Capstone Project Evidence-Based Proposal essay

CapstoneProject Evidence-Based Proposal

Fallsin Nursing Homes

Abstract

Thepurpose of this study was to identify the causes of patient fallsprimarily in nursing homes and suggest measures that ought to betaken to address this serious problem. Independent studies have beenable to determine that the patient falls one of the most dangerousand costly problems affecting the health care system in the UnitedStates. It is reported that in a single year, approximately 700,000patient falls are recorded in the US (Breimaier et al. 2015). This isserious, especially if considered that close to 50 percent of allfalls reported to result in injuries (Teresi, 2013). Some injuriesmay be a predisposing factor to the death of patients affected. Thisstudy was able to determine that age was a factor in patient falls asmost falls were reported among elderly people. Patients aged wellover 60 years were more likely to fall because they are weak and findit difficult for them to go out and return to their beds. Otherfactors are the structure of beds, slow response from caregivers andlack of safety measures in care homes.

Toaddress the problem, the study will go through a carefully executedplan, which establishes that the patient falls is an issue that canbe prevented (Neyens et al., 2012). One of the solutions to theproblem is to implement a safety companion in the nursing homes.Alarms can also be mounted on beds with patients having the highestrisk factor to falls so that caregivers can be notified once thepatients are up. These suggestions, with among others discussed inthis report will go a long way in helping address the problem ofpatient falls (Teresi, 2013).

Keywords:patient fall, safety companion, morbidity, mortality

LiteratureReview

Thefollowing is an analysis and appraisal of the 15 articles in orderrelated to: Falls in Nursing Homes

Colon-Emeric,C. S., McConnell, E., Pinheiro, S. O., Corazzini, K., Porter, K.,Earp, K. M., &amp … Anderson, R. A. (2013). CONNECT for BetterFall Prevention in Nursing Homes: Results from a Pilot InterventionStudy. JournalOf The American Geriatrics Society,61(12),2150-2159 10p. doi:10.1111/jgs.12550

Thisis an article which focuses on the improvement of staff connection,communication and problem solving to see the effect this would haveon the implementation of a falls reduction education program. Thestudy uses a group of nurses in a nursing home to try and see theimplementation of the education program without the improvement ofnursing staff connection, communication and problem solving.According to the article, the nursing staff whose connection,communication and problem solving skills were improved showed thatthey enhanced the implementation of falls reduction educationprogram. The article also asserts that the nurses who were trained onconnection, problem solving and communication offered better andquality care.

Thearticle has presented immense evidence and the data collection methodproves its conclusions to be prudent. The research uses a controlgroup and this helps in adding credence to the research. Theconclusions in the article are based on the evidence and the datathat has been collected. The research used 497 participants whoprovided credible results. The falls per bed per year in situationswhere there was no intervention did not change. The results were 2.61at baseline and 2.64 at the end of the intervention. However, therewas a 12% reduction of falls from 2.34 to 2.06 falls per bed peryear.

Teresi,J. A., Ramirez, M., Remler, D., Ellis, J., Boratgis, G., Silver, S.,&amp … Dichter, E. (2013). Comparative effectiveness ofimplementing evidence-based education and best practices in nursinghomes: Effects on falls, quality-of-life and societal costs. InternationalJournal of Nursing Studies,50(4),448-463 16p. doi:10.1016/j.ijnurstu.2011.07.003.

Thisis a research study that focused on assessing the effects ofapplication of evidence-based practices and education programs onpatient falls and the cost of health. It was found out that theapplication of these evidence-based nursing practices and educationprograms reduces the cost and reduces patient falls.

Theresearch used the experimental quasi design where there were threegroups with each having 15 nursing homes. Data was collected,analyzed and results published. It is clear that the three groupsrecorded a reduction in falls. It is clear that the research hasgathered sufficient evidence for the conclusions. The falls recordedwere between 5 and 12 per year in the nursing homes.

Berry,S., Zhang, Y., Lipsitz, L., Mittleman, M., Solomon, D., &amp Kiel,D. (2011). Antidepressant prescriptions: an acute window for fallsin the nursing home. JournalsOf Gerontology Series A: Biological Sciences &amp Medical Sciences,66A(10), 1124-1130 7p.

Thisis a study which ought to find out the effects of antidepressants onthe risk of falling in a nursing home. The research sought to alsofind out whether antidepressants have an acute effect or their effectis slow and progressive. The results found out that the introductionof a new prescription such as an antidepressant increases thelikelihood of a fall. It is essential to note that even an increasein the dosage of an antidepressant can also increase the risk of afall.

