Abstract
The rate of falls within healthcare institutions is on the rise. The problem identified was that falls cause injuries and distress, which increase hospital stay and heighten healthcare costs for the patients as well as the hospitals that offer healthcare services. Most of the individuals affected are the elderly, given that they have mobility, visual, and hearing challenges. The plan was to create a fall-prevention plan that incorporated a multidisciplinary approach, leveraged the benefits of standardized intentional rounding, and applied risk assessment tools in the delivery of quality care. The implementation process was the identification of a preceptor and the attainment of organizational approval. This was followed by a discussion with the preceptor to propose solutions to the high frequency of falls within healthcare facilities. The next step involved conducting a comprehensive literature review and selecting a change theory that guided the implementation process. The gathered information was then used to develop a fall-prevention guideline which was presented to the preceptor for approval. Preventing falls is critical because it facilitates the delivery of quality care to patients admitted to the hospital, in addition to reducing overall healthcare costs.
Background
Clinical safety is pivotal when delivering care to patients in a health institution. Hospitals must strive to identify and eliminate risks that threaten the patients with whom they interact in the healthcare system. Hospital falls are responsible for a high number of accidents within care facilities across the United States. About 50% of these events are avoidable if suitable measures are implemented in a timely manner (Montejano-Lozoya et al., 2020). A hospital fall is described as an incident in which a person inadvertently comes to rest on the floor or a lower level. However, the situation must not be triggered by an overpowering exterior force such as a shove. Making sure that the frequency of falls within healthcare institutionsis reduced is vital for the provision of quality care.
Problem Statement
Hospital falls are a serious challenge, particularly in facilities that take care of elderly patients. Epidemiological studies point out that these events occur at a rate of 3-5/1000 bed-days, and an estimated 700,000 to 1 million admitted individuals fall every year (Department of Health and Human Services, 2019). It is critical to point out that approximately a third of hospital falls lead to injuries (Department of Health & Human Services, 2019). In some instances, patients experience head trauma or fractures. The incidence of falls in healthcare facilities is a serious matter given the fact that the Centers for Medicaid and Medicare services do not offer additional reimbursement to health facilities to pay for costs resulting from these events.
Practice Change, Quality Improvement, or Innovation
The proposed change involves the creation of a guideline that allows a clinical nurse leader to assemble an interdisciplinary team whose primary objective will be to reduce the fall rate in the facility’s surgical ward. The practice change incorporates three vital components in its structure. It will include a quality enhancement initiative, a risk evaluation strategy, and homogeneous intentional rounding. The team will be made up of the unit manager, the department’s nurses, patient care technologists, ward unit assistants, and hospitalists. It is crucial to note that the surgical department applies a face-to-face hand-off communication strategy, and the primary physicians conduct multidisciplinary rounds to plan various aspects of routine patient care.
Rationale
Patient falls are an elemental aspect of patient safety in the hospital context. Patients aged between 64 and 75 years stand the highest chance of experiencing falls (Ruby, 2017). Also, the prevalence of falls peaks in the morning and during the night shift. A rise in self-care activities as the patients wake up and reluctance to ask for assistance from nurses are considered to be the main causes of falls among admitted patients (Ruby, 2017). It should be noted that attempting to reach the bathroom or access possessions while in a sitting position often leads to accidents among patients at an elevated risk of falling.
Falls that seldom result in injuries often lead to a number of complications. For instance, affected individuals experience heightened anxiety and distress. In addition, their families and caregivers get stressed as a result of the experience. The aforementioned falls also lead to a negative cycle where patients who fear falling restrict their activities, thus limiting strength and autonomy (Department of Health & Human Services, 2019). It is essential to prevent hospital falls in view of the fact that they are linked to prolonged lengths of stay, negative health outcomes, and heightened consumption of limited healthcare resources (Slade et al., 2017). Also, experiencing fractures and soft tissue injuries is linked to distress, pain, distress, and varying degrees of functional impairment. In older people, falls are the foremost cause of mortality as a result of fall-associated injury (Heng et al., 2020). It is essential to implement strategies designed to reduce the incidence of falls within healthcare institutions.
Ensuring that falls are prevented is important when providing quality healthcare services. Even though the prevention of all falls is a daunting challenge, approximately 20 to 30% of the occurrences can be avoided through the institution of risk assessment strategies and the application of evidence-based interventions (Morris &O’Riordan, 2017). In addition, facilitating a culture of extreme vigilance and safety consciousness by providing continuous feedback is crucial. It is critical to point out that maintaining a precise, intentional rounding program that allows easy access to personal items and eliminates hazards in the patient’s room (Sims et al., 2018). It is vital to note that adhering to the steps in a rounding protocol improves patient outcomes and limits fall incidences.
