Medical Education: Developing an Implementation Plan for Prevention of Patient Falls - Essay Example

Developing an Implementation Plan Developing an Implementation Plan Prevention of patient falls is multifactorial. The proposed solution is a package entailing the identification of risk factors, patient and family education, adequate staffing and a multidisciplinary approach. Therefore, this paper will discuss the approval and support from the organization’s leadership, description f the current problem, rationale, evidence from previous literature, implementation logistics and the resources required for the implementation. Obtaining Approval The proposed change is expected to reduce the number of patient falls among the elderly in hospital care facilities as well as in long-term care facilities. Therefore, it is expected that the care facilities would offer support for the proposed change. It offers a number of benefits to these care institutions. First, it reduces the cost of care. Patient falls require additional care not anticipated by the care facility. It results in longer hospital stay and is resource-intensive. Besides, it will increase the patient turnover, ensuring efficiency of running the institution. There are absolutely no risks posed by the proposed change. In order to obtain an approval from the organization’s administration, these potential benefits will be explained and discussed. It is expected that the organization will adopt the proposal and thus give an approval. Secondly, the proposal will be discussed with the staff. As it is anticipated to reduce the hospital work load, naturally the health care staff will give an approval to the proposal. By increasing the patient turnover, health care staff gets to experience newer experiences in care from a variety of clinical situations. Such a turnover is beneficial to them as it kills monotony. In lieu of the potential benefits expected to be accrued from the proposed change, the proposed solution is likely to get an approval. Description of Current Problem Currently in the United States, the American Geriatrics Society’s clinical guideline provides a template for fall prevention among the elderly. The strategies adopted by the society include fall risk assessment and the development of incorporating fall prevention strategies into practice. Additionally, it supports continuing medical education to health care providers on risk assessment and how to educe the risk of falls among the elderly. Furthermore, it refers health care providers to evidence-based fall prevention programs (National Conference of State Legislatures, 2014). In states such as Minnesota, policies enshrined in the Minnesota Hospital Association ha developed a policy named SAFE from Falls Tool Kit that aims at safety coordination, accurate and concurrent reporting methods, staff education and accountability, patient and family education, assessment of risks and ensuring a safe environment (Minnesota Hospital Association, 2013). The Agency for Health Care Research and Quality recommends an assessment of falls risk, good communication among health care providers, surveillance and multifactorial interventions (Agency for Healthcare Research and Quality, 2013). The current policies are bordered on health care providers in prevention of falls among the elderly. Although it has covered most of the highlights in the proposed change, little has been covered on the role of the patient and family in prevention of falls. Therefore, this proposed change introduces the aspect of patient and family education in prevention of patient falls among the elderly. Moreover, it would serve as a comparison to monitor the effectiveness of the proposed solution. Explanation of the Proposed Solution The proposed solution is a package of adequate staffing, assessment of risk factors, patient and family education and a multidisciplinary approach to the prevention of patient falls among the elderly. To begin with, adequate staffing is a function of the state and the local government. There is need fro enough health care staff in a long-term care facility. The demands of the elderly in long-term care facilities may occasionally be overwhelming. The elderly are not as active as young patients; therefore, they require more attention. Secondly, assessment of risk factors is important in the management of patient falls among the elderly. Risk factors could either be infrastructural of medical. Example is slippery floors at the care facility would trigger a fall in a patient. Medical conditions such as cardiovascular accidents, neurodegenerative diseases predispose patients to inadvertent falls (Soriano, DeCherrie, & Thomas, 2012). Patient and family education is an essential part in the management of falls. Patients need to know about factors that predispose them to falls, effect of falls on their physical, emotional and economic status and ways of preventing falls. Haines et al. (2011), observe that patient education and trained health professional follow up reduces the incidence of falls in patients with an intact cognitive function. Additionally, the patient family must be engaged in the fall prevention care program. Elderly patients are known to be dependent; therefore, any care-centered intervention should be communicated to the immediate family. Ryu , Roche and Brunton (2010), opine that