Mitigating Falls in Elderly Patients in Acute Care Facilities

PROFESSIONAL RESEARCHMITIGATING FALLS IN ELDERLY PATIENTS IN ACUTE CARE FACILITIES
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Abstract
The population of old people aged above 65 years of is increasing worldwide, with China posting 2.8 million elder people in its entire population. This population faces an increasing threat in falls attributed to visual problems, chronic diseases, inadequate lighting, unsafe footpaths, and foot wares, and prescribed drugs (Bell et.al, 2015). The prevalence to falls among this group results in body injuries and fatal experiences that elongates their hospital stays and causes immense liability to hospitals. This also results patients developing additional complications, which increases medical costs. The susceptibility to falls among the elder population depends on the mobility, balance, and the leg strength. Therefore, the best approach towards solving this problem requires addressing the mentioned issues. Huang et al. (2012), suggests using a community based multifaceted approach, whereby the family and physicians shall aid the patients in normal daily routines to reduce prevalence of falls. The plan entails setting up safety standards and procedures such as patient education, using walking aids and patient response mechanism among others. Data on falls prevalence from patients shall be requisite during admission to gain knowledge on the susceptible individuals.
This study shall utilize a multifactorial and multifaceted approach in addressing falls among elder patients in acute health care facilities. This project proposal describes a new policy aimed at addressing the problem of falls in acute health care facilities and the implementation plans to affect the policy. All the facets of the approach shall aim to ease the burden on physicians and improve clinical outcomes on patients.
KEY WORDS: Falls; multifactorial; multifaceted interventions; acute care facilities;
Problem statement
Adults patients over 65 years of age admitted to acute health care facilities have a prevalence of experiencing falls, which may cause them injuries and result in longer hospital stays. A multifaceted intervention is requisite in reducing falls by educating patients and their families of care, having proper procedures in plan for reducing falls.
Rationale for the study
According to Jong-Long et.al (2014), Rose (2014), Lin et.al (2012), Rapp et.al (2011), and Kim et.al (2014), the population of older adults is significantly increasing in several regions, with particular reference to China. A research study conducted in this country by the Shanghai Public Security Bureau revealed that close to 2.8 million adults are aged between 60-65 years and account for 21.2% of the country entire population. Given this, Jong-Long et.al (2013) clearly indicates the frequencies in falls, and fall-related injuries as some of the common health issues that this population faces, thus depicting the statistical information provided by these authors to establish the gravity of this problem. On the other hand, Vlaeyen, et.al (2015), Bleijlevens, et.al (2010), Choi, et.al (2011), and Colon-Emeric, et.al (2013) allege that these statistics from different populations are bound to vary, with 16.9% of the adult population reported to have fallen over a period of 3 months in the USA. On the other hand, 28% of older people in Turkey said to have fallen within a year.
Solution strategy
Fall injuries among the adult population have several adverse effects on the quality of health and life, an aspect that has turned out to be of the burden to the society and families. However, non-fatal injuries are in most cases associated with morbidity, a point that includes the decrement in the functioning of the adult population, the significant need for health services, and the loss of independence (De Souza Moreira, et.al.2015). The risk factors for adult falls are consequently multiple. According to Bell, et.al (2015), several studies indicate that falls among the elderly population result from visual problems and chronic diseases including environmental factors such as inadequate lighting, unsafe footpaths, and foot wares, and prescribed drugs.
In addressing this challenge, Tse (2015) suggests the inclusion of a multifaceted intervention that takes into consideration environmental factors and behavioral components directed towards caregivers and the older people. These programs include health education and consultations directed towards enhancing the environmental factors that contribute to falls. Mackenzie, et.al (2013) details that the multifaceted approach is directed towards improving community and indoor safety through the inclusion of hazard assessment and elimination methods. In this case, it is essential to consider that the community-based multifaceted approach as detailed by these authors was considered as efficient in improving the mobility, balance, and the leg strength of the adult population since these are considered as the risk factors (Huang, et.al.2012). Given this, these articles clearly support my proposed change approach that seeks to establish multifaceted intervention programs in minimizing adult falls in different regions. Using these approaches, families, the community, and caregivers are in a position to decrease the frequencies of adult falls.
Mitigating Falls In Elderly Patients in Acute Care Facilities
Introduction
The desire to have an idea implemented in an organization always appears to be an uphill task however brilliant it is. Convincing the audience to buy the idea and the executive to fund it requires a sober approach. In this case, implementation of a policy to mitigate falls in elderly patients in acute care facilities shall require input from various stakeholders to reduce falls instances. This discusses the method to follow in obtaining support for the idea in a hospital, the description of the idea and the requirements of the policy.
