Reducing Patient Falls in Elderly Patients Orthopaedic Dept Order Instructions: Hourly rounding reduces patient falls in elderly patient’s orthopedic department.
For this assignment, we are required to locate a minimum of eight(8) secondary literature sources that relates to a nursing issue topic. The Nursing issue chosen for this assignment is FALLS PREVENTION; Preventing falls and harms from falls in older people. we are required to construct a Clinical Practice Improvement (CPI) report using the supplied CPI template that I HAVE ATTACHED a copy of. we must address each criteria outlined on the attached template such as the Project Aim, Relevance of clinical governance to the project, Evidence that the issue/problem is worth solving, the key stakeholders involved, CPI tools(PDSA/PEPPA definition and how it is used and how it was applied in your paper), summary of proposed intervention, Barriers to implementation & sustaining change, and finally evaluation of the project (we can’t really evaluate the project as we have not carried the project out but we can discuss what could be done such as having surveys, feedback, pre, and post-session knowledge tests etc)
PLEASE ATTACH A COPY OF THE Literature used for this assignment because I need it when submitting this paper also please provide a link if it is an online article for future reference.
Reducing Patient Falls in Elderly Patients Orthopaedic Dept Sample Answer
|NURS2006 ASSIGNMENT 3
Clinical Practice Improvement Project Report
|Hourly rounding reduces patient falls in elderly patient’s orthopaedic department.|
|The project aim of this study is to evaluate the effect of hourly rounding on patient fall rates in the orthopedic department. This is because several studies have established protocols that have varying ranges of rounding’s, but the most commonly identified by evidence-based practice are hourly rounding’s. The project aims to integrate hourly rounding into the healthcare patient-fall management interventions.|
|Relevance of Clinical Governance to your project|
| The concept of clinical governance is very important as it acts as an umbrella that covers the quality care that is safe. The key pillars of CIP include patient focus, information focus, quality improvement, staff focus and leadership. The effectiveness of an organization largely depends on the contribution of each theme. The main focus on CIP is how these themes interact, which is facilitated with the central role. The concept management of CIP are illustrated clearly by the principles of nursing. This is important because these principles articulate what is expected in the healthcare setting, irrespective of the healthcare provider and the stakeholders involved. The proposed project highlights the four pillars of CIP in that it addresses the importance of integrating individualised care to meet each patient individual needs (patient focus) (Goldsack et al., 2015).
Additionally, the project addresses the nurses pivotal contribution especially during communication (information focus), and also emphasize the benefits of multidisciplinary and friendly working environment (quality improvement). The project will also emphasize the value of effective leadership skills in reducing patient-falls. The proposed project will ensure that patient hospital stays, and the healthcare costs are reduced considerably. The proposed project will ensure that patient access more integrated care, care that will ensure that people meets the demands and the priorities of the community the healthcare community demands. The overall consequence is low patient –fall rates, readmission rate, cost of care, lengthened hospital stays and improve patient satisfaction and quality of life (Haines et al., 2013).
|Evidence that the issue / problem is worth solving:|
| Patient falls is a great threat in public healthcare. The rates of patient’s falls are considerably high in orthopaedic department, and especially among the elderly patients. This is attributable to the fact that these patients are undergoing physiological changes such as poor eyesight, poor hearing abilities, lower cognitive functions, poor balancing and increased muscle weakness and fatigue (Hempel et al., 2013). Research indicates that hospital falls are the leading cause of mortality, and lengthened hospital stays. Despite the numerous researches on this topic, numerous data are continuing to be recorded because the strategies identified usually lack long term solutions (Trepanier, 2014).
Patient falls among the elderly are the main source of non fatal injuries as well as trauma. Research indicates that patient-falls rates correlate with the staffing ratio and organization safety culture. The healthcare providers, especially the nurses are responsible for patient safety (Hutchings, Ward, and Bloodworth, 2013). It is estimated that integration of evidence based practice in the healthcare will reduce approximately, 1000 falls every month. In some nations, the concept of safe and quality care is being emphasized too an extent that the public medical insurance fails to cater for hospital costs associated with patient safety, claiming that these costs are preventable if the healthcare staff practice EBP (Hicks, 2015).
