Change Process Regarding Falls Among Elderly Patients

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Topic and Nursing practice issue

The topic for this evidence-based practice change process is falls among the elderly patients. Falls are a nursing practice issue as it concerns patient safety and indicates gaps in nursing care.

The rationale for Topic Selection

Despite falls being a global concern in medical care, many health facilities are yet to treat the issue with the gravity it requires. People are more susceptible to falls as they age and while receiving inpatient hospitalized care (Santos et al., 2019). The trial process aims to reduce fall rates among elderly patients in the chronic disease unit in a nursing home. The intervention will use the elderly patients in another unit as a control group and will run for nine months.

Practice Problem and PICOT question

The high rate of falls worsens the health conditions of the elderly in the nursing home. The lack of safety measures, staff carelessness, and psychoactive prescriptions contribute to these rising rates.

P = Patients who are 65 years and above in the Chronic Disease Unit (CDU)
I = Formulate and implement interventions in CDU and compare them with other units
C = Comparison of the two units related to the rates of falls in each unit
O = The expected outcome is a decrease in the number of falls
T = The timeframe is a nine-month trial period

Systematic Review

Alshammari et al. (2018) conducted research in Riyadh, Saudi Arabia, to establish if health issues and environmental factors contribute to falls among the elderly. The cross-sectional analytical study established that a previous history of falls is positively related to physical crippling. Adverse environmental conditions influence falls by 81.7% of the study population (Alshammari et al., 2018). Falls are a leading contributor to deaths and morbidity among the elderly.

Supplement to the Systematic Review

Santos et al. (2019) assessed the predominance and elements related to falls among the elderly in the countryside. The cross-sectional study sampled 870 elders between 60 to 69 years in the Family Health Strategy (Santos et al., 2019). The inquiry proved that falls are prevalent by 27.9% in rural areas and among the female gender (Santos et al., 2019). Additionally, chronic diseases are associated with an increased risk of falls.

Summary of Main Findings

The systematic review reveals falls cause impairment and environmental hazards and noncommunicable diseases are risk factors to falls. Additionally, falls are more dominant among women and occur 27.9% in rural areas (Santos et al., 2019). The studies provide evidence that the risk factors assessed during this project contribute to falls rates among the elderly patients.

Two Evidence-based Solutions

Firstly, physical exercise is an evidence-based solution that will reduce falls incidences among the elderly. Physical activity builds muscle resilience and increases metabolism, building stamina among the elderly (Pratt, 2021). Secondly, modification of the hospital equipment may decrease fall rates in the CDU (Stevens & Lee, 2018). Putting in place bed alarms, supporting frames, and increasing surveillance will help to prevent falls.

Action Plan

Care Standards, Practice Guideline, or Protocols to Support Intervention Planning

The nursing home care standards indicate that caregivers should embrace practices that foster quality of medical care. The practice guidelines requires that interventions should have evidence backings before their approvals. The protocol requires the finance department to approve the economic feasibility of a trial. Afterward, the charge nurse must approbate the proposal before it proceeds to the hospital board for assessment before its implementation.

Stakeholders and Their Roles in the Change Process

Physicians are vital in the change process as they record patients’ clinical history and prescribe medications. Registered nurses and nurse aides take care of patients and monitor their progress. Physical therapists will invent physical training programs suitable for the patients during the change process (Pratt, 2021). Cleaners and other support staff create a conducive environment for fall prevention.

My Role in the change process

I will provide an empirically backed intervention to reduce instances of falls in the CDU. I will also get the approval of the administrators to implement the program. I must champion the initiative among nurses and other staff to attain their backing for the fruitful implementation of the change process.

Stakeholders and their Importance to the Project

The stakeholders for my project include physicians, charge nurses, registered nurses, physical therapists, nurse aides, cleaners, other support staff, and elderly patients. Doctors are chosen as they have the first contact with patients and determine the course of treatment (Stevens & Lee, 2018). The charge nurses will supply input that will better the project and oversee nurses. Nurses will train patients on using the modified equipment and give feedback to physicians on patient progress. The nurse aides will administer medication, monitor response, respond to falls alert and conduct tours to assess the environmental conditions. Physical therapists will aid patients in embracing physical training programs and motivate them to adopt healthy lifestyles.

