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Capstone Project-Change Proposal Portfolio

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Capstone Project-Change Proposal Portfolio

Hospital falls have become a common menace facing many health practitioners and institutions around the globe. The population in focus is the elderly patients who have demonstrated susceptibility to falls in the course of their stay in hospitals. It is noteworthy that most falls occur at the bedside and in the washrooms. These falls are far fetching with respect to their impact on both patients and practitioners, therefore necessitating for immediate intervention measures. This paper focuses on developing a change project pertaining adaptation of new policies and strategies in hospitals that will be effectual in curbing hospital falls for the elderly patients.

Background

            According to studies conducted, it has been found out that many falls tend to occur during shift changes in instances where nurses are pre-occupied with report.  In this case, patients tend to fall in times when there’s no one to check on them. According to (Haines, Lee, O’Connell, McDermott, & Hoffmann, 2012) for every 1000 beds occupied by patients, approximately 3 to 20 falls are bound to occur. There are several factors that contribute to patient falls. These majorly include chronic health conditions and medications.  A substantial contributing factor that cannot be overemphasized is that elderly patients have a weak bone structure as a result of age hence their general body weakness. As a result of this bone structure weakness, these patients are not able to support themselves efficiently hence result to falling while in the hospital (Thomas & Mackintosh, 2016).

 

Problem Statement and Purpose for Change

           

PICO(T)

            For the growing pool of hospital patients 65 and older (P), will the increased presence of nurses at a patient’s bedside (I), compared to those receiving the current nurse attention (C), experience less falls during their stay in the hospital in addition to a lesser degree of severity in said falls (O), over a 6-month period (T)?

Hospital falls have been disastrous occurrences for older patients, and on a worst case, leading to injuries hence extension of recovery time. A weak bone structure which is a marker of the old age has been a significant contributor to the frequent falls for this population. Medications, with respect to patient ailments, have played a big role as substantial risk factors that are worthwhile noting.

Literature Search

Strategy Employed

            Haines et al. (2012). provided insight on qualitative research consisting of 16 patients between the ages of 72-75 years with a history of falls, 8 care providers, and 33 medical professionals to evaluate why they take risk, the nature of the risk itself, and factors that described the risk taking.  Cabrita Guerrero Jose (2013) provided research study on 53 patients aged 65 years and older to detail the risk factors for why elderly patients continue to fall.  Sakai et al. (2016) analyzed research on 1408 patients admitted to a public university hospital to evaluate fall risks in adult patients and prevention measures.  Abreu et al. (2012) provided research from 2007-2009 on patients between the ages of 64-74 years old and found that most patients who fell were in fact elderly and partially dependent while Morello et al. (2017) evaluated Fall Bundle evaluating 31, 411 patients from 12 acute wards in 6 public hospitals in 2 states of Australia.  Lim & Yum (2016) assessed the Morse Fall Scale and 100 nurses in a private hospital from 2012-2014 while Aranda-Gallarto et al. (2017) provided research on the STRATIFY and Downton instruments for evaluating fall risks from May 2014-March 2016 and evaluated 977 patients and Ponds (2017) uses a case study of an 80-year old patient to reiterate the recommended fall bundle to decrease the rates of patient falls. 

 

Evaluation of Literature

Hospital falls continue to be a common menace involving elderly patients. This calls for immediate attention and implementation of measures centered on best practices, effective innovations and research-oriented methodologies. Falls demonstrate a significant impact not only on the quality of care but the financial aspects pertaining to institutions. Severity of impact varies, with a worst case being further deterioration of a patient’s present health condition, therefore delaying quick recovery and elongating their hospital stay. This author’s proposed change project is to implement a fall bundle that is consist of assessing patients regarding mobility and medications at the beginning of each shift within the first hour, implementing a fall bundle.  Consistency is an important component; therefore, upper leadership will provide in-service, reviews, and daily audits at shift change and throughout each shift with feedback to staff.

Change or Nursing Theory

In order to effectively counter the hospital falls menace, the nursing scope has to be subjected to changes to enhance service delivery and decision making. It is recommended that nurses get to assess fall risk at the beginning of every shift. This will enable the nurses to identify any potential for a fall during the shift period. Secondly, interventions are to be implemented immediately. These include installation of call light at bedside, beds are to be locked and be positioned at the lowest position, mobility aids are to be placed within reach of patients, and alarms are to be kept on as necessary.  In addition to this, nurses are to perform handoff at the bedside to ensure that IV lines and meds are evaluated, that patients get involved in their plan of care, and to ensure that patients are safe and both staff member should sign off.  Finally, constant learning and pursuit of further education ought to be continuous for all staff as well as patients. This is with respect to the importance of adhering to the plans discussed. 

