Effectiveness of fall prevention
programs
Between about three quarter of a million
and a million people fall in United States’ hospitals every year (AHRQ, 2013),
with many of them experiencing injuries. The injuries include fractures,
lacerations or bleeding. This subsequently leads to an increase in cost and
time used in healthcare.
About a third of falls and subsequent
injuries can be prevented by having effective and efficient fall prevention
programs. Such programs emphasize on managing individual and collective fall
risk factors. It also includes a nosocomial environment that optimizes the
hospital population’s safety and comfort.
This study program analyzes whether implementation
of fall prevention programs reduces falls at St Agnes Hospital and how the
programs can be improved. Specifically, it will evaluate the validity of risk
assessment tools for reducing patient falls in an acute care setting at St
Agnes Hospital and recommend solutions, based on the John Hopkins
Evidence-Based Practice (JHNEBP) model (Dearholt & Dang, 2012). In so
doing, internal and external factors will be considered in assessing, reviewing
and designing effective fall prevention programs.
It is recommended that St Agnes Hospital
adopts High-Regarded Organization (HRO) concept. Evidence-based practice
implementation based on HRO concept will promote overall healthcare at the
hospital, including in fall and fall injury intervention.
Implementation of JHNEBP in a hospital
based on the HRO concept will advance standardization and minimize variation of
the fall prevention programs (Joint Commission, 2015). It will be able to
translate the evidence according to patient’s specific needs with relation to
their risk factors.
Reviewing the evidence involves
description of evaluated interventions that include post-fall and medication
reviews, patient and staff education, and scheduling and supervising patient
activities (AHRQ, 2013).
Change
Model Overview
The JHNEBP model helps nurses to make
decisions to effectively solve problems in a clinical setting. To maximize the
benefits from JHNEBP, the nurse involves all other stakeholders in making and
implementing the best decisions based on the stakeholder’s knowledge, skills and
experience (AHRQ, 2013). Based on practice question, evidence and translation
(PET), this model draws on research and non-research to chart out best practice
in healthcare.
Practice
Question
Step 1: Recruit
Interprofessional Team
In recruiting a team to help gather
evidence and translate the fall and injury prevention programs at St Agnes
Hospital with a view to full implementation, it is important to consider the
people who interact with patients in acute care and the entire nosocomial
environment.
To determine how falls are prevented and
to translate best practice, apart from the nurse manager, there will be a
physician and pharmacist on the team. There will also be a therapist; physical
and or occupational. The patient and a family member will be involved too. Each
member will have a backup member to represent them in the team if they are not
present.
Step 2: Develop and
Refine the EBP Question
This project is to gather research and
non-research internal and external evidence affecting fall and injury prevention
for acute care patients at St Agnes Hospital so as to determine efficacy of
fall prevention programs. The study aims to disseminate the gathered
information to the relevant stakeholders with a view to translating best
practice in the nosocomial environment.
Step 3: Define the
Scope of the EBP
Most patients in acute care need active,
short-term treatment to recover from surgery, severe injury or a medical
urgency. The patients may suffer anticipated or unanticipated physiological
falls and also accidental falls depending on the patient’s risk fall factors. A
fall may prolong the recovery period of a patient and increase the cost of
treatment.
To prevent falls, universal fall
precautions that apply to all patients at all times need to be part of the
hospital culture practiced by all the staff, patients and visitors. Universal
fall precautions may vary slightly from hospital to hospital, but the commonly
practiced generally ensure safety and comfort of the patient with efficient
call light use (Haines, Bennell, Osborne and Hill, 2007).
Continuous standardized risk assessment
for falls by all patients is also important so as to have personalized
interventions for enhanced efficacy. This is followed by care planning for
patients with risk factors that involves identifying and implementing specific
care practices.
No fall prevention program in a
nosocomial environment can eliminate falls completely. Post-fall procedures
include assessing and attending to the patient. A clinical review is also
required.