Thestudy used 1181 participants and this is a clear indication that theresults that were arrived at were not by chance. The use of a controlgroup during the study gives credence to the conclusions arrived atby the researchers. The evidence collected was immense and theparticipants were of the right age and gender to carry out the study.The effect on falls with non SSRI change within 2 days was an oddsratio of 4.7, 95% and confidence interval of 1.3-16.2.

Leland,N. E., Gozalo, P., Teno, J., &ampMor, V. (2012). Falls in NewlyAdmitted Nursing Home Residents: A National Study. Journalof The American Geriatrics Society, 60(5),939-945 7p. doi:10.1111/j.1532-5415.2012.03931.x

Thisis a research which sought to find out the relationship between thelikelihood of a fall and the organizational characteristics in anursing home. The researchers looked at the various aspects of thenursing home such as the funding, presence of special care unit,number of beds and the facilities in the nursing home. It was foundout that the nursing homes with certified nursing assistantsexperienced fewer falls than the nursing homes without the certifiednursing assistant staff (oddsratio = 0.97, 95% confidence interval = 0.95-0.99).

Theresearch has gathered enormous evidence and data that is relevant forthis study. 230 newly admitted patients in a nursing home wereobserved over a period of one year. It is essential to note that thiswas an enough period to determine the relationship between falls andthe organizational characteristics of the nursing home.

Burland,E., Martens, P., Brownell, M., Doupe, M., &amp Fuchs, D. (2013). Theevaluation of a fall management program in a nursing homepopulation. TheGerontologist,53(5), 828-838. doi:10.1093/geront/gns197

Thisstudy was done in Manitoba, Canada and it sought to find out whethernursing home fall management programs were effective in reducinginjurious falls. According to the article, it is clear that theapplication of the programs reduces injurious falls, as well as thefalls that result in hospitalization. The falls that lead tohospitalization reduced by 0.036–0.021per person-year [ppy] p= .043. Residents under the program also recorded fewer injuriousfalls of 0.596–0.746 ppy p= .02.

Theevidence in the study is enormous. It is evident from the articlethat data was collected for a period of 5 years from 2003 to 2008 andthis is a testament that the results are not by chance. The use ofcontrol groups also indicated that the results were original andgenuine.

Magaziner,J., Miller, R., &amp Resnick, B. (2010). Intervening to preventfalls and fractures in nursing homes: are we putting the cart beforethe horse? Journalof the American Geriatrics Society,55(3),464-466 3p. doi:10.1111/j.1532-5415.2007.01088.x

Thejournal entry contains four articles which are seeking to findinterventions in nursing homes that would reduce the falls especiallythe ones resulting in injuries and deaths according to theinformation herein it is evident that most of the falls occur innursing homes as opposed to within the community. This implies thatthere are some personal and or nursing home characteristics thatcontribute to the falls. According to this research, it is evidentthat 12% of falls result in serious injuries where 4% result infractures.

Thefour articles have gathered sufficient information over the years inorder to propose the various intervention measures such as use of bedrails and bed alarms. Considering that the four articles areproposing similar intervention measures, it is clear that theevidence is sufficient and the conclusions made are indeed truthful.The researchers relied on 2711 residents for the data and evidence.

Rubenstein,L. Z. (2010). Falls in older people: epidemiology, risk factors andstrategies for prevention. Age&amp Ageing,35ii37-ii41.doi:10.1093/ageing/afl084

Thisarticle asserts that falls are extremely common and they are one ofthe leading causes for morbidity, injuries and mortality. They arecommon among the elderly people and they are the leading cause fortheir admission in nursing homes. The risk factors mentioned in thearticle are muscle weakness, medication and environmental factors.Falls occur in 13% of the population and 40% in people older than 65years. Environmental factors were figured out as the major causes offalls constituting 31% followed by weaknesses at 17%.

Thearticle has relied on immense data in order to arrive at conclusionsand to propose various intervention measures. The research hasidentified risk reduction measures as the best intervention programsto reduce falls.

Parikh,S., Avorn, J., &amp Solomon, D. (2010). Pharmacological managementof osteoporosis in nursing home populations: a systematic review.Journalof the American Geriatrics Society,57(2),327-334 8p. doi:10.1111/j.1532-5415.2008.02119.x

Thearticle asserts that there are numerous falls in nursing homes ascompared to the people dwelling in the community. The study sought tofind out the effects of osteoporosis medication on falls. Somemineral such as calcium and vitamin were found to reduce the risk offractures during falls

Theresearch relied on literature since 1974 regarding the use ofosteoporosis medication. This provided sufficient data and evidenceregarding their use in reducing falls and or reducing the effects ofthe falls. It is essential to note that the research did not rely onany research design but data was gathered using any appropriatemethod. Research indicated that 9-25% of the hospitals used themedication.