 

Proposed Implementation Plan with Outcome Measures

The absence of nurses at the bedside of patients has been of immeasurable impact to the escalation of hospital falls incidents. Absent nurses means limited or insufficient assistance to patients in the event assistance is needed most. Such an incidence would be when a patient needs to access the bathroom and there is no any nurse available to give a hand. In order to counter this menace, it is of immeasurable importance that the amount of time that nurses spend with patients at their bedsides be increased.

Currently, during nurse shifts, nurses have been preoccupied with reports leaving them minimal time to spend with inpatients under their care. In addition to this, there has been poor risk assessment procedures by nurses, a measure that would be impactful in curbing falls risk factors.

With an increase in the amount of time spent by nurses with patients under their care, it goes without saying that there will be a significant reduction in the cases reported of hospital falls for inpatients aged 65 and above. The reliable presence of nurses means that patients are able to access help at any time a need arises. For example, a nurse can help a patient with mobility issues to access the toilet safely without risking falling.

The implementation of this practice is set to significantly decrease hospital falls cases within a 6 months’ timeframe. In this duration, proper risk assessment practices are to be put into consideration by nurses as they tend to spend more time with their patients.

 

Potential Barriers and Strategies to Overcome

Haines et al.’s (2012) research was limited to only one geographic region and hospitals within one health service and only English speaking patients so this limited data on cultural and linguistic backgrounds. Morello et al.’s (2017) research consisted of randomized controlled trial (RCT) and suggested that qualitative data would have helped to provide additional data on factors that may influence implementation of a fall risk bundle’s reliability but it was beyond the scope of the study. Lim & Yum’s (2016) study was limited to only a small sample size of 100 nurses at one location.  This may not represent nurses in other areas and therefore the results cannot be comprehensive to the population as a whole.  Cabrita & Guerrero-Jose’s (2013) research is specific to elderly patients in the Equipe de Cuidados Continuados Integrados nurse program for fall preventions.  Although it is found that the Morse Fall Scale is effective for this specific program, it does not represent the community. Aranda-Gallarto et al.’s (2017) research was limited to observational design that can result in inferred conclusions without a clear cause-effect relation as well as possible poor reporting of falls due to fear of retaliation. 

 

Conclusion

       Elderly patients are a high risk group for hospital falls. It is extremely essential that implementation of appropriate nursing practices towards safeguarding the wellbeing of these patients is ultimately adhered to. As one of the appropriate interventions, nurses are encouraged to spend more time with their patients so as to be of assistance whenever necessary. With this implementation, nurses will have ample time to conduct risk assessments and also be of great help to their patients in terms of mobility. In the event where nurses are undertaking shift phases, prior analysis of falling possibilities ought to be taken so as to ensure that a patient is not left susceptible to falling without any help. In addition to this, essential technologies such as bedside bells ought to be installed with which a patient can raise alarm for help in case it is needed. With the implementation of these strategies, it is projected that hospital falls cases will significantly drop within the first 6 months.

 

 

 

 

 

 

 

 

 

References

Grove, S., Gray, J., & Burns, N. (2015).  Understanding nursing research (6th ed.).  St. Louis:Elsevier.

Morello, R., Barker, A., Ayton, D., Landgren, F., Kamar, J., Hill, K., … Stoelwinder, J. (2017). Implementation fidelity of a nurse-led falls prevention program in acute hospitals during the 6-PACK trial. BMC Health Services Research, 17(383). http://dx.doi.org/10.1186/s12913-017-2315-z

Hoffman, V., Neumann, L., Golgert, S., & Von Renteln-Kruse, W. (2015, November 10). Pro-active fall-risk management is mandatory to sustain in hospital-fall prevention in older patients – Validation of the Lucas fall-risk screening in 2, 337 patients. Journal of Nutrition Health and Aging, 19, 1012-1018. Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org

Haines, T., Lee, D., O’Connell, B., McDermott, F., & Hoffmann, T. (2012). Why do hospitalized older patients take risks that may lead to falls? Health Expectations, 18, 233-249. Retrieved from http://eds.a.ebscohost.com.lopes.idm.oclc.org

Arau?jo, J., Fernandes, A., Moura, L., Santos, M., Ferreira, M., & Vitor, A. (2017, May). Validation of nursing outcome content fall prevention behavior in a hospital environment. Revista da Rede de Enfermagem do Nordeste, 18(3), 337-344. http://dx.doi.org/10.15253/2175-6783.2017000300008