Falls are a common occurrence in the modern world because of balance difficulties and general muscle weakness. Many patient falls are attributed to long-term problems such as diabetes, heart disease, and hypotension. Among the elderly population, poor vision and depreciating physical fitness are often associated with falls, which expose them to a wide range of problems that influence their perspectives towards life. Three million older adults are treated in emergency units for fall injuries each year, where one in five falls causes hazardous injuries such as broken bones and head injury. In 2015, medical costs associated with elderly falls exceeded $50 billion.
Falls are a public health problem worldwide. Hospitalization increases fall risk due to unfamiliar environments, illnesses, and treatments. Patient falls, and fall-related injuries are devastating to patients, clinicians, and the health care system. Individuals aged 65 years and over exhibit a greater prevalence to the problem of falls that mainly result in injuries (Chan, W. C., Yeung, Wong, Lam, Chung, Luk, and Law, 2015). The combination of healthcare needs and risks involved in elderly falls often increases this unique patient population’s complexity in primary nursing care.
Purpose of Change Proposal
The purpose of this change proposal is to reduce the number of falls among geriatric patients. Since more than 20% of falls yield injuries, there is a need to promote fall prevention approaches that lower individual lifestyle outcomes. Considering the nature of mid-aged individuals’ practices, it is essential to focus on various aspects of existence that influence people’s perspectives towards falls. However, increasing physical activity levels, wearing comfortable shoes, and removing health hazards at home are alternative approaches that promote fall prevention in the world today.
The PICOT question begins with identifying the target population (P) that comprise the mid-aged population (above 35 years) with an average risk of experiencing falls instead of the elderly with imminent risk. The intervention (I) measures proposed using training and exercise programs to strengthen the muscles, conduct fall risk assessment, and medical reviews to identify underlying conditions (Cheng, Tan, Ning, Li, Gao, Wu, and Hu, 2018). The control (C) measures outlined by the research comprises a pacemaker’s insertion, increased vitamin D supply, vision treatment, removing of home hazards, and use of assistive devices to facilitate more accessible and safe movement. The intended objectives and outcomes (O) focus on attaining reduced fall tendencies among the target population. This is bound to culminate in an increase in the quality of life. The reduction of falls leads to a subsequent reduction in the reduction of injuries associated with putting the lives of individuals at risk. The time frame (T) proposed in the PICOT question consists of four weeks of therapy that lead to increased awareness and physical mobility improvement. Consequently, the PICOT questions cover extensively every aspect of the proposed problem leading to critical diagnosis and prevention.
Literature Search Strategy Employed
In formulating the PICOT question, a search was conducted on research databases such as ProQuest to identify the causes of falls and how they can be prevented using the following words; Patient care, patient falls, and falls prevention. Articles were limited to five years after their publication to ensure the study relied on recent nursing insights. The literature used is primarily based on peer-reviewed journal articles accessible in public databases such as PubMed and Google Scholar. Qualitative research methods were used to understand causes, opinions, trends and develop a hypothesis. The articles’ literature review relied upon adequate data and information on the subject of falling and its consequences on the elderly population to build logical intervention and prevention techniques.
Evaluation of the Literature
The result of the research shows that multifactorial interventions reduce the susceptibility of falling. The interventions include sensory stimulation through exercises, provision of medications, and supervision. Increased awareness of falls’ potential symptoms also reduces the risk of falls as the older adults inform caregivers of changes in their health. The evidence provided shows that falls in older adults are multifactorial where several factors are contributing to the risk of falling (Vlaeyen, Stas, Leysens, Van der Elst, Janssens, Dejaeger, and Milisen, 2017). For the implementation of the interventions, a list of triggers and practical strategies to address the issue is initiated to reduce falling frequency. The studies’ implications to nursing practice entail understanding the interventions relating to each type of risk, including health-based risks and environmental risks and their interventions. Health-based hazards include chronic illness-specific to an individual, while environmental risks include improper use of canes. The interventions used should match the exposure to the specific type of risk.
Many factors must be examined and combined to determine the fall risk status of a patient. They include age, sensory deficits, mobility problems, neurological disorders, history of falls, cognitive impairment, and depression. Some medications, such as those associated with postural hypotension and psychotropic medications, may increase falls’ danger. Patient falls are considered a challenge to the patient’s safety in hospitals, which, in addition to increasing the length of stay and costs, may also result in severe injuries or even patient death.