It is vital to apply a multidisciplinary approach when designing a quality improvement strategy to reduce hospital falls. This is critical, seeing as a proficient team of physicians, nurses, and social workers offers diverse viewpoints and solutions for fall incidents in health facilities (Dhillon et al., 2019). Hajduchová et al. (2019) point out that the Morse Fall Scale, which quickly determines the patient’s chances of falling, is quite effective. In essence, nurses should use the tool to categorize high-risk patients and spend more time assessing their activities. Additional evaluation strategies such as the nurse-led fall-prevention toolkit, which links evidence-based prevention initiatives to precise risk factors, can drastically reduce the frequency of falls (Dykes et al., 2020). Making sure that patients admitted to health facilities avoid falls is vital for their wellbeing.
Literature Review
Patient Falls
Hospital falls are among the most widespread causes of preventable injuries. According to Dykes et al. (2020), hospitalized patients face an increased risk of falls which may be linked to serious complications such as subdural hematomas, fractures, or the loss of life. According to Coe et al. (2017), non-fatal falls are a serious health challenge in view of the fact that they predispose affected individuals to serious economic and social burdens. For instance, 2.8 million emergency department visits in 2013 were linked to preventable falls, with approximately a third of the affected individuals requiring hospital admission resulting in 34 billion dollars in healthcare costs (Coe et al., 2017). Dykes et al. (2020) further note that falls associated with injuries increase hospital stay for a period of between 6 and 12 days.
Falls are a serious global health problem in addition to being the foremost cause of hospital injuries. Falls are linked to a variety of long-term consequences such as the loss of independence, morbidity, and loss of life. Hopewell et al. (2020) point out that the risk factors associated with patient falls include advanced age, history of falls, weak muscles, vision problems, and chronic illnesses such as arthritis. Medications are an important risk factor for falls among patients admitted to healthcare institutions. Seppala et al. (2019) recommend using the Reduce the Use of Fall-Risk-Increasing Drugs (FRIDs) guideline to limit the incidence of falls. It is essential to avoid the inappropriate use of medication among members of the population at risk. Using tools such as the Medication Appropriateness Index helps support a clinician’s clinical decision-making skills.
Environmental factors such as the absence of handrails, uneven surfaces, poor footwear, and poor lighting increase the incidence of falls. According to Slade et al. (2017), there are approximately 424000 fall deaths globally every year, which accounts for 17 million disability-adjusted life years. In addition, adults over sixty-five years of age stand the highest risk of falling, with most experiencing hip fractures (Slade et al., 2017). It should be pointed out that the financial impact of falls is immense. Slade et al. (2017) note that in 2014, the United States spent approximately 31 billion dollars in annual Medicare costs resulting from fall injuries.
A study by Hajduchová et al. (2019) revealed that most patient falls occurred in subsequent care wards, and 46.5% of the patients affected had been hospitalized for between 1 to 7 days. In addition, the average age of patients who experienced a fall was 76.9 years, and most of the incidents occurred in the rooms (Hajduchová et al., 2019). A study by Hajduchová et al. (2019) showed that a medical worker was absent in 93.3% of the cases and that the time of day when most of the events occurred was between 10 pm and 6 am. Developing effective mechanisms to address patient falls in hospitals is essential. A review by Avanecean et al. (2017) showed that patient-centered interventions coupled with patient education have the capacity to reduce patient falls. However, there is little high-quality evidence showing the effectiveness of patient-centered interventions. Therefore, Avanecean et al. (2017) propose that novel solutions should be sought to address the high rate of patient falls.
The uptake of fall prevention strategies is low in a number of healthcare institutions. According to Clemson et al. (2017), the execution of fall deterrence initiatives depends on the accessibility of referral pathways and the facilitation of collaborative partnerships that encourage knowledge transfer. It is vital to build capacity and engineer improved outcomes for patients at risk of fall-related injuries. A number of programs have been instituted in an attempt to reduce the incidence of hospital falls. According to Heng et al. (2020), initiatives that include patient education effectively reduce the frequency of falls and resultant injuries such as fractures and lacerations. Heng et al. (2020) note that the mode of delivery, design, and quality of the educational material impact outcomes.
Effective initiatives improve the patient’s self-perception of risk and increase knowledge. In effect, individuals are empowered to reduce their susceptibility to falls while admitted to the healthcare facility. It is vital to note that educational interventions aimed at nurses play a critical role in reducing hospital falls. According to Montejano-Lozoya et al. (2020), offering advanced fall prevention training to nurses drastically improved patient outcomes. The study demonstrated that the patients who received the intervention had a lower incidence of falls. The length of stay of the individual’s age had no impact on the outcome. Montejano-Lozoya et al. (2020) conclude their findings by stressing that nurses must undergo advanced fall-prevention training as a way of improving the quality of care in health facilities.