Anderson,R. A., Corazzini, K., Porter, K., Daily, K., McDaniel Jr, R. R., &ampColón-Emeric, C. (2012). CONNECT for quality: protocol of a clusterrandomized controlled trial to improve fall prevention in nursinghomes. ImplementationScience,7(1),11-11 1p.

Thisarticle proposes that there needs to be a good interaction betweenstaff in a nursing home if the quality improvement programs to reducefalls have to be implemented effectively. The research applies theCONNECT model to enhance interaction amongst staff in a nursing home.The research found that there are 1.5 falls per bed per year of which40 were recurrent falls.

Theresearch relied on experimental design to gather data and evidencehence the research leads to credible results. The researchers used acontrol group which does not participate in CONNECT but participatein the quality improvement program. This shows that the researchesare determined to find out whether effective interaction among theemployees improves their knowledge and implementation of theprograms. The results are positive and the researchers conclude thatindeed good relations among the employees result in the improvementof the intervention programs

Capezuti,E., Taylor, J., Brown, H., Strothers HS, 3.,&ampOuslander, J.(2010). Challenges to implementing an APN-facilitated fallsmanagement program in long-term care. AppliedNursing Research,20(1),2-9 8p.

Accordingto this article, there are various challenges that affect thesuccessful implementation of falls reduction programs. The removal ofconsultants and the advance practice nurses are some of the factorsinfluencing the implementation of the programs. The advance practicenurses offer effective nursing assessment of the programs and alsoassist in making decisions.

Thearticle has relied on empirical evidence to reach into conclusions.The researchers relied on literature and also interviews to gatherdata and information regarding the factors affecting theimplementation of falls reduction programs.

Neyens,J., Dijcks, B., van Haastregt, J., de Witte, L., van den Heuvel, W.,Crebolder, H., &amp Schols, J. (n.d). The development of amultidisciplinary fall risk evaluation tool for demented nursinghome patients in the Netherlands. BmcPublic Health,6.

Thisis a research study that sought to develop a multidisciplinary riskassessment tool for demented patients who are at risk of falling. Thearticle asserts that demented patients are at a greater risk offalling and therefore there needs to be an intervention plan thatwill address the risk factors. The authors have asserted that it isimportant to consider every patient independently in order to developtailor made solutions to the problems.

Theevidence gathered in the development of the risk assessment tool wasfrom previous scientific research. The authors of the article alsorelied heavily on expert opinions regarding the risk factors of fallsin nursing homes and the best intervention measures. This informationtogether with the data from the scientific studies was used asevidence in order to arrive at conclusions.

Breimaier,H. E., Halfens, R. G., &ampLohrmann, C. (2015). Effectiveness ofmultifaceted and tailored strategies to implement a fall-preventionguideline into acute care nursing practice: a before-and-after,mixed-method study using a participatoryaction researchapproach. BMCNursing,14(1),1-12. doi:10.1186/s12912-015-0064-z.

Thisis a study that sought to find out how evidence based practiceprograms are implemented in acute care hospitals. The researchershave hypothesized that the time investment, as well as theeffectiveness of the multifaceted and tailor made strategies ofimplementation have not been tested and therefore they seek to testthem in this study.

Theresearch relied on participatory action design to gather data. Allthe graduate and assistant nurses participated in the research andtherefore the findings were not by chance. The study was conducted inthe hospital department of an Australian university. Questionnaires,interviews and discussions were used to gather data for the study.

Sakamoto,Y., Ebihara, S., Ebihara, T., Tomita, N., Toba, K., Freeman, S., &amp… Kohzuki, M. (2012). Fall Prevention Using Olfactory Stimulationwith Lavender Odor in Elderly Nursing Home Residents: A RandomizedControlled Trial…[corrected][published erratum appears in J AMGERIATR SOC 2012 Nov 60(11): 2193]. JournalOf The American Geriatrics Society,60(6),1005-1011 7p. doi:10.1111/j.1532-5415.2012.03977.x

Thisis a research study that sought to find out the effects of Lavenderolfactory stimulation on patient falls in a nursing home. Previousresearch has shown that the lavender olfactory stimulation reducespatient falls. These research also found the same results andtherefore proven its hypothesis. The lavender group had 26 fallswhile the placebo group had 36 falls. The incidence rate in thelavender group was 1.04 while that in the placebo group was 1.4 perperson per year.

Theresearch used 145 participants and divided them into two groups withone being the control group and which received placebo. The number ofparticipants was sufficient to provide credible results.