Literature indicates that a lot of resources are wasted during the treatment of the hospital falls rather than identifying the approaches that will strategize on minimizing the rates of hospital falls (Rowe, 2012).This calls for a change of approaches by the healthcare providers, and to embrace the innovative strategies that are identified by evidence based strategies to prevent patient falls. This includes the use of assistance during toileting, use of fall assessment risks during admission and integration of the healthcare providers in refresher training programs that are geared towards reduction of patient falls in hospital setting (Kieke, 2014).
| Stakeholders are very important especially when implementing change within an organization. Understanding the impact of the proposed project in the organization will require understanding of the types of stakeholders, and analysing how the proposed project will influence their interest. Stakeholders are people within an organization who have something to lose or to gain through the implementation of the proposed project. The stakeholder engagement is important as it effectively elicit their views on the proposed project. This is important, particularly when conducting project assessment. It is important to identify the external and internal stakeholders, the nature of each and their influence in the proposed project (Trepanier & Hilsenbeck, 2014).
The internal stakeholders who will be involved in this project include clinical staff in the orthopaedic department including the physician, general practitioners and the orthopaedic manager, whereas the external stakeholders include the customers and the healthcare organizations that support safe and quality care. The internal stakeholders in this project will be involved in funding, coordination and resourcing of the proposed project (Olrich, Kalman, & Nigolian, 2012). The role of the external stakeholders will be informed of advises based on their experiences and their views in addressing the issue of patient falls. The engagement of these stakeholders is important as it facilitates in decision making. This is because the stakeholders have values that important in the health care facility. The integration the stakeholder addresses the negative perceptions and any source of doubts regarding the policy changes (Lowel and Hudgson, 2012).
| Plan-do-study-act (PDSA) offers effective cycles that can be used to evaluate the outcomes that results from the proposed solution. This method is accepted in healthcare. The planning stage involves setting of goals based on the patient demands. The Do stage is the implementation stage, whereas the study stage involves the analysis of the outcomes. Act is the step conducted to ensure that the improvements made are permanent (Dyck et al., 2013).
From this framework, the planning stage will involve intensive research to identify the healthcare facility safety measures to identify the underlying gap that is causes increase in patient –fall rates. This framework will facilitate in the process of identifying the conditions that precipitate the project, the areas affected, and the people affected by the poor safety measures in the orthopaedic department. This framework guides the exploration of the causes of this critical issue and the characterization of the problem. The framework helps in the establishment of the baseline that will be used to evaluate the outcome (Falls free, 2014). In this context, the number of injuries associated with fall rates will be recorded before and after the implementation of the program. This data will be used to examine the rates of readmission rates due to issues associated with patient-fall incidences, and the additional cost of care due to lengthened hospital stays. This is proposed to take place for six months. This short term project is aimed at providing conclusive decisions that can be applied in long term strategies (Zephir, Minel, and Chapotot, 2011).
PEPPA refers to “participatory, evidence-informed, patient centred process for project development, implementation and evaluation processes.” This framework outlines nine key steps that will be used in this project. The first stage is to define the population and describe the present patient safety measures in the organization. The next step will be to identify the relevant stakeholders and the recruitment processes. The recruited stakeholders will participate in discussions to identify the critical issues, which need to be addressed to improve the quality of care (Trepanier, 2014). The fifth step is to define the strategic interventions that will address the critical interventions that will fit within the healthcare facility goals and mission. The next step is planning of the strategic implementation, including the identification of outcomes and the evaluation plan. The facilitators and barriers of the project will also be identified. The plan (hourly rounding) will be identified, evaluated and monitored (Graham, 2012).
Healthcare quality improvement requires a broad range of activities with varying level of complexity in their methodological as well as the statistical rigor, which involves developing, implementation and the assessment of the interventions proposed. All processes of improving quality in the health care is geared towards achieving effective, safe, timely, efficient , patient centred and equitable healthcare services (Trepanier, 2014).
|Summary of proposed interventions:|
| The proposed intervention is to perform hourly rounding in the orthopedic department. The department ward will be divided into groups; the intervention group will have a nurse perform hourly rounding from 6 am to 10 pm in addition to the healthcare facility safety measure process. The other ward will have only the tradition measures in place, which includes use of call lights, labeling of the slippery floors and use of wrist bands indicating the high-risk patients (Bennet et al.,2014).
Prior to the implementation process, the nurses and assistive nurses will undergo training on the relevance of the proposed intervention. As stated previously, the hourly rounding will begin at 6.00 am to 11 pm. After every rounding, the nurses in charge will fill in the log book provided. The logbook will indicate the patient admission date, reason for admission, patient fall incidence and any other information relevant to hospital stays. The rounding will be routinely monitored by managers and will be supplemented by questionnaires filled by patients (Dykes et al., 2010).