The high incidence of fall rates across America has prompted various trials designed to address the issue. Reuben et al. (2017) note that the Patient-Centered Outcomes Research Institute (PCORI), in association with the National Institute on Aging, funded a trial designed to reduce the frequency of falls in healthcare facilities. It featured five specific components that were delivered by nurses tasked with handling fall risk in association with patients. It is believed that the suggested strategies will reduce the frequency of falls in healthcare facilities. Several programs have been developed to assess the quality of patient education initiatives in fall prevention. For instance, Cuttler et al. (2017) assessed the effectiveness of patient education videos and visual signaling icons in fall prevention among hospitalized patients in a public health institution. The researchers noted a 20% decrease in the rate of falls while falls with trauma declined by 40% during the research period (Cuttler et al., 2017). Patient education and bed exit alarms proved beneficial in reducing fall rates in the facility.
Falls are particularly common among the elderly in hospital settings. Leggett et al. (2017) note that people over sixty-five years of age are the most affected, and the terror of falling drastically reduces the quality of life. It is vital to note that individuals identified to have balance and gait challenges should undergo a multi-factorial fall assessment and intervention plan (Leggett et al., 2017). These include balance and strength training, medication review, and vision assessment.
Multidisciplinary Team Approach
A multidisciplinary approach is useful in the reduction of falls within a healthcare institution. Dhillon et al. (2019) note that multidisciplinary teams have the capacity to reduce hospital falls in a cost-effective manner. In addition, they promote critical thinking with regard to fall prevention. A study by Dhillon et al. (2019) in a psychiatric health facility proved that the multidisciplinary approach significantly reduced patient fell when the rate declined from 4.22 per 1000 patient days to 2.24 per 1000 patient days over a six-month period. Falls occur as a result of various behavioral and biological factors cause by specific environmental and socio-economic conditions. Hyndman (2018) points out that comprehensive multi-strategy interventions are necessary to address both extrinsic and intrinsic factors associated with hospital falls. Creating a multi-disciplinary team is useful because it facilitates the incorporation of a variety of perspectives in the formulation of solutions.
Falls are harmful in view of the fact that they are associated with a number of psychological sequelae that result in loss of confidence and prolonged hospital stay. According to Morris and O’Riordan (2017), a coordinated multidisciplinary approach facilitates the decline in the frequency of falls within a hospital. Morris and O’Riordan (2017) note that the timely identification of risk elements and the implementation of clear programs intended to limit risk reduce the frequency of patient falls by approximately 20 to 30%. Well-designed multi-professional interventions have the capacity to improve patient wellbeing and safety.
Standardized Intentional Rounding
Evidence-based interventions must be applied to keep patients safe in healthcare institutions. Ruby (2017) highlights the importance of a multidisciplinary approach in the creation of a safe environment that includes an effective fall prevention program. Among the strategies that have shown significant results include hourly rounding, which helps patients feel safe in addition to reducing apprehension. Ruby (2017) notes that effective rounding must address vital aspects such as pain, possessions, position, and toilet needs. These four key areas are intended to prevent falls by offering assistance and supervision when needed.
Rounding is an essential aspect of patient care because it improves patient experiences and safety. According to Langley et al. (2017), the premise of rounding is the belief that responsiveness coupled with a strong nursing presence is essential for meeting patient needs. The Meade protocol of nurse-led rounding has specific steps designed to improve patient safety. The initial step is to assess the patient’s pain to limit the usage of the call bell for pain medication. It is essential to check if the patient needs other medications and offer toileting help (Langley et al., 2017). The next step involves the assessment of the client’s position and comfort and makes sure that the bell is within their reach. It is vital to ensure that the bedside table is correctly positioned and tissues and water are easily accessible. It is critical to ask if there is anything else that the patient needs before leaving the room. It is also critical to clarify that a member of the nursing staff will pass by the room after two hours (Langley et al., 2017). Langley et al. (2017) noted in their study that intentional rounding markedly improved patient outcomes and reduced the incidence of accidents.
Intentional rounding has a number of advantages in a hospital setup. According to Sims et al. (2018), the consistent and comprehensive implementation of intentional rounding enhances the quality of care while limiting potential harms. In addition, ensuring that intentional roundingis practiced routinely facilitates the incorporation of an allocated time of care in health facilities. Sims et al. (2018) also point out that documentation during intentional rounding increases accountability which is essential when standardizing care. The increased contact with patients increases the awareness of patient needs and addresses emergent safety concerns that may increase incidences of falls. In a research study designed to assess the effects of intentional rounding on patient and nursing outcomes, Christiansen et al. (2018) noted that there was a drastic drop in falls in institutions that applied the strategy. In addition, there was a significantly positive attitude among nurses in the studies evaluated. Despite the fact that the caliber of the studies was poor, there was a positive correlation between the implementation of intentional rounding and low fall rates.
