Project (Falls Prevention among the Elderly People) Essay Example

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    Nursing
  • Document type:
    Research Proposal
  • Level:
    Undergraduate
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NURS2006 ASSIGNMENT 3

Clinical Practice Improvement Project Report

Student Name, FAN and ID:

Project Title:

Fall prevention strategies among the elderly people

Project Aim:

To ensure there is 20% decrease of rate of falls in Blacktown Hospital, NWS, Australiaamong the elderly in-patients in 5 monthsby using education and falls risk assessment

Relevance of Clinical Governance to your project

Clinical governance involves quality improvement and ensuring high standards of care are maintained by creating an environment where excellence in clinical care thrives (ACSQHC, 2012, p. 1). Therefore, clinical governance is also involved in ensuring safety and preventing harm. In regard to this project, clinical governance is relevant in prevention of falls as well as reducing harm caused by falls. This projects aims to use fall prevention strategies to reduce rate of falls and hence this clinical governance aspect will also reduce costs associated with treating injuries that result from falls. In addition, nurses have a responsibility of participating in quality improvement activities. Accordingly, this project is a quality improvement activity.

Clinical governance also aims to reduce healthcare costs. Falls and treated of injuries related to fall result to significant costs to the healthcare system (ACSQHC, 2012, p. 1). The cost of falls including indirect costs like the costs that the family and the community bear was more than $1 billion annually in 2003 (Watson et al, 2010, p. 3). This therefore means that currently the cost of falls to the health care is significantly higher than $1 billion annually in Australia. In 2007-2008, the cost of acute care for injuries related to falls was about $648.2 million in Australia (Watson et al, 2010, p. 3). In New South Wales, the total cost of healthcare in treatment of injuries related to falls was almost $560 million (Watson et al, 2010). Furthermore, cases of hospital admission to treat injuries related to falls accounted for 84.5% of the total costs (Watson et al, 2010, p.3). This indicates the severity of the falls. Falls are also common cause of early admission to residential aged care facilities and this further augments the healthcare costs associated with falls. As Watson et al (2010, p. 4) explain, individuals living with homecare facilities accounts for more than 15% of the total healthcare costs for treatment of injuries related to falls. This further indicates the high costs of falls to the healthcare system. Accordingly, this project is relevant to clinical governance because with effective fall risk assessment and education, costs associated with treating fall-related injuries will reduce.

Evidence that the issue / problem is worth solving:

Fall rate in the older people is very high worldwide. The rate of hospitalization as a result of falls among the elderly people is very high and it ranges from 1.6 to 3.0 per 10 000 population in Australia, Canada and UK (Watson et al, 2010, p.3). The rate of injuries caused by falls and result to emergency visits within Western Australia and UK is very high and ranges between 5.5-8.9 per 10 000 population total. This indicates that falls and the ensuing injuries among the elderly population pose a major public health issue. This is because falls can cause significant injuries, disability and death among the elderly people. AIHW (2013, p. 1) also explains that 1 out of 3 people aged 65 years and over fall every year and ensuing effects include death, disability and reduced quality of life. According to Allan et al (2009) falls are the leading cause of accidental injuries among the elderly and cause of them being hospitalized. The rate of falls continues to increase with age. Evidence further indicates that about 50% of individuals 80 years and above fall experience at least one fall in a year (AIHW, 2013, p. 1). In Australia, the incidence and prevalence of falls among the elderly is very high. For example, in Australia, between 2011-2012 (AIHW, 2013, p.1). Similarly, in 2011-2012, 96,385 people aged 65 and above were admitted in hospital because of injuries related to falls (AIHW, 2013, p. 1). All these statics indicates the significance of developing strategies that reduce falls in the older people.

More than 80% of hospital admissions due to injuries in individuals aged 65 and above are because of falls and injuries allied to falls (Quigley & White, 2013, p. 1). Falls rate in Australian hospitals is estimated to be 4-12 falls per 1000 bed days in patients aged 65 years and above. In addition, more than 40% of patients with health problems such as diabetes in a hospital setting experience falls during their hospitalization. About 30% of such falls within a hospital setting, result to injuries (Bloch et al, 2010, p. 895).