After every two weeks, a formal meeting will be conducted. This will form the platform for the nurses’ dilemmas and challenges during the implementation process are addressed. At the end of the proposed project, 45 minutes focus group interview will be conducted. Data collected included semi-structured interview as well as the use of questionnaires. This will ensure that the data is explored holistically (Graham, 2012).
|Barriers to implementation and sustaining change:|
|The possible barriers that would affect the proposed strategy will involve limited knowledge on their expected of the nurse during the hourly rounding. There are challenges that there could be under reporting of the proposed research. There is issue of organizational culture readiness. This is because there is always some staff resistance to change, which could affect the study results and conclusions. This should be addressed by assessing the organizational readiness.|
|Evaluation of the project:|
| The process of evaluation will be conducted to ensure that proposed intervention is sustainable. This process is important because it indicates if the intervention outcomes have beneficial or adverse effects. In this context, the evaluation process will be done after the implementation of the project. Additionally, the evaluation process will be done after every twelve months after the initiation of the study. However, it is important to note that the interventions outcomes may not be realised immediately. This is because it takes some time before change is accepted, integrated in the organization and realization of the outcomes (Baker, 2014).
The evaluation process will be conducted using questionnaire and patient’s feedback. The questionnaires will be structured in a way that it appraises the patient’s perceptions on threats and vulnerability associated with patient falls. It will also assess the patient healthcare relation and interaction to evaluate on how it impacts patient falls.
Reducing Patient Falls in Elderly Patients Orthopaedic Dept References
Barker, W. (2014). Assessment and prevention of falls in older people. Nursing Older People, 26(6), 18-24. doi:10.7748/nop.26.6.18.e586.
Bennett, P., Ockerby, C., Stinson, J., Willcocks, K., & Chalmers, C. (2014). Measuring hospital falls prevention safety climate. Contemporary Nurse, 47(1-2), 27-35. doi:10.1080/10376178.2014.11081903
Dyck, D., Thiele, T., Kebicz, R., Klassen, M. and Erenberg, C. (2013). Hourly Rounding for Falls Prevention: A Change Initiative. Creative Nursing, 19(3), pp.153-158.
Dykes, P., Carroll, D., McColgan, K., Hurley, A., Lipsitz, S., & Colombo, L. et al. (2010). Scales for assessing self-efficacy of nurses and assistants for preventing falls. Journal Of Advanced Nursing, 67(2), 438-449. doi:10.1111/j.1365-2648.2010.05501.x
Falls Free. (2014). Issue Brief: Funding for elder falls prevention. Retrieved from http://www.caremanager.org/wp-content/uploads/Falls-Prevention-Issue-Brief-3-26-14.pdf
Graham, B. (2012). Examining g Evidence-Base d Interventions to Prevent Inpatient Falls. MEDSURG Nursing, 21(5), 267-272
Goldsack, J., Bergey, M., Mascioli, S. and Cunningham, J. (2015). Hourly rounding and patient falls. Nursing, 45(2), pp.25-30.
Haines, T., Hill, A., Hill, K., Brauer, S., Hoffmann, T., Etherton-Beer, C., & McPhail, S. (2013). Cost effectiveness of patient education for the prevention of falls in hospital: economic evaluation from a randomized controlled trial. BMC Medicine, 11(1), 135. doi:10.1186/1741-7015-11-135
Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., & Johnsen, B. et al. (2013). Hospital Fall Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness. Journal Of The American Geriatrics Society, 61(4), 483-494. doi:10.1111/jgs.12169
Hicks, D. (2015). Can rounding reduce patient falls in acute care? An integrative literature review. MEDSURG Nursing 24(1); 51-57
Hutchings, M., Ward, P., Bloodworth, K., (2013). Caring around the clock: a new approach to international rounding. Nursing management, UK. 20(5) 24-32
Kieke , R. (2014). Joint commission center for transforming healthcare approach leads to reduction in in patient with injury. Journal of Health care compliance 27-28
Lowel, L., & Hodgson, G. (2012) Hourly rounding in a high dependency unit. Nursing standard 27(8); 35-40
Olrich, T., Kalman, M. , & Nigolian , C., (2012). Hourly rounding : A replication study. MEDSURG nursing 21 (1); 23-30
Rowe, R. (2012). Preventing Patient Falls: What Are the Factors in Hospital Settings That Help Reduce and Prevent Inpatient Falls?. Home Health Care Management & Practice, 25(3), pp.98-103.
Trepanier, S., & Hilsenbeck, J. (2014). Sylvain Trepanier Julie Hilsenbeck A Hospital System Approach At Decreasing Falls with Injuries And Cost. NURSING ECONOMIC$/, 32(No. 3), 136-144.
Trepanier,S., (2014). A hospital system approach at decreasing falls with injuries. Nursing economics. 32 (3);132-140
Zephir, O., Minel, S. and Chapotot, E. (2011). A maturity model to assess organisational readiness for change. International Journal of Technology Management, 55(3/4), p.286.