Proposed Implementation Plan
The practice change project proposed aligns with the nursing education to patients with high fall risk, especially patient at night, mainly due to the change in environment setting such as new faces from the day shift to the night shift, not always remembering the nurse’s name, feeling they can do it without assistance and waiting too long before someone come to the room. The older adult patient’s level of functioning must be assessed before teaching. Cognitive abilities and mental functioning may be affected by illness and aging, leading to short-term memory loss, concentration decrease, delay in reaction time, and decreased vision and hearing. Teaching patients is essential to understand their health status and become capable of self-care compliance with the therapeutic plan (Heng, Jazayeri, Shaw, Kiegaldie, Hill, and Morris, 2019). Teaching will be used along with a yellow wrist band, gowns, footwear, bed alarms, and chair alarms. The family should be included with teaching patients to help them remember key points after discharge. Patients need education about the risk, complication, medications, and treatments of falls to become an informed client that can advocate for their healthcare. Teaching should include age-related problems that they may encounter. There are times when nurses act as advocates for their patients and families. Critical thinking combined with skill, compassion, and moral and ethical principles helps patients achieve the highest level of healthcare possible for them.
Discussion of Evidence-Based Practice
Falls are a public health problem worldwide. Hospitalization increases fall risk because of the unfamiliar environment, illnesses, and treatments. Patient falls, and fall-related injuries are devastating to patients, clinicians, and the health care system. The evidence-based practice evaluation aims to systematically review the literature on the effectiveness and investigate whether a fall prevention tool kit using today’s health information technology decreases patient falls in hospitals. The process to evaluate fall prevention intervention occurs after the project has been completed. A summative evaluation determines the proposed change project’s success in terms of time, cost, and outcomes. At this point, the project is either terminated or integrated into the routine of the hospital practice. Evaluation of fall prevention is an ongoing process, especially in older adult patients. Although the outcomes are the most important, cost and time are critical elements as well.
Plan for Evaluating the Proposed Nursing Intervention
The evaluation plan consists of observing the environment layout and risk factors that are impediments to their safety related to falling in a hospital and whether call lights are within their reach. Availability of mobile devices, cluttered rooms, bed left in a high position, time delays in nurses answering call bells, implementation of hourly rounding, and lack of pull bars was reported as barriers to their ability to be compliant with fall prevention strategies. Measurable outcomes for the proposed change project ensure the nursing staff understands that they must ensure the environment is clear of hazards before they leave the room. Personal devices are within reach, and they must also remind the patient why this is important to prevent a fall (Najafpour, Godarzi, Arab, and Yaseri, 2019). To integrate evidence professional organizations in each medical discipline, publish Internet guidelines that are updated with evidence-based changes regularly and practice policies on their websites. An evidence-based practice used by clinical staff helps deliver quality care in the most cost-effective manner possible. The research will continue to study the impact of fall prevention tools and other practice change work to know which devices will be most effective.
Barriers to Implementation
Finance is one of the most important aspects of a business. The hospitals have to organize their budget and keep track of their hospital expenditures to outplace their revenues and help the organization determine what to spend, where to spend, and when to spend. Strong financial performance is associated with the improved patient-reported care experience, the most vital component distinguishing quality and safety. These findings suggest that financially stable hospitals can maintain highly reliable systems and provide ongoing resources for quality improvement. Hospitals under financial pressure may struggle to maintain quality and patient safety and have worse patient outcomes than well-resourced hospitals. Therefore, hospitals must align the cost of prevention measures with the budget as the plan is proportionate to cost.
Chan, W. C., Yeung, J. W. F., Wong, C. S. M., Lam, L. C. W., Chung, K. F., Luk, J. K. H., … & Law, A. C. K. (2015). Efficacy of physical exercise in preventing falls in older adults with cognitive impairment: a systematic review and meta-analysis. Journal of the American Medical Directors Association, 16(2), 149-154.
Cheng, P., Tan, L., Ning, P., Li, L., Gao, Y., Wu, Y., … & Hu, G. (2018). Comparative effectiveness of published interventions for elderly fall prevention: a systematic review and network meta-analysis. International journal of environmental research and public health, 15(3), 498.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A., & Morris, M. E. (2019, September 01). Educating hospital patients to prevent falls: Protocol for a scoping review. Retrieved from https://bmjopen.bmj.com/content/9/9/e030952
Najafpour, Z., Godarzi, Z., Arab, M., & Yaseri, M. (2019, May 01). Risk Factors for Falls in Hospital In-Patients: A Prospective Nested Case-Control Study. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571495/
Vlaeyen, E., Stas, J., Leysens, G., Van der Elst, E., Janssens, E., Dejaeger, E., … & Milisen, K. (2017). Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators. International journal of nursing studies, 70, 110-121.