involvement of the family in a fall prevention program reduces the incidence of falls in a neuroscience unit. The same principle applies in long-term care facilities and health care institutions. Moreover, prevention of falls in multivariate; therefor, a multidisciplinary approach yields the best results. The factors hat lead to patient falls cut across the hospital management, the patient, the health care staff and other stakeholders. It is logical that all the stakeholders are involved. Although most institutions have instituted risk assessment, adequate staffing and an elaborated program on patient and family education is still a long call. Rationale for selecting proposed solution is that prevention of falls among the elderly requires a multidisciplinary approach. Besides, it affects all the cadres in health care delivery, beginning from the highest pinnacle of the care institutions administration trickling down to the lowest recipients of care. Therefore, for the proposed solution to be relevant, change must be instituted across all the stakeholders. Deverka, et al. (2012), observes that an effective engagement is marked by active participation of all the stakeholders. He further notes that failure of one part would ostensibly lead to failure of the whole project. The proposed change targets a change in behaviour. Secondly, a multidisciplinary approach to a change project minimizes loop holes and attempts to address all the issues. Thirdly, the proposed solution is based on the need to change. In view of this, the factors that necessitated the need for a change were identified. Fourthly, the multidisciplinary nature of the proposed solution ensures that the change process can be monitored, and changes made a long the way. It provides grounds for discussion of issues or concerns regarding the change project. Nevertheless, it empowers action among the stakeholders and ensures that the change is cultured, ways to develop it sustained in addition to providing training and support. Review of Literature Rao (2013), in an article featured in the American Family Physician Journal opines that patient falls is considered to be one of the most common geriatric problems that threatens the independence of elderly individuals in long-care facilities. He observes that among patients aged 65 years and above, the incidence of hospital falls is 30-40%. Although he does not provide statistics of incidence, morbidity and mortality among the general population, he concurs with the proposed solution that a multidisciplinary approach is essential in the reduction of patient falls. Gillespie, Gillespie, Robertson, Lamb, Cumming and Rowe (2011), in an article published in the Cochrane Database Systematic Reviews opine that the prevalence and incidence of falls in health care institutions and long-term care facilities is relatively high. They observe that approximately 30% of hospital-related falls occurs among patients aged 65 years and above. Although, the article does not provide statistical data on the prevalence and incidence of falls in the general population it concurs that a careful modeling of interventions should put into consideration the local health care system and its systems of care delivery. An article published in the American Journal of Medicine authored by Moyan and Binder (2014), observes that falls are indeed a frequent cause of concern among elderly individuals; therefore, appropriate screening for the risk factors should be done during routine health maintenance examination. Although the authors do not provide any statistical numerical data on prevalence, incidence, morbidity and mortality among the general population, they agree early assessment of risk factors would result in a reduction in patient falls. An article published in The Lancet authored by Close, Ellis, Hooper, Glucksman, Jackson and Swift (2013), depicts that patient falls among elderly individuals is a frequent presentation at the hospital’s accident and emergency departments. The article does not provide numerical statistical data on the incidence and prevalence of patient falls in the general population; however, it notes that a multidisciplinary approach is necessary in the prevention of patient falls. Wu, Li, Hu and Liao (2012), in an article published in the US National Library of Medicine National Institutes of Health observe that indeed falls among the elderly individuals are of significant concern. In view of this, effective implementation strategies should be given a consideration. The authors do not provide a numerical statistical data on the prevalence and incidence of patient falls. Nonetheless, they concur that assessment of risks as well as targeted intervention is important in the prevention of patient falls among the elderly individuals. Peeters, Vries, Elders, Pluijm, Bouter and Lips (2011), posit that falls among the elderly is likely to result in serious complications including fractures and head injuries. Moreover, such patients are prone to intracranial bleeds as a result of minor falls. They further observe that approximately 30% of elderly individlas aged 65 years and above would experience an inadvartent fall at least once. Approxiately 25% would havea fall at least twice. They observe that in the general population, approximately 5% of the falls would cause fractures whereas 5% would result into other