Additionally, falls pose a high risk to the health and well-being of the elderly population within the society. After a person sustains a fall, their confidence can be really affected and such people end up developing fear of falls. Fear of falling can reduce a person’s quality of life (Quigley & White, 2013, p. 1). This is because dear of falls can make people avoid certain activities such as even walking to the shops. Injuries resulting from falls can encompass cuts, bruises, abrasions, and fractures (Tinetti& Kumar, 2010, p. 260). A vicious cycle then develops where an individual ends up becoming less active and consequently physically weaker and this decreases an individual’s quality of life and independence as well (Quigley & White, 2013, p. 2). Fractures are particularly very common and very serious injuries because it can result to loss of mobility and independence. Evidence indicates that approximately 5% of falls among the elderly result to a fracture (Quigley & White, 2013, p. 2).

Performing fall risk assessment has been evidenced to be effective in reducing fall rate because risk factors to falls are identified and appropriate fall prevention measures implemented. Educating the staff members and also the patients on fall risk factors and how to avoid them has also been evidenced as effective in reducing fall rate.

Key Stakeholders:

The key stakeholders in this project will consist of the managers, the staff, partnering healthcare providers, and older people and their families and carers. Managers are key stakeholders in this project because they will play a very important role in the success of this project. Managers will provide resources for the project and also have the responsibility of authorising the conducting and implementation of this project. Staff members such as physicians and nurses will play a central role in the successful implementation of this project. Physicians will play the central role in regard to the treatment and management of patients.Physicians will be identifying patients at risk of fall and referring them for assessment. This is because physicians have the role of diagnosing and prescribing examinations for patients.

Nurses will also play an important role in this project because they are the primary healthcare providers. Nurses will have the role of performing fall risk assessment on patients as well as identifying patients at risk of falls after the fall risk assessment. In addition, it is nurses who will have the primary responsibility of educating the patients about risk factors for falls and the preventative measures that they should follow to avoid falls. Generally, nurses have the responsibility of providing care to the patients and hence they will be actively involved in the implementation of this project. Other partner healthcare providers such as physiotherapists will also be involved. Finally, the elderly patients and their carers/families will also be involved in this project. This is because the patients and their families might be concerned regarding the falls intervention strategies in case they are not involved. Therefore, it will be necessary to provide the elderly and their families with simple and enough information as well as the reasons for the project.

CPI Tool:

This project will use the Plan-Do-Study-Act (PDSA) tool to implement and test the effect of the implemented intervention (Curran E & Bunyan D, 2012, p. 108). All the prescribed four steps will be used to guide the thinking process when implementing the interventions used in preventing falls. Accordingly, the tasks involved in the implementation of the interventions will be broken down and the outcome will be evaluated, improved and then tested again (Curran E & Bunyan D, 2012, p. 108).

The focus of this project is implementation of falls prevention strategies to reduce falls rate among the elderly. Therefore, this project plans to reduce the rate of falls among the elderly in-patients by 20 % in 5 months using various fall prevention strategies. The second plan will include providing all project stakeholders with information regarding the fall prevention strategies.The third plan will be carrying out post-intervention audit 2 weeks after the completion of the project and another audit after a month and comparing the fall rate in the two audits.

This phase encompasses actions that will be carried out in ensuring the implementation of the project is a success. Therefore, this phase will include budgeting for the project and then making arrangements to ensure that the funds are availed. This phase will also include assignment each project team member their responsibilities. It will also include educating all the stakeholders regarding the project. More importantly, this phase will include putting into practice the project’s interventions, such as educating patients in their rooms regarding fall prevention strategies or performing fall risk assessment , among other interventions. This phase will also involve avoiding resistance to change by the staff will be reduced by educating them about the project. Nurses will also receive training on how to perform fall risk assessment and have them assessed for their adherence to the assessment.

The records regarding the interventions will be reviewed to determine if all the planned interventions have been executed. A simple table will be maintained to document all project steps and interventions. Display in the hospital’s conference room will run a percentage of patients and other stakeholders who have received the interventions. In addition, information regarding the rate of falls before and after project implementation will be collected to evaluate the efficacy of the project in reducing falls rate.

This stage will include implementing the interventions and adapting. This means it will encompass performing the proposed interventions by actually implementing them. Actions include ensuring every elderly person in the hospital undergoes fall risk assessment, educating both nurses and patients about the fall prevention strategies and implementing improvements after evaluations. This stage will also include revising the PDSA.

Summary of proposed interventions:

Seeking authorization/ Funds application

The first step will be to seek permission from the relevant authority in the hospital in order to get approval to perform the project. Secondly, application for the funds that will be used to cater for the project will also be done. The estimated budget will be presented to the hospital’s management.

Training the appropriate stakeholders regarding the project

All stakeholders who will be actively involved in implementing the fall prevention strategies will be need to received training in order to acquire the appropriate skills to perform the fall prevention strategies. Additionally, all the equipment that will be used in the project will be availed to all project stakeholders apart from the patients and their families in order to familiarise them with the equipment before the actual project. Training will be carried by people with appropriate expertise.