Obtaining approval and support
The policy shall affect the hospital staff, patients, and their families. Therefore, in order to make the idea acceptable and improve its likelihood for success, the concerned parties and colleagues shall have the wind first. By informing and discussing with fellow staff members in the acute care department, nurses, the patients, ambulance drivers, and members of the hospital administration shall be helpful in building alliances and gathering important additional information for the project (Gallo, 2010). The input from experts shall also be imperative in decision-making. Before the presentation, enough preparation shall follow, in order to gauge the audience reactions for a positive response, and to plan for effective way of responding to important questions.
The presentation shall aim to position the idea to the audience to enable them create a right mindset towards accepting the idea. The audience shall get information on how the policy shall help the hospital in avoiding injuries, preventing extension of patients’ hospital stay through injuries sustained in falls, and its effectiveness in saving lives. The presentation shall also be in simple language to prevent the audience finding it difficult to fathom some ideas and words. As Gallo (2010) further mentions, the answering of the questions with confidence shall aid in communicating to the audience about the seriousness of the idea.
Description of the Old and New Policy
Falls is a major health concern and occurs among elderly patients with several impairments in the domains of sensory, cognitive and gait (Berry, Kiel, Schmader, & Sokol, 2016). This has several implications such as emotional and physical injuries leading to poor quality of life among the patients (Stern & Jayasekara, 2009). Additionally this may lead to longer stay in the hospital, increase in hospital liability and cause functional decline among the patients. Falls has frequently occurred among elderly patients in acute hospitals, rehabilitation facilities, and nursing homes (Berry et al., 2016). According to Berry et al. (2016), 50% of the patients in the long-term care facilities fall every year. Nursing homes report 1.5 falls annually, 3.4 falls in acute rehabilitation centers, and 5% among ischemic stroke patients (Berry et al. 2016).
The risk posed on the patient’s health and quality of life by falls is immense. The older methods of falls management have not been effective in reducing the number of falls. Owing to the large discrepancy between reported incidences and limited research-based prevention models for mitigating these challenges, there is need for a complete overhaul of former practices. The current problems emanate from lack of real time alerts concerning falls incidences and patients’ susceptibility to falls, lack of protection, poor knowledge base among the patients, and lack of effective falls assessment criteria (Degelau, Belz, & Bungum, 2012). This has caused increased falls cases, placing high responsibility, and liability to prevent and reduce these cases.
According to Hempel et al. (2013), the Centers for Medicare and Medicaid Services in the U.S. stopped reimbursing hospitals for falls trauma. This means that hospitals must create sustainable policies to manage falls and reduce costs and liability. Additionally, there are gaps noticed in the old policy such as lack of adequate education on the patients and their families concerning fall risks and prevention plans, lack of standardized consistent communication procedure concerning falls risks and prevention plans, and lack of proper orientation plan for newly recruited staff into the hospital’s falls prevention culture (Coppedge, Conner, & Se, 2016). These contribute to high falls. The new policy shall properly address these gaps. The new policy shall ensure placement of proper strategies to ensure interventions, formulation of appropriate intervention components and ensuring adherence to the intervention policy (Hempel et al. 2013).
Incorporated theory
The need to have falls prevention strategies is critical. Falls causes significant fatal and non-fatal injuries among older patients in critical hospital settings, and may result to significant mortality and morbidity (Berry et al., 2016). Most of the conditions that lead to falls are preventable. The risk factors associated with falls, mainly result from lack of assessment or attention from the patient and the medical team side. Falls may evade clinical attention because of the patient avoiding to alert the medical team of the event, lack of injury during the fall, the health team failing to evaluate the history of falls from the patient, or the patient and the medical team ignoring falls as an important issue in the aging process (Berry et al., 2016). The treatment of falls often does not include investigation into its cause, and may cause long-term effect.
The large number of researches and recommendations from health professionals has largely informed the new policy. According to Stern and Jayasekara (2009), the first step is to do a complete risk assessment of the susceptibility of the patients to falls. An interdisciplinary approach required in the new policy shall incorporate the collaboration of clinicians, pharmacists, physicians and nurses during and between a patient’s admission processes (Degelau, Belz, & Bungum, 2012). Close collaboration between the hospital administration and the medical staff shall ensure the success of the policy. Additionally, the new policy shall ensure adherence to best practices required to prevention of risks associated with falls. These shall include formulation of the best communication strategy to report cases of falls and using factor-directed prevention for fall risks.
Additionally, the medical team, patients, and their families shall undergo education and coaching on the best ways of falls prevention and assessment (Coppedge, Conner, & Se, 2016). This shall include use of visual tools and standardized communication method in reporting of falls cases. The new policy shall generally implement a culture involving the medical team, the patients, and their families into prevention of falls cases. The nurses shall carry occasional falls assessment on every patient and formulate an annual report regarding the cases involved in the facility. This shall aid in making informed decision on procedure for fall risk prevention.