Fall prevention is secondary
intervention for an acute care patient (Bouldin, 2013) preventing harm to the
patient. The patient is primarily at St Agnes Hospital for treatment of their
illness. The facility basically is offering the patient acute care, and this
takes precedence (AHRQ, 2013).
Together with fall prevention, there are
other secondary interventions in a hospital. These include infection control
and ethics. For example, too much bed rest is discouraged, with ambulation
being recommended.
Falls are a major health concern
worldwide being the leading adverse event in a nosocomial setting. 3-20% inpatients fall one or more times during
hospital stay, with up to over 50% of the falls resulting in injury (Bouldin,
2013). Each time a patient falls is very expensive (about US$4000), with
subsequent falls making the cost even more prohibitive – US$16,500 for
non-serious injuries and US$27,000 for serious injuries.
In the United States, between 700,000
and 1,000,000 patients fall in hospitals every year (AHRQ, 2013), with 30-50%
of the falls result in injury. The injury may lead to additional treatment with
a mean cost of $14,000 and prolonged stay at the hospital estimated to be 6.3
days (Joint Commission, 2015).
Falls among elderly inpatients in acute care
are especially prevalent, affecting up to over 30% of admitted patients in some
instances, with 70% resulting to injury. Up to 47% of stroke rehabilitation patients
have been reported to be affected by falls (Joint Commission, 2015). There are many
instances where falls are fatal, with up to 40% of injurious falls in certain
health institutions being reported to have led to fatalities.
Steps 4 and 5: Determine
Responsibility of Team Members
The nurse manager and the physician will
lead the assessment of the evidence and translation of the EBP project, with
the nurse manager coordinating and championing it. The nurse manager and the
physician will lead the team various processes and procedures, including medical
review. They will involve the whole team, including the patient, pharmacist,
the therapist and the family member; with each member being assigned
responsibilities according to their role (AHRQ, 2013). All members will observe
and report any incidences of falls at the hospital, with the nurse manager and
the physician performing medical reviews for arising instances of falls and
fall injuries.
It is important to determine the fall prevention
programs at St Agnes Hospital. The study will determine their availability and
efficacy, with members of the team assisting in evidence collection and
subsequent translation.
Evidence
Steps 6 and 7: Conduct
Internal/External Search for Evidence and Appraisal of Evidence
This will include thorough search of
databases e.g. Medline, Precinahl and Cochrane Library for relevant literature
using appropriate keywords. The literature has to be primary research on the
effectiveness of fall and full injury prevention programs in hospitals. The
study will exclude study of patients who are not in acute care.
Observation and interviewing will be
used to help determine the efficacy of various fall prevention programs. The
appraisal for reviewing the efficacy will be based on a criteria of 1 to 6
depending on whether the purpose of the prevention program is 6) met, 5) partially
met, 4) not met, 3) mentioned, 2) not clearly mentioned or 1) not mentioned.
Steps 8 and 9:
Summarize the Evidence
Searching and appraising the evidence of
fall prevention programs will form a basis for St Agnes hospital to review and
redesign its programs for the better (Haines, Bennell, Osborne and Hill, 2007).
To calculate the rate of falls and fall
injuries at acute care unit at St Agnes Hospital, there will be an incident
report for every fall (AHRQ, 2013) recording the specifics and circumstances of
the fall and the level of any subsequent injury (Bouldin, 2013).
It is also important to take the
unit’s census on a daily basis. This information is tallied with the fall rates
being calculated monthly or quarterly (Dearholt & Dang,
2012).
Step 10: Develop
Recommendations for Change Based on Evidence
Effective communication and teamwork
reduce healthcare errors. According to Oliver et al. (2010) evidence for the
most successful fall prevention programs suggests multifactorial and
interdisciplinary components (Bouldin, 2013). Sets of multifactorial, interdisciplinary
fall prevention barriers are systemic in HROs, with it being recommended St
Agnes adapt this concept.