Evaluating the efficacy of the project

In order to know if the project has been effective in reducing the rate falls, it will be important to collect data before and after the project is implemented. Information on rate of falls before and after project’s implementation will be collected from the hospital records. This data will be used in analysing the efficacy of the project’s interventions in reducing rate of falls.

Barriers to implementation and sustaining change:

Barriers to implementing the change during this project’s implementation may encompass lack of enough resources and resistance to change. First, lack of enough resources can occur if the management fails to avail enough funds to cater for all project expenses. This barrier can be overcome by trying to seek for funds from organisations that can sponsor the project. Again, shortage of funds can also be overcome by trying to improvise any equipment if possible rather than buying new ones. Another barrier to change implementation is resistance to change. Studies show that many people during change implementation resist change. Generally, people fear changes and hence this project is not an exception. Resistance to change manifests in different ways such as inertia, being rebellious or even sabotage (Kohet al, 2008, p. 4). Therefore, in this project, there may be case of change resistance which can be manifested in many different ways. This barrier can be overcome by identifying the sources of resistance and secondly interviewing the resistance to get feedback that can help in enhancing the process of gaining acceptance for change (Kohet al, 2008, p. 4). Lack of managerial support is also another barrier. This can be overcome by educating the management about the significance of the project in order for them to see how much important the project is to the hospital.

Evaluation of the project:

  • Observed reduction in the incidence of falls in the hospital. Observations will be done to examine if the elderly persons are experiencing falls as much as before. This can be done when the elderly patients are walking in the hospital’s corridors or when they are performing activities of daily living. Reduced incidences of falls will indicate efficacy of the project in preventing falls.

  • Secondly, information will be obtained from the hospital records before and after the completion of the project. The information that will be collected will encompass statistics about the falls rate before and after project implementation. A drop in the falls rate will mean that the project has been effective in preventing falls.

  • Thirdly, an audit will be performed to determine of the healthcare providers are using the project’s interventions with the elderly patients

  • Fourth, face-to-face feedback will be obtained from the elderly in-patients to get the primary data whether the falls rate has reduced or not.

Reference List

Allan, LM, Ballard, CG, Rowan, EN, Kenny, RA &Baune, B 2009, ‘Incidence and prediction of falls in dementia: a prospective study in older people (Falls in Dementia)’, PLoS ONE, vol. 4, no. 5, pp. e5521,

AIHW, 2013, Hospitalisations due to falls by older people, Australia: 2009-10, AIHW.

Bloch F, Thibaud M, Gudue B, Breque C, Rigaud A &Kemoun, G, 2010, Episodes of falling among elderly people: a systematic review and meta-analysis of social and demographic pre-disposing characteristics, Clinics (Sao Paulo), vol. 65, no. 9, pp: 895–903.

Commission on Safety and Quality in Health Care, 2012, Safety and Quality Improvement Guide Standard 10: Preventing Falls and Harm from Falls, Sydney, ACSQHC

Curran E & Bunyan D, 2012, Using a PDSA cycle of improvement to increase preparedness for, and management of, norovirus in NHS Scotland, JHospInfect, vol. 82, no. 2, pp: 108-113.

Hill, A., Hoffman, T., & Haines, P, 2013, Circumstances of falls and falls-related injuries in a cohort of older patients following hospital discharge, Clinical Interventions in Aging, vol. 8, no. 1, pp: 765-774.

Koh S, Manias E, Hutchinson A, Donath S & Johnson L, 2008, Nurses’ perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals, BMC Health Serv Res, vol. 8, no. 105

Tinetti, M & Kumar, C 2010, ‘The Patient Who Falls: It’s Always a Trade-off’, JAMA, vol. 303, no. 3, pp. 258-266.

Quigley, P & White, S 2013, ‘Hospital-Based fall program measurement and improvement in high reliability organizations’, Online Journal of Issues in Nursing, vol. 18, no. 2.

Watson W, Clapperton A & Mitchell R, 2010, The incidence and cost of falls injury among older people in New South Wales 2006/07, Sydney: NSW Department of Health.

NURS2006 Assignment 3- CPI paper Marking Rubric

PERFORMANCE STANDARD

CATEGORY & WEIGHTING

Excellent Work

Good Work

Passing Work

Unsatisfactory work

Project Aim and Evidence the issue is worth solving

Aim succinct & clearly

defined. All evidence relevant & rigorous. Shows a very high level of insight & relevance to the issue.