The new policy shall be effective due to use of visual tools to reduce cases of falls. The placement of an electronic toolkit and poster above the patient’s bed shall be effective in reducing falls (Coppedge, Conner, & Se, 2016). The toolkit helps in assessment of falls risk, tailored falls prevention plan, plan of care communication and family and patients’ fall prevention education (Coppedge, Conner, & Se, 2016). The toolkit provides a complete means of assessing the patients’ needs, for educating the patients and their families, and prevention plans for the patients’ falls risks. The toolkit shall include the patients’ history of falls, frequency of special toileting needs, morbidity problems or need for special devices and possible conditional changes that contribute to falls (Coppedge, Conner, & Se, 2016). There shall be use of hip protectors to reduce injury and the susceptibility to falls (Stern and Jayasekara, 2009).
According to Degelau, Belz, and Bungum (2012), the use of visual aid in fall risk prevention in acute care facilities greatly aid in assisting patients with severe complications. The use of standardized assessment tool shall also assist in evaluating and predicting a patient’s susceptibility to falls. This will require regular assessment of the patient, and close monitoring as a means of providing safety measures to the patients. The newly recruited nurses and other medical staff members shall undergo a thorough training and inculcated into the culture of falls risk prevention models used in the hospital (Coppedge, Conner, & Se, 2016). Other means implemented shall include use of assistive devices and osteoporosis screening (Berry et al 2016).
Implementation plan
The implementation of the policy shall require authority from the hospital administration through the human resource department, to empower clinicians, physicians, nurses, and psychiatrists towards reduction of falls in the hospital. The risks associated with falls and the associated medical costs are high, therefore this shall require an urgent response to the problem. The personnel in charge of human resource shall oversee the implementation of the policy, and shall evaluate monthly data to ensure adherence to the requirements of the policy (Degelau, Belz, & Bungum, 2012). The staff shall receive initial training from qualified medical consultants who shall ensure the policy is in practice. Upon qualification, the lead staff in each department, with authority from the administration, shall ensure adherence to the policy, and constantly evaluating the gains met. New staff members shall undergo training under the current staff members.
The new policy shall incorporate a “multidisciplinary multifactorial interventions that consist of systematic assessment and treatment of fall risk factors, as well as active management of postoperative complications” (Stern and Jayasekara, 2009). The success of the new policy shall require seamless multidisciplinary communication. The staff in the reception, radiology, procedure rooms, surgery, and rehabilitation therapy shall be educated on a common way of handling patients (Degelau, Belz, & Bungum, 2012). The medical team shall strictly follow quality procedures to reduce risks due to injury caused by falls. The patients and their family members, during admission, shall undergo training on management and prevention of falls.
Requisition for implementation
The provision of learning and teaching materials to the staff during training shall enable them to get accustomed to the new policy. The hospital shall also prepare pamphlets, books, posters, and visual aids for the patients and their family members. This shall be useful in providing information regarding prevention, assessment, and management options for falls. The patients’ beds shall also spot electronic toolkits, visual assessment cards, alert cards, alert buttons, and hip protectors. Assistive devices such as crutches shall be available for the patients.
Evaluation plan
The pillars of the new policy shall rest upon education and data collection. The staff shall have to be competent in detecting prevalence of patients to falls. According to Coppedge, Conner, and Se (2016), the propensity of falls in hospitals is due to lack proper standardized communication, lack of proper staff and patient education and requisite for educating new and hired staff concerning procedures entailed in falls prevention. There is therefore need in family and staff partnership in prevention of falls.
The existing staff shall undertake the task of educating the patients and their families on proper methods of communication and seeking assistance in case of need. The patients shall have walking crutches, rubber sandals, and proper room lighting to avoid falls caused by environmental factors. The patients’ beds shall have hip protectors and alarm response gadgets in case of need for assistance.
The data collection for evaluation plan shall use the yellow fall tool for communication. This tool shall address the history of falls, special toileting needs, mobility problems, and conditions resulting to falls.
The tool has four quadrants. “The left upper quadrant addresses the patient's history of falls, with boxes to check for alarms, such as bed alarms, and settings, such as for out of the bed. The right upper quadrant addresses toileting needs with specific toileting methods. The lower right quadrant addresses condition changes such as the addition of medications that can cause change in mental status, BP, or gait steadiness; medical conditions that could increase the fall risk, such as orthostatic hypotension or bradycardia; or having surgical procedures or interventions requiring sedation. There should be assessment of patients for the presence of risk factors that increase fall risk. The listing of possible causes for falls is on the back of the tool. This information acts as a guide for novice nurses to assess their patients for the risk of physiological changes that could lead to falls. The last quadrant addresses mobility needs, including any special patient-handling needs” (Coppedge, Conner, & Se, 2016).