Patient safety is a top priority in many healthcare settings. Harris et al. (2019) conducted a national survey that demonstrated that communication and multidisciplinary teamwork played a critical role in improving patient safety. Their inquiry indicated that the efficacy of intentional rounding is dependent on a multiplicity of factors. There was concern that intentional rounding simplifies nursing and promotes a transactional approach which diminished rational nursing care. In addition, it stresses accountability and risk management over personal, responsive care.
Risk Evaluation Strategies
An exhaustive fall risk assessment offers vital information that can be used to prevent falls. According to Chang et al. (2017), fall risk scales are effective when used to screen and evaluate risk factors. They also facilitate the creation of individualized intervention plans whichsignificantly reduce the incidence of hospital falls. It is worth noting that a majority of risk assessment tools are coupled with standardized prevention strategies. However, Chang et al. (2017) note that overestimating a patient’s fall risk may significantly hamper their mobility and independence while admitted at a facility. Therefore, assessment tools must be highly sensitive and specific to facilitate the delivery of quality care.
There are a variety of fall risk assessment strategies employed in a variety of healthcare settings. Van Vost Moncada and Mire (2017) propose an assessment strategy that has several key stages of evaluation. First, it is critical to screen for fall risk by asking if the patient fell in the past year. It is essential to ascertain the exact number of times and whether or not injuries were sustained. In addition, it is vital to note is the patient feels unsteady when walking or standing. The next step involves the assessment of gait, balance, and strength. Van Vost Moncada and Mire (2017) recommend a time up and go test to assess the aforementioned parameters. Patients without a strength, gait, or balance problem are rated as low risk and should be educated on the potential for falls and should be referred for balance and strength exercises.
In the event a balance, strength, or gait problem is noted, specific measures must be taken. According to Van Vost Moncada and Mire (2017), individuals without a history of a fall or those with one fall without injury are considered moderate-risk patients. These patients should be put on individualized fall intervention programs, and their medications should be reviewed. In addition, they should be sent to a physical therapist for poise, gait, and strength exercises. Individuals who have experienced more than two incidents in the last year or had one fall with an injury are considered to be high-risk patients. Van Vost Moncada and Mire (2017) note that it is vital to conduct a multifactorial risk evaluation among these patients by assessing their footwear, conducting a cognitive screen, and evaluating their visual acuity.
High-risk patientsshould be referred to a physical therapist for balance, gait, and strength exercises. Their medications must be modified, their vision optimized, and any associated medical conditions addressed. A study by Barmentloo et al. (2021) revealed that a significant percentage of adults with an elevated fall risk had a poor quality of life. In addition, they had serious mobility problems in addition to various comorbidities. Barmentloo et al. (2021) point out that over 50% of patients screened during the study took specific steps to reduce their fall risk. However, they did not necessarily adhere to the outlined protocols. Most of the patients responded by having their eyes checked and enrolling in exercise programs to improve strength and balance.
Quality Improvement Models
Fall prevention quality improvement models must address the factors that predispose individuals to falls. According to Duan and Zou (2017), a comprehensive model involves carrying out a root cause analysis and the provision of fall prevention education for patients. However, the process may be ineffective if it does not include adequate collaboration between disciplines and excludes individuals at risk of falling (Duan & Zou, 2017). Therefore, it is vital to conduct a monthly interdisciplinary meeting and the expansion of education initiatives to people who are not at risk of falling. Many health institutions take issues regarding patient falls and associated injuries seriously. According to King et al. (2018), the resultant intense messaging from the institution’s administration to ensure that each department achieves zero falls leads to an intensified fear of falls among the staff. They consequently protect themselves and their units by restricting fall-risk patients from engaging in routine activities in an attempt to meet the institution’s goals (King et al., 2018). Therefore, the fall prevention strategies must be tailored to address the staff’s needs and ensure that they are comfortable implementing the proposed strategies.
A variety of quality enhancement initiatives have been implemented with the intention of reducing the frequency of falls in healthcare facilities. A review by Tricco et al. (2019) revealed that team changes were a significantly superior modality for the diminution of traumatic falls when compared to standard care. In addition, Tricco et al. (2019) noted that patient reminders, combined case management, and personnel education markedly reduced the incidence of falls in healthcare institutions.