Cost Analysis

A cost-benefit analysis is essential before the implementation of the trial. The evaluation will comprise the cost of upgrading hospital equipment and training in addition to the benefits realized due to reduced falls. I will draft the estimated costs and benefits and pass them to the finance department for rectification and approval.

Implementation

Process for Gaining Permission to Plan and Begin a Trial

First, the finance department must appraise the cost-benefit analysis as feasible. Secondly, the charge nurse must approve that the issue is viable in the institution and pass it on to the hospital board. The hospital board will then evaluate its viability and commend it for implementation.

Plan for Educating the Staff

The education of the staff will be through issuing pamphlets and sending emails detailing the change process trial. Furthermore, the program will enlist champions among the workers to ease the adoption of the intervention among employees. The implementation team will formulate a training program for the staff to aid their transition to better patient care through falls prevention.

Implementation Timeline for the Change Process

The project should start running from 2nd May 2022 to 2nd February 2023. During the first week, the implementation team will plan and organize resources. Staff training and modification of CDU equipment will run concurrently for three weeks. The physical therapists will develop a suitable physical exercise scheme for patients during the second month. The trial will pick up from the third month to the end of the trial period. Evaluations will occur every three months during the change process.

Measurable Outcomes

P = Patient outcomes will reflect the fall rates before and during the interventions
I = Intervention outcomes will show the association between the risk factors and the number of falls
C = The number of falls recorded in the CDU will be compared with those from the other unit
O = The expected outcome is reduced fall rates during trial and a lower number of falls in the CDU than the other unit.
T = The timeframe outcome is measured through successful completion of the trial within nine months

Forms for Recording Purposes

The technical team will update the patient electronic medical record form to include the variables of the trial. Nurses on duty will fill an after-fall evaluation note, assessing all the risk factors and outcomes of a fall (Stevens & Lee, 2018). Sign-in sheets will monitor the staff on duty and their input to the trial.

Available Resources

The home has an electrical record system for keeping the patient’s history, easing the recording process. The nurses, including myself, are certified hence competent and familiar with evidence-based solutions. The home also has two technicians who can help monitor patients through CCTVs. The nursing home also has an inbuilt gymnasium with physical therapists.

Meetings of Stakeholders throughout the Trial

The implementation team will meet every two weeks to discuss the trial’s progress, roadblocks, and solutions. All stakeholders will also meet after every three months for the trial’s evaluation.

Evaluation

Reporting the Outcomes

I will summarize the outcomes in tabular and graphical form. I will forward it via email to various stakeholders and conduct a PowerPoint presentation in the last evaluation meeting.

Next steps

The outcomes evidence of the effectiveness of the evidence-based solutions and foster access to fundings for adoption of the intervention in the nursing home (Stevens & Lee, 2018). The trial report will guide the implementation of fall prevention intervention in the whole facility.

References

Alshammari, S. A., Alhassan, A. M., Aldawsari, M. A., Bazuhair, F. O., Alotaibi, F. K., Aldakhil, A. A., & Abdulfattah, F. W. (2018). Falls among elderly and its relation with their health problems and surrounding environmental factors in Riyadh. Journal of Family & Community Medicine, 25(1), 29–34. Web.

Pratt, M. (2021). What’s new in the 2020 world Health Organization guidelines on physical activity and sedentary behavior? Journal of Sport and Health Science, 10(3), 288–289. Web.

Santos, F. dos, Lange, C., Llano, P. M., Lemões, M. A., Pastore, C. A., Paskulin, L. M., Costa, A. E., & Raymundo, J. L. (2019). Falls of elderly people living in rural areas: Prevalence and associated factors. Revista Brasileira De Enfermagem, 72(suppl 2), 177–183. Web.

Stevens, J. A., & Lee, R. (2018). The potential to reduce falls and avert costs by clinically managing fall risk. American Journal of Preventive Medicine, 55(3), 290–297. Web.

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