There shall be a falls committee to ensure patients receive assistance in a timely manner. The nurses shall update the tool concerning the intervention required by the patients (Appendix B). The physical therapists shall also include their recommendations and interventions on the tool. The unit educator, director of patient care and falls champion shall educate the bedside nurses, unit secretaries and patients’ assistance on the use of the yellow tool, which shall hung above the patients’ bed. The family members shall learn how the tool works and the need to involve the staff on the need to prevent falls on their relatives.
The falls committee shall evaluate the data collected on each patient on a weekly basis and compile a report on the efficiency of the method for six month. This data shall useful for the nurses in evaluating the effectiveness of their practice. The hospital oncology unit and falls director shall ensure the data is consistent with the aim of the policy to reduce falls.
Dissemination plan
The ultimate goal of introducing the new policy is to reduce the prevalence of falls among the elderly patients. The overall process of falls prevention involves the hospital administration, the medical team, the nursing unit, and the conglomerate of the patients with their families. The falls committee shall print the new policy and disseminate it among the nurses, the oncology and acute care units and the patients’ family upon admission. The assessment shall take 2-6 months to evaluate the effectiveness of the process. The falls committee shall ensure adherence to the policy in the hospital.
The data collected using the yellow tool shall undergo processing using proper statistical software such as SPSS. The medical director, senior administrator and nursing director shall evaluate this data on a consistent basis to ensure compliance with the policy. Any recommendation will be useful for the nursing team involved in provision of care.
Conclusion
The prevention and reduction of falls among elderly patients in acute care facilities require education, assessment, and constant monitoring. Good communication must exist among the staff across the disciplines to meet the needs of the patients. The implementation of this policy shall involve education of the staff members concerning the best practice, education of the patients and their families, and adherence to the requirements of the policy by all stakeholders. This policy shall oversee reduction of number of falls and protection of the patients.
The use of the yellow tool in data collection shall aid in enhancing communication between the staff and the patients, aiding the hospital administration in ensuring adherence to proper care standards. The implementation of this policy is beneficial to the patients and the hospital at large.
Analysis and Appraisal of Literature
Bell, H. T., Steinsbekk, A., & Granas, A. G. (2015). Factors influencing prescribing of fall-risk-increasing drugs to the elderly: A qualitative study. Scandinavian Journal of Primary Health Care, 33(2), 107-114. doi:10.3109/02813432.2015.1041829
Summary of Article
The author of this study explores the injuries mainly caused by falls as a leading cause of death among the elderly and longstanding disabilities and pain.
Research Elements
According to this author, the increase in adult population in several regions has seen an increase in fall-related fatalities and injuries. Given this, a study conducted by the Shanghai Public Security apparently revealed that close to 2.8 million adults aged between 60 and 65 accounts for the population of China. Out of this, 15.5% of the adult population falls has significantly been recorded in this country.
Study
In a bid to find explications to this problem, a qualitative study was conducted on 13 General Practitioners who provide care to the senior citizens to establish the inclusion of a multicoated approach in minimizing adult falls. The participants in the study were required to share their thoughts on the use of the multifaceted approach and the management of these falls especially those caused by the fall-risk-increase dugs (FRIDS).
Results and Significance to Patient Care
The study exhibited that the General Practitioners had no knowledge of the use of the multifaceted approach in minimizing falls among the elderly patients, exceptions being they lacked the proper knowledge on this method.
Bleijlevens, M. C., Hendriks, M. C., Van Haastregt, J. M., Crebolder, H. M., & Van Eijk, J. M. (2010). Lessons learned from a multidisciplinary fall-prevention programme: The occupational-therapy element. Scandinavian Journal of Occupational Therapy, 17(4), 319-325. doi:10.3109/11038120903419038
Summary of Article
This study was designed to give insights into the impact of the occupational-therapy of the multidisciplinary fall prevention approach aimed at reducing falls that contribute to functional decline in the adult population.
Research Elements
As detailed in this journal falls, and the consequences that Results and Significance to Patient Care from them are considered as a great strain on the health and well-being of the adult population. Each year as detailed in this article, approximately 30% of adults aged between 65 and above sustain falls that Results and Significance to Patient Care in fatal injuries.
Study
An analytical and descriptive study was conducted in which data were collected through a random control trial that found no effects on the multidisciplinary fall prevention methods. The population of the study comprised of 166 participants and two occupational therapists.
Results and Significance to Patient Care
Through the occupational therapy initiative, 458 recommendations regarding the inclusion of assistive devices were incorporated. It was established that the effec...