursing home. Falls among elderly residents in nursing homes are caused by a combination of both extrinsic and intrinsic risk factors. Some of the intrinsic factors include behavioral symptoms and risky behaviors, effects of inactivity on strength, acute medical conditions, effects of aging on gait and balance, medication side effects, and chronic diseases.
On the other hand, the extrinsic factors are unsafe built environment, equipment hazards, and unsafe personal care items. Although extrinsic factors can be addressed to reduce risk of falls and fall-related injuries among elderly residents, the intrinsic risk factors are harder to eliminate. For instance, it is impossible to completely eliminate age-related effects or chronic diseases although medical management of these conditions can help reduce residents’ risk of falling. On the other hand, extrinsic risk factors can be addressed by modifying the built environment and equipment. Some of the ways nursing homes can reduce the number of falls and fall-related injuries with relation to extrinsic risk factors include addressing issues of poor lighting, improper footwear, wobbly furniture, ineffective wheelchair brakes, cluttered living space, hard-to-manage clothing, uneven floors and wet areas, inaccessible personal items, and unstable bed wheels. This capstone essay will focus on assisting facilities tackle both intrinsic and extrinsic risk factors using a multifaceted and evidence-based approach to individualized care planning and organizational commitment to comprehensive falls assessment and prevention.
Clinical problem statement
A fall is defined as a sudden, unplanned shift in position that results in a person hitting the ground or another object below his or her initial position. The American Medical Directors Association (AMDA) recognizes falls as a serious cause of injuries and death among elderly individuals residing in long-term care facilities. Moreover, the Agency for Healthcare Research and Quality (AHRQ) reports falls as one of the leading causes of grave and non-fatal injuries among elderly populations, particularly people aged 65 years and older. Furthermore, the AHRQ determined that falls were responsible for over two million emergency room visits: a tenth of all emergency room visits among older people were related to fall-related injuries. The Centers for Disease Control and Prevention (CDC) also reports that one out of four older people (those aged 65 years and older) fall every year and that less than half inform their doctor. Falling not only doubles the chances of older people falling again but also results in serious injuries like head injury, hip fracture, and broken bones. For instance, hip fracture is responsible for at least 300,000 cases of hospitalizations every year. Worse, the number of fall-related deaths among older adults in America increased by 30% between 2007 and 2016. Falls are especially dangerous to older people taking certain medications such as blood thinners, which tend to exacerbate fall-related injuries such as brain injury. Moreover, many older people who fall but are not injured become paranoid of falling and cut down most of their everyday activities, which results in further physical inactivity and body weakness, all of which heighten their risk of falling again.
Purpose of the change proposal in relation to providing patient care in the changing health care system
The purpose of the change proposal in relation to providing patient care in the changing health system is implementing evidence-based fall prevention interventions that are more effective than standard fall prevention interventions in reducing incidents of falls. This change proposal will conduct a literature search of current best practices in fall prevention and identify evidence-based strategies that can be applied in nursing homes to reduce falls and fall-related injuries among elderly residents. Identifying evidence-based fall prevention methods will help nursing homes identify residents at high risk of falls and fall-related injuries and implement personalized fall prevention strategies. On the whole, the purpose of this change proposal in relation to providing patient care in the changing health care system is to improve clinical outcomes, increase patient satisfaction levels, and reduce healthcare costs in nursing homes.
PICOT question
Among residents in a skilled nursing facility (P) would the implementation of evidence-based fall prevention interventions (I) be more effective compared to the standard fall prevention interventions (C) in reducing incidents of falls (O) three months after implementation (T)? 
Literature search strategy employed
The literature search strategy primarily involved an online search of relevant, current, and credible research articles in various clinical databases. In particular, the online literature search strategy involved combining the key concepts of the PICOT question in order to conduct accurate search efforts. Moreover, the literature search focused on credible literature sources: some of the databases used for the nursing research include ClinicalKey Nursing, JBI EBP Database, CINAHL Plus, PubMed Clinical Queries, Nursing Reference Center, Embase, PubMed, and the Cochrane Library. This list of databases was deemed credible on account of the fact that most of the research articles contained in them are peer-reviewed and authored by respected scholars in the nursing field. The search strategy accounted for possible search items, subject headings, keywords, and shortened variations of search phrases. After using the search terms and phrases to identify relevant research articles, the researcher focused on understanding the obtained resources. The researcher was interested in research articles whose clinical implications were evidence-based and supported the capstone change proposal. This process of familiarizing with all identified resources allowed the researcher to identify relevant findings that meaningfully addressed the issue of falls and fall-related injuries among elderly patients in nursing homes
Evaluation of the literature
The study by Bjerk et al. (2019) investigated the effectiveness of a falls prevention exercise program (The Otago Exercise Programme (OEP)) on health-related quality of life (HRQOL), physical functioning, and falls self-efficacy among elderly individuals. Falls adversely impact the quality of life of elderly people in nursing homes and significantly add to the global burden of disease. The study employed a parallel-group randomized controlled trial study design and recruited 155 participants into the OEP. Moreover, the study measured HRQOL using the SF-36 survey tool and other secondary outcomes like instrumental daily living activities and self-capacity to prevent falls. The authors determined that the OEP program improved HRQOL, physical functioning, and falls self-efficacy among elderly individuals in the intervention group compared with those in the control group.
Burke et al. (2017) explored the process used by clinicians in determining which older adults in the hospital should be moved to a skilled nursing facility (SNF) for post-acute care. The study employed a qualitative analytical study approach that involved semi-structured interviews with inpatient care unit staff in three hospitals. Moreover, the authors focused on themes tied to the decision-making process used by clinicians in patient evaluation and discharge to SNF. The study determined that the process of evaluating which older adults in the hospital should be moved to a SNF was rushed and that many clinicians were forced to use SNFs to avoid accountability. The staff lacked a clear decision-making framework for deciding which patients should be directly discharged or moved to a SNF and therefore used the latter became the default option. More importantly, the study highlighted the need for clear decision-making systems during transition of care, particularly in the post-acute care of elderly patients.
Castellini et al. (2017) evaluated the suitability of a fall risk prevention initiative using the STRATIFY evaluation instrument to determine acute-care inpatient fall risk. The authors gathered statistics of falls and near falls from the study hospital’s incident reporting web-system and then evaluated the fall risk using STRATIFY. Using 365 incident reports, the study focused on determining the fraction of inpatients categorized as having a high risk of falling and who fell as well as the fraction of inpatients categorized as having a low risk of falling but who fell nonetheless. The study defined the particulars of the study group and fall events using the identified true positive rate and false...