It is vital to note that a comprehensive fall prevention initiative does not guarantee the care team’s participation in all the elements vital for the reduction of fall incidences. Vonnes and Wolf (2017) note that the Fall Risk and Prevention Agreement is seldom initiated at admission. It is essential to include patients and their families in fall prevention initiatives through collaborative communication (Vonnes & Wolf, 2017). The encouragement of family participation ensures that the acute care experience is safe and free of falls. Fall prevention strategies are designed to limit complications or injuries associated with falling. Miranda-Duro et al. (2021) note that a number of studies demonstrate how a majority of falls can be avoided through effective assessment and intervention. Some of the most efficient initiatives include vitamin D supplementation, the use of gait stabilizing footwear, and cognitive monitoring (Miranda-Duro et al., 2021). It is vital to note that the risk of falling increases in the context of multiple risk factors. Therefore, multi-factorial interventions should blend exercise and individualized risk assessment initiatives.
Best Practices
Addressing Risks Due to Medicines
There are various best practice initiatives that must be implemented to reduce the incidence of falls. For instance, Seppala et al. (2019) recommend using the Reduce the Use of Fall-Risk-Increasing Drugs (FRIDs) guideline to limit the incidence of falls. It is essential to avoid the inappropriate use of medication among members of the population at risk. In addition, using tools such as the Medication Appropriateness Index helps support a clinician’s clinical judgment.
Designing Interventions
The design of interventions aimed at reducing patient fall risks must meet specific criteria. For instance, a review by Avanecean et al. (2017) showed that patient-centered interventions coupled with patient education have the capacity to reduce patient falls. In addition, Heng et al. (2020) note that interventions that incorporate patient education effectively reduce the frequency of falls and associated injuries such as fractures and lacerations. Effective initiatives improve the patient’s self-perception of risk and increase knowledge. In effect, individuals are empowered to reduce their susceptibility to falls while admitted to the healthcare facility.
The Multi-disciplinary Approach
It is essential to include all members of the care team in interventions designed to reduce patient falls. A study by Dhillon et al. (2019) in a psychiatric health facility proved that the multidisciplinary approach significantly reduced patient fell when the rate declined from 4.22 per 1000 patient days to 2.24 per 1000 patient days over a six-month period. Creating a multi-disciplinary team is useful because it facilitates the incorporation of a variety of perspectives in the formulation of solutions. It is vital to conduct a monthly interdisciplinary meeting and the expansion of education initiatives to individuals who are not at risk of falling.
Intentional Rounding
Rounding is an essential aspect of patient care because it improves patient experiences and safety. The Meade protocol of nurse-led rounding has specific steps designed to improve patient safety. The initial step is to assess the patient’s pain to limit the usage of the call bell for pain medication. The next step involves the assessment of the client’s position and comfort and makes sure that the bell is within their reach. It is essential to ensure that the bedside table is correctly positioned and tissues and water are easily accessible. It is critical to ask if there is anything else that the patient needs before leaving the room. It is also critical to clarify that a member of the nursing staff will pass by the room after two hours (Langley et al., 2017). The aforementioned protocol ensures that the patient environment is safe and the incidence of falls is reduced.
Risk Assessment
Risk assessment is essential because it helps determine each individual’s degree of risk. Vonnes and Wolf (2017) highlight the importance of initiating a Fall Risk and Prevention Agreement at admission. It outlines the measures and steps to be taken to prevent falls while admitted to the institution. According to Van Vost Moncada and Mire (2017), individuals with no history of a fall or those with one fall without injury are considered moderate-risk patients. These patients should be put on individualized fall intervention programs, and their medications should be reviewed. In addition, they should be referred to a physical therapist for balance, gait, and strength exercises.
Individuals who have experienced more than two falls in the past year or had one fall with an injury are considered to be high-risk patients. Van Vost Moncada and Mire (2017) note that it is essential to conduct a multifactorial risk assessment among these patients by assessing their footwear, conducting a cognitive screen, and evaluating their visual acuity. High-risk patients should be referred to a physical therapist for balance, gait, and strength exercises. Their medications must be modified, their vision optimized, and any associated medical conditions addressed. It is vital to note that encouraging the patient’s family to participate in the care initiatives ensures that the acute care experience is safe and free of falls.
Evidence Summary
Fall Risk Factors
Hospitalized patients face an increased risk of falls which may be associated with serious complications such as subdural hematomas, fractures, or the loss of life. Falls are linked to a variety of long-term consequences such as the loss of independence, morbidity, and loss of life. Hopewell et al. (2020) point out that the risk factors associated with patient falls include advanced age, history of falls, weak muscles, vision problems, and chronic illnesses such as arthritis. According to Slade et al. (2017), there are approximately 424000 fall deaths globally every year, which accounts for 17 million disability-adjusted life years. According to Chang et al. (2017), fall risk scales are effective when used to screen and evaluate risk factors. They also facilitate the creation of individualized intervention plans which significantly reduce the incidence of hospital falls. A study by Barmentloo et al. (2021) revealed that a significant percentage of adults with a high fall risk had a poor quality of life. In addition, they had serious mobility problems in addition to various comorbidities. Therefore, it is vital to implement measures that address the risk of falls.