(17-20)

Aim well defined.

Some irrelevant information but most evidence relevant & rigorous. Shows a very good level of insight & relevance to the issue.

(13-16.5)

Aim stated with some ambiguity. Some evidence relevant and rigorous,

Acceptable level of insight.

Quite a lot of irrelevant information is present. May be overlong/ too brief

(10-12.5) 

Aim not clearly stated

Most evidence is not relevant or rigorous.

Poor level of insight & relevance to the issue. Significant amount of irrelevant/ missing information.

(0–9.5) 

Relevance of Clinical Governance to your project

Succinct and highly relevant discussion of the relevant pillar of clinical governance related to the chosen clinical issue.

(9-10) 

Succinct and mostly relevant discussion of the relevant pillar of clinical governance related to the chosen clinical issue.

(7-8.5) 

Adequate discussion of the relevant pillar of clinical governance related to the chosen clinical issue.

Some parts not relevant Overlong / too brief, may be missing relevant information.

(5-6.5) 

Inadequate discussion of the relevant pillar of clinical governance related to the chosen clinical issue. Overlong / too brief, may be missing a significant amount of relevant information

(0-4.5) 

Key Stakeholders

Identifies most relevant key stakeholders. Discusses clearly how they could be involved in the project.

Succinctly and expertly written. Very high level of insight into the role of stakeholders.

(4.5 — 5) 

Identifies some relevant key stakeholders and adequately discusses how they could be involved in the project.

Very well written. Good level of insight into the role of stakeholders.

(3.5-4.25) 

Identifies a few relevant key stakeholders. Mentions briefly how they could be involved. Quite well written but contains some irrelevant information, or minor information is missing. Adequate level of insight into the stakeholder role.

(2.5 – 3.25- ) 

Contains irrelevant information, or major information is missing.

Inappropriate or no key stakeholders are identified Poor insight into the stakeholder role.

(0-2) 

Clinical Practice Improvement Tool

Describes a relevant CPI tool Very clearly discusses how it could be used to address the aim and implement the interventions. Succinctly and expertly written with no omissions of relevant information.

(17-20) 

Describes a relevant CPI tool Discusses quite clearly how the tool could be used to address the aim and implement the interventions. Well written but may contain some irrelevant information, or some minor information is missing

(13-16.5) 

Describes a relevant CPI tool and adequately discusses how the tool could be used to address the aim and implement the interventions.

Not succinct, contains irrelevant information, significant information is missing

(10-12.5) 

A relevant CPI tool is not identified. There is no adequate discussion of how the tool could be used to meet the aim or implement the interventions.

Contains irrelevant information or some major information is missing.

(0–9.5) 

Summary of proposed interventions

All relevant interventions are discussed very well.

Project outline is very clear and the relevance to clinical practice is very high.

(17-20) 

Most relevant interventions discussed quite well.

Project outline is clear & relevance to clinical practice is good. Contains some irrelevant information, minor information may be missing.

(13-16.5) 

Acceptable level of relevant interventions discussed.

Project outline mostly clear, although it may be unclear how the project would actually be implemented in clinical practice due to irrelevant/missing info

(10-12.5) 

Some elements missing or incomplete. May contain large amounts of irrelevant information.

Project poorly described and it is unclear what the project actually entails or its relevance to clinical practice.

(0–9.5) 

Barriers to Implementation

Identifies most potential barriers to implementation & clinical change. Discusses in depth how these barriers could be overcome or minimised.

(13-15) 

Identifies some potential barriers to implementation & clinical change. Discusses how these barriers could be overcome or minimised.

(10-12.5) 

Identifies a few potential barriers to implementation & clinical change. Discusses how barriers could be overcome or minimised. Minor omissions and/or some irrelevant information present

(7.5-9.5) 

Relevant barriers not identified. Poor or no discussion about how they could be overcome or minimised. Major omissions, much of the information provided is irrelevant / unrelated to the CPI goal.

(0-7) 

Evaluation of the project

Succinct discussion of an excellent and achievable plan for how the intervention/s could be evaluated.

(9-10) 

Succinct discussion of a very good and mostly achievable plan for how the intervention/s could be evaluated.

(7-8.5) 

Discussion of an adequate plan for how the intervention/s could be evaluated. Some parts not relevant or achievable

Overlong / too brief, may be missing relevant information.

(5-6.5) 

Plan absent or not well described. Most or all of the plan is not relevant or achievable

Overlong / too brief, may be missing a significant amount of relevant information

(0-4.5) 

Name of Marker

Overall Comments