potentially serious injuries. In support of the proposed change, the authors concur that a multidisciplinary approach in the evaluation of risk factors would significantly decrease the incidence of falls among the elderly in long-term care facilities. Implementation Logistics The proposed change would be implemented as soon as it is feasible. The integration of the change project into the current organizational structure involves a discussion with the hospitals and care facilities management team. The reason for this is that part of the proposed solution to the prevention of patient falls is adequate staffing. Recruitment of new staff is a process that is determined by the deficit, the expected work output and remuneration concerns. Patient ad family education are relative easy to manage. Patient education as well as family education can easily be integrated during the care process and workflow. The hospital or care facility’s administration will oversee the implementation process. Nurses as well as other trained health care professionals in the management of the elderly will be recruited in educating the patient and the family during the care process. In addition, a separate program will be put in place to educate and train the staff. Resources Required for Implementation A number of resources will be needed to ensure the effective implementation of the change project. Adequate staffing is a resource as well as part of the proposed change. Patient and family education will involve use of accessories such as pamphlets, posters and handouts on prevention of patient falls. These would be distributed to the patients and the family during the care process. Secondly, there would be organized sessions of PowerPoint presentation by training health care professional on the management of falls. These sessions would involve all the stakeholders. Use of monitor screens and projectors are the technological aspects of dissemination of information. The evaluation of the objectives of the proposed change will be by issuance of questionnaires before the implementation and after the implementation. Additionally, pre- and post-test surveys will be used. Ostensibly, this will be to assess areas of improvement and to get a general picture of the change project. Funds will be needed as costs will be incurred in educating staff, printing and producing educational materials. Moreover, gathering and analyzing data during, before and after the implementation would require some funding. Finally, there would be a need to train staff for the initiation, overseeing and evaluation of the change project. References Agency for Healthcare Research and Quality. (2013). Preventing Falls in Hospitals. Retrieved March 6, 2015, from Agency for Healthcare Research and Quality: http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/ Close, J., Ellis, M., Hooper, R., Glucksman, E., Jackson, S., & Swift, C. (2013). Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet, 353(9147), 93-7. Deverka, P., Danielle, L., Desai1, P., Esmail, L., Ramsey, S., Veenstra, D., et al. (2012). Stakeholder participation in comparative effectiveness research: defining a framework for effective engagement. Journal of Comparative Effectiveness Research, 1(2), 181-194. DOI 10.2217/cer.12.7 . Gillespie, L., Gillespie, W., Robertson, M., Lamb, S., Cumming, R., & Rowe, B. (2011). Interventions for preventing falls in elderly people. The Cochrane Database of Sytemic Reveiws, (4), CD000340. Haines, T., Hill , A., Hill, K., McPhail, S., Oliver, D., Brauer, S., et al. (2011). Patient education to prevent falls among older hospital inpatients: a randomized controlled trial. Archives of Internal Medicine, 171(6), 516-24. doi: 10.1001/archinternmed.2010.444. Minnesota Hospital Association. (2013). Preventing Patient Falls. Retrieved March 6, 2015, from Minnesota Hospital Association: http://www.mnhospitals.org/patient-safety/current-safety-quality-initiatives/falls Moylan, K., & Binder, E. (2014). Falls in older adults: risk assessment, management and prevention. The American Journal of Medicine, 120(6), 493. National Conference of State Legislatures. (2014, July 28). Elderly Falls Prevention Legislation and Statutes. Retrieved March 6, 2015, from National Conference of State Legislatures: http://www.ncsl.org/research/health/elderly-falls-prevention-legislation-and-statutes.aspx Peeters, G., Vries, O., Elders, P., Pluijm, S., Bouter, L., & Lips, P. (2011). Prevention of fall incidents in patients with a high risk of falling: design of a randomised controlled trial with an economic evaluation of the effect of multidisciplinary transmural care. BMC Geriatrics, 2(7),15. Rao, S. (2013). Prevention of falls in older patients. American Family Physician, 72(1), 81-8. Ryu, Y., Roche, J., & Brunton, M. (2010). Patient and family education for fall prevention: involving patients and families in a fall prevention program on a neuroscience unit. Journal of Nursing Care Quality, 24(3), 243-9. doi: 10.1097/NCQ.0b013e318194fd7c. Soriano, T., DeCherrie, L., & Thomas, D. ( 2012). Falls in the community-dwelling older adult: A review for primary-care providers. Clinical Interventions in Aging, 2(4), 545–553. . Wu, L., Li, Y., Hu, X., & Liao, Z. (2012). Prevention of falls of hospitalized elderly patients using clinical pathway. Journal of Sichuan University, 43(2), 222-5. Read More