Preventive Measures
It is essential to institute measures designed to reduce the incidence of falls. Miranda-Duro et al. (2021) note that a number of studies demonstrate how a majority of falls can be avoided through effective assessment and intervention. Some of the most effective strategies include vitamin D supplementation, the use of gait stabilizing footwear, and cognitive monitoring (Miranda-Duro et al., 2021). According to Montejano-Lozoya et al. (2020), offering advanced fall prevention training to nurses drastically improved patient outcomes. Sims et al. (2018) note that the consistent and comprehensive implementation of intentional rounding improves the quality of care while limiting potential harms. In a systematic mixed-method review designed to assess the impact of intentional rounding on patient and nursing outcomes, Christiansen et al. (2018) found that there was a significant reduction of falls in institutions that applied the strategy. In addition, there was a significantly positive attitude among nurses in the studies evaluated. In essence, fall prevention strategies are widely accepted since they improve the patients’ quality of life and boost morale among staff who participate in the improvement of patient lives.
Dykes et al. (2020) further note that falls associated with injuries increase hospital stay for a period of between 6 and 12 days. Hopewell et al. (2020) point out that the risk factors associated with patient falls include advanced age, history of falls, weak muscles, vision problems, and chronic illnesses such as arthritis. A systematic review by Tricco et al. (2019) revealed that team changes were a significantly superior modality for the reduction of injurious falls when compared to standard care. In addition, Tricco et al. (2019) noted that patient reminders, combined case management, and personnel education markedly reduced the incidence of falls in healthcare institutions. While the desire to eliminate falls is admirable, several institutions employ aggressive tactics in meeting this goal. King et al. (2018) state that the resultant intense messaging from the institution’s administration to ensure that each department achieves zero falls leads to an intensified fear of falls among the staff.
Recommendation
The best recommendation for the prevention of hospital falls is the development of guidelines that define three essential components. The first is a quality improvement model, the second is a risk evaluation strategy, and the final one is standardized intentional rounding. The team defined in the guidelines will be made up of a nursing unit manager, the department’s registered nurses, care technicians, unit assistants, and hospitalists. It is vital to note that the guidelines are designed to address concerns in the hospital’s surgical ward. The team will facilitate leadership rounding in patient rooms. In addition, the multidisciplinary team will assess the effectiveness with which the hospital’s staff transmits fall prevention initiatives to the patients and their families. It is vital to note that conducting risk assessments and instituting policy changes are vital steps that will ensure that patients get the best care while hospitalized in healthcare facilities.
Implementation
Description of Steps
The quality improvement model applied principles proposed by the Institute of Healthcare to identify the leading causes of falls in the hospital’s surgical department. The first step was to identify the problem that defined the project. This was accomplished by accessing the institution’s adverse event reporting system. This was followed by the identification of a preceptor and gaining organizational approval. A phone discussion with the preceptor regarding the high frequency of falls in the surgical department facilitated the creation of a roadmap that guided the project.
Permission was granted through an alternative clinical activity process at WGU. A literature review was then conducted using relevant websites and the institution’s database. The keywords that were implemented in the research process at the WGU library included terms such as patient falls, risk assessment, rounding, and Kotter’s theory. The process started with the identification of resources that quantified or defined fall risks. Eventually, resources that identified evidence-based solutions were recorded. The findings were instrumental in the creation of a hospital fall-prevention guideline that incorporated a quality improvement model, standardized intentional rounding, and a risk evaluation strategy. The final step was a phone meeting where the guideline was presented to the preceptor.
Discussion of Changes
No changes were made from the original plan of action. All the steps were followed as outlined in the original plan. Therefore, the application of a multidisciplinary approach through the creation of a competent team was prioritized, after which standardized intentional rounding was implemented. It is vital to note that risk assessment tools were used to categorize patients into various groups, and care was administered based on need.
Discussion of Barriers
One of the most significant barriers encountered during the project was the lack of reliable cell service for contact with the preceptor. There were frequent interruptions to service that made communication strenuous. In addition, the increased cost of communication in view of the fact that certain aspects of the project required long conversations was problematic. This limited the amount of time available for constructive discussions, which in turn affected the quality of conversations. It is vital to note that increased dependence on the telephone slowed progress on the project leading to some delays.