Better process standardization and
reduced variation will be the major results of evidence-based fall intervention
(Dearholt & Dang, 2012). Checklists of fall and fall injury prevention
intervention procedures, safer and more comfortable environment (lighting,
flooring, handrails), relaxed patients and eliminating and or marking trip
hazard are some of the evidence-based processes that help achieve this (AHRQ,
2013).
Translation
Steps 11, 12, and 13,
14: Action Plan
The characteristics and efficacy of
intervention programs will be got from the study program, and sorted according
to whether they are unifactorial or multifactorial intervention. Their efficacy
will be classified according to outcomes e.g. number of fallers and falls, fall
injuries, time they fell, etc. Experimental and control groups will be used (Haines,
Bennell, Osborne and Hill, 2007).
Steps 15 and 16:
Evaluating Outcomes and Reporting Outcomes
The outcomes will be tabulated and
presented in a report that will include discussion of the findings. The report
will be represented to the senior management of the hospital with the
recommendation that it be discussed and implemented in the nosocomial environment
of St Agnes Hospital.
The study will take place at St Agnes
Hospital and all acute care patients will be considered. Distinctions between
age, condition and length of stay will be clearly captured and tabulated.
Steps 17: Identify Next Steps
Steps 17: Identify Next Steps
This program will be applicable to any
other health center or hospital within Maryland, USA or anywhere in the world.
As hence, to scale up the implementation of this program, a case by case EBP
assessment and implementation that caters for institutional and cultural nuances
is recommended (AHRQ, 2013).
Step 18: Disseminate
Findings
A copy of the report will be handed to
the management, with the nurse manager and physician seeking permission for
further discussion and its implementation. It will also be abstracted in
various medical databases. The authors will also seek to have the program
report published in a professional journal for wider dissemination of the
findings.
Conclusion
To what extent do fall prevention programs
reduce falls of acute care patients at St Agnes Hospital and how can this be
made more effective? Based on the JHNEBP process, this study program evaluates
the validity of risk assessment tools in reducing patient falls at the health
center and makes recommendations for improvement.
In a bid to maximize the benefits
accrued from the program, the nurse manager will answer this question by
working with a team of relevant stakeholders to assess the evidence and
translate the findings at St Agnes Hospital. The evidence will consider internal
and external factors by use of experimental and control groups to minimize
variation and bias (Joint Commission, 2015).
Evidence-based practice implementation
based on HRO concept will promote healthcare in fall and fall injury
prevention. Improved standardization, reduced variation, and better post-fall
review will also result. Reviewing the evidence involves description of
evaluated interventions that include post-fall and medication reviews, patient
and staff education, and scheduling and supervising patient activities (AHRQ,
2013).
Translation will include making
recommendations to the management of St Agnes Hospital for implementation of
the findings as well as dissemination of the findings internally and
externally.
References
AHRQ.
(2013). Preventing Falls in Hospitals. http://www.ahrq.gov/sites/default/files/publications/files/fallpxtoolkit.pdf.
Accessed July 29, 2016.
Bouldin,
E. D. et al. (2013). Falls Among Adult Patients Hospitalized in the United
States: Prevalence and Trends. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3572247/
Dearholt,
S. L., & Dang, D. (2012). Johns Hopkins nursing evidence-based practice:
Model and guidelines (2nd ed.). Indianapolis, IN: Sigma Theta Tau
International.
Haines,
T. P., Bennell, K. L., Osborne, R. H. and Hill, K. D. (2007). Effectiveness of
targeted falls prevention randomised controlled trial programme in subacute
hospital setting. http://espace.library.uq.edu.au/view/UQ:116842/UQ_PV_116842.pdf.
Accessed July 29, 2016.
Joint
Commission. (2015). Preventing falls and fall-related injuries in health care
facilities. http://www.jointcommission.org/assets/1/18/SEA_55.pdf
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