Explanation of Overcoming Barriers
In a bid to overcome the exorbitant cost of prolonged phone conversations, internet platforms were used to hold vital meetings. This solution was effective because the internet was cheaper by comparison and it facilitated a face-to-face exchange which was more beneficial. In order to gain access to better cell service, a change to a different service provider was necessary. The new platform allowed for better clarity at a more affordable price. As a result, the phone conversations were seamless and important timelines were met without any further challenges.
Identification of Interprofessional Relationships
There are a variety of interprofessional relationships that were formed during the project implementation process. The first one involved interactions with the WDU librarian, whoprovided relevant guidance over the phone. The librarian facilitated access to online resources tailored to address key sections of the project. In addition, they mailed relevant documents that were incorporated in the literature review that was conducted as part of the project’s activities. The relationship with the preceptor was particularly important because they offered guidance on how to carry out various aspects of the project.
Discussion of Relationships
The preceptor played a critical role in the unique implementation of the project. For instance, they were instrumental in the identification of project problems, and they facilitated access to the institution’s event reporting system. The preceptor also offered critical advice on how to obtain organizational approval from the administrators at the institution. It is vital to note that the preceptor’s input with regard to the creation of a multidisciplinary team, the implementation of intentional rounding, and a risk assessment strategy was invaluable. The preceptor facilitated the creation of a strategy for conducting a comprehensive literature review. They offered advice on how to choose search terms in addition to suggesting the most suitable databases to access the resources needed to successfully complete the project. It should be pointed out that the preceptor offered guidance on the choice of the change theory that would be used in the project implementation process. The decision to use Kotter’s theory was largely influenced by the preceptor’s advice. Finally, the preceptor gave critical pointers that facilitated the development of a fall prevention guideline that incorporated a quality improvement model, risk evaluation strategy, and standardized intentional rounding.
Post Capstone Project Considerations
Discussion of Successes
The most notable success was the completion and presentation of an evidence-based literature review designed to support the project. The literature review identified the potential causes of hospital falls and proposed solutions that would reduce the incidence of the adverse event. It is vital to note that the proposed solution as identified in the literature review includes a quality improvement model, standardized intentional rounding, and a risk evaluation strategy. Further success was witnessed when a framework and plan were created and successfully presented to the preceptor.
How Successes will Inform Future Projects
Future projects stand to benefit from the successes witnessed in this project in a variety of ways. For instance, the literature review can be used to inform change and best practices that will benefit the patients by ensuring their risk of falling is reduced. In addition, the organization will benefit from improved fall prevention initiatives which will significantly reduce the cost of care by reducing hospital stay and avoiding lawsuits. It is worth noting that a successful nurse-driven change practice will encourage future nurses to engage in innovative projects designed to address critical patient issues. Healthcare practitioners will be encouraged to apply innovation to solve persistent organizational challenges.
Aspects that Did Not Go Well
The one aspect of the project that did not go well was the lack of real-time feedback from nurses regarding the fall prevention initiatives in place at the facility. The lack of contact with the nursing staff limited access to their expertise and input with regard to the effectiveness of current strategies, the predisposing factors, and the potential solutions implemented in the unit. It is vital to note that while access to the preceptor and the library were invaluable, the absence of the nursing staff’s contributions made the project development process challenging.
Understanding What Did Not Go Well
It is vital to note that the lack of input from the nursing staff with regard to the factors that predispose patients to falls and the prevention strategies implemented in the surgical department affected project development. Limited access to expertise is likely to negatively affect future project implementation because specific environmental and contextual factors may be overlooked. In effect, project implementation may be slow, seeing as multiple adjustments will be required to effectively address the problem under investigation. It is vital to note that the aforementioned challenge was overcome by relying heavily on the Writing Center to access research data that best addressed falls in healthcare institutions. A compressive literature review effectively addressed all the issues related to fall prevention in a hospital context. It is vital to note that understanding the impact of limited staff input can inform future projects by equipping facilitators with the skills required to access alternative sources of credible and reliable information.
Explanation of How Gap was Bridged
The problem that was identified was the frequency with which hospital falls were increasing within the institution. These incidents are a challenge, particularly in situations where elderly patients are involved. A significant proportion of these falls lead to injuries that are not covered by the Centers for Medicaid and Medicare services in the United States. as a result, hospital falls deny much-needed revenue to institutions in the form of increased hospital stays, reduced reimbursements, and malpractice suits. In addition, the affected individuals suffer pain, anxiety, and ill health that negatively impact their quality of life.
The literature review highlighted key facts regarding the severity of hospital falls. Epidemiological studies indicate that falls occur at a rate of 3-5/1000 bed-days, and approximately 1 million admitted patients fall annually (Department of Health & Human Services, 2019). The factors that contribute to hospital falls include advanced age, confusion, a recent history of a fall, and adverse drug reactions (Morris &O’Riordan, 2017). Other medical conditions such as orthostatic hypotension, visual blurring, mobility difficulties, and hearing loss contribute to the increased frequency of falls. The hospital environment contributes significantly to the increased incidence of falls. For instance, when patients come into contact with new equipment, they may be susceptible to falling (Hajduchová et al., 2019). In addition, faulty equipment may lead to accidents within a healthcare institution.
The full implementation of the project will reduce the incidence of falls by applying specific principles. First, the plan dictates that a nurse leader will be tasked with the responsibility of creating an interdisciplinary team within the surgical unit at the hospital. The team will be made up of a unit manager, unit assistants, registered nurses, hospitalists, and patient care technicians. The plan’s overall structure includes an implementation of a multidisciplinary team approach, standardized intentional rounding, and a risk evaluation strategy. The multidisciplinary team will facilitate the incorporation of a variety of perspectives with regard to finding effective solutions to hospital falls. Standardized intentional rounding will ensure that specific measures are implemented to ensure that the nurse pre-empts the patients’ needs, eliminates environmental factors that are likely to cause accidents, and assesses the patient at scheduled intervals. Finally, risk assessment strategies will be used to group patients into categories where high-risk patients will receive specialized fall-prevention care services.
Supporting the Plan (Post Implementation)
The plan is unlikely to succeed in the absence of specific maintenance procedures. Short and long-term plans are critical to guarantee sustainability and efficiency, especially in situations where the institution experiences changes in personnel. In the short term, the installation of a project leader would ensure continued program development in addition to facilitating team collaboration and conflict resolution. It is essential that the team leader ensures that the program is implemented as originally designed and any changes are agreed upon and discussed comprehensively. The implementation of an institutional maintenance plan to ensure the continuity of the training program could include a file at the nurses’ station that outlines the program’s rationale, expectations, and resources. In addition, frequent meetings are required to assess progress and address emerging issues with regard to implementation.
A long-term plan must be implemented to ensure continuity after the plan’s creators leave the institution. For instance, the provision of an outline, the current budget, the available resources, and the maintenance of minutes from all meetings is vital. In addition, a quarterly meeting to share information and make recommendations on changes that can be made to the program is critical. It is worth noting that adapting the initiative for institution-wide implementation is an effective way of ensuring the program improves outcomes in the organization.
Ensuring the project continues after the founder’s exit is essential. This can be accomplished by conducting a postmortem to evaluate successes and challenges. Building a catalog of historic data ensures that individuals who will take over the project have valuable reference points. Archiving important documents is an essential step in ensuring the program flourishes after its creator exits the hospital. Creating a database ensures that future managers learn valuable lessons from past mistakes and successes.
Resources for Post-Implementation
The post-implementation phase of the project will require the use of specific resources. For instance, staff time to facilitate training and hold meetings to address implementation challenges and equip personnel with the skills required to apply the fall-prevention initiatives is critical. In addition, funding to facilitate the acquisition of communication materials and run training programs will be critical. This is because all personnel will be required to participate in continuous medical education to ensure that they apply evidence-based practice as they attend to their patients. Providing continued access to the institution’s data systems is vital because it will facilitate the generation of incident reports which will be used to assess the program’s effectiveness with regard to the prevention of patient falls within the institution. It is worth noting that access to the hospital’s amenities such as conference rooms and educational equipment will be essential to ensure that healthcare workers have an avenue to meet for training and important meetings meant to streamline the implementation process.
Reflection
Integrated Outcomes
Evidence-Based Practice
Evidence-based practice is premised on the idea that practitioners apply research findings in a clinical context. The identification of the prevalence of falls within healthcare institutions was the first critical step. The literature review that was conducted as part of the project proposed specific solutions that could be applied to resolve the problem. These included the implementation of a multidisciplinary approach, intentional rounding, and risk assessment strategies. The research studies evaluated supported the use of the aforementioned strategies owing to the fact that the outcomes demonstrated a marked reduction in hospital falls in the institutions under review. The fall-prevention program leverages evidence from the literature review to propose a multifaceted plan to ensure that patients are protected from the adverse effects associated with falls. The application of the proposed plan would facilitate the improvement of the quality of care offered to patients in the health facility’s surgical unit.
Designing Innovative Nursing Practices
The ability to design programs focused on maintaining the inherent dignity of all human beings is a critical outcome that was achieved in the implementation of the fall-prevention program. The ability to plan, deliver and evaluate patient-centered initiatives was demonstrated through the creation of a plan that necessitated the adoption of an interdisciplinary approach, risk assessment, and intentional rounding. The plan is crafted to offer care to individuals of all ages who are afflicted by a variety of illnesses in the surgical unit. The project highlights the use of advanced knowledge and insight in the provision of culturally competent care for a diverse population.
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