Broe,K., Chen, T., Weinberg, J., Bischoff-Ferrari, H., Holick, M., &ampKiel, D. (2011). A higher dose of vitamin D reduces the risk offalls in nursing home residents: a randomized, multiple-dose study.JournalOf The American Geriatrics Society,55(2), 234-239 6p. doi:10.1111/j.1532-5415.2007.01048.x

Thisstudy sought to find out the effects of vitamin D supplements on thereduction of falls in a nursing home. It was found out that there islittle or no difference in rates of falls for patients using vitaminD supplements and those not using the supplements. According to thefindings of the research, there were 44% falls in the placebo group,58% in the 200 IU group, 60% (15/25) in the 400 IU group, 60% (15/25)in the 600 IU group, and 20% in the 800 IU group.

Thestudy relied on two groups of patients with one receiving placeboover a period of five months. The other group received the fourcategories of vitamin D (200 IU, 400 IU, 600 IU, or 800 IU). Thevitamin D 800IU was the only one that reduced fall rates in thenursing home. The other categories recorded almost similar rates withthe placebo group.

Kobayashi,N., &amp Sugai, Y. (2011). Witnessed and un-witnessed falls amongthe elderly with dementia in Japanese nursing homes. Japan Journalof Nursing Science, 3(1), 31-41 11p.

Thisresearch sought to describe the falls among the elderly with dementiawhether witnessed or not. According to the research, it is essentialto note that the cognitive level of the elderly patients and theshifts of the professional caregivers contribute to the huge numberof the un-witnessed falls in a nursing home. The witnessed fallsconstitute only 14% of all the falls in a nursing home.

Theresearchers relied upon over 276 study reports in Japan to arrive atconclusions. The researchers also used descriptive statistics to findout when a fall occurred. It is clear that the researchers reliedupon a huge body of research and therefore the findings andconclusions are credible.

Giles,C. Et al. (2010). Can volunteer companions prevent falls amonginpatients? A feasibility study using a pre-post comparative design.BMCGeriatrics.

Thisarticle focuses on researching on the effects of introducingvolunteers to accompany patients who are at a risk of falling.According to the authors who carried out the research, when elderlypatients who are at risk of falling are accompanied by volunteers,they hardly fall. It is therefore recommended that nursing homes forthe elderly should consider having volunteers to look after thepatients who are at risk of falling.

Volunteerswere introduced and the worked for 2345 hours to find out the effecton falls that they would have on high risk patients. The rates offalls were measured per 1000 of occupied bed days. The data wascollected between February to March 2002 and February to March 2003.The research found out that there were 14.5falls per 1000 occupied bed days at the baseline while there were15.5 falls per 1000 OBD during the implementation period. It isessential to note that the 2345 hours that the volunteers gave areworth over $57,000. This research provided credible results since theperiod of study was long and the volunteer’s dedicated immense timeto the services.

ProblemDescription

Patientfalls are a serious concern. It said that each year, one out of threeold patients fall. In healthcare systems, this problem continues tocause injuries and deaths among affected patients (Giles et al.,2010). Fall injuries have been discussed among healthcare acquiredconditions. It is also reported that at least one in five falls leadsto broken bones or other unforeseen health conditions. Head injuryand hip fractures have been reported commonly as a result of patientfalls. Available evidence suggests that 12% of falls result inserious injuries where 4% result in fractures (Magaziner &ampResnick, 2010). Again, falls may cause traumatic brain injuries tothe patients.

Ithas been established that patient falls occur mostly in nursing homesas opposed to within the community. This has a meaning that nursinghomes have conditions that contribute to the falls (Magaziner &ampResnick, 2010). Falls are mostly reported in the elderly people andare a leading cause of their admission in to nursing homes. The riskfactors include medical, muscle weakness and environmental factors.Falls occur in 13% of the population and 40% in people older than 65years. Environmental factors were pinpointed as the major causes offalls constituting 31% followed by weaknesses at 17% (Rubenstein,2010).

Fallsimpact negatively on the recovery of patients and also on the carequality. Patients will extend their length of stay in hospitals andnursing homes because of falls. As a result of the increased durationof residence, the quality of care provided in nursing homes comesunder scrutiny by the public (Teresi, 2013). Most people will feelthat nursing homes are not even safe for their patients who areexposed to even more danger as a result of the inadequate safetyprotocols by the care providers.

Synergisticefforts are required to address the problem of falls because it iscostly both to the public and the families. World Health Organization(WHO) estimates that $34 billion regarding costs are used annually todeal with conditions arising from patient falls (Breimaier et al.,2015). Further, two-thirds of the cost figure accounts for carecosts. Because of the gravity of the issue of the health care system,it was imperative that an implementation plan is forged so as toaddress the menacing issue (Giles et al., 2010). Recommended measuresshould draw more focus on bringing down the number of fallsexperienced in hospitals.

SolutionDescription

Onerecommended solution to deal with patient falls in nursing homes isthe introduction of safety companions. Security partners will providepatients who are disoriented with directions and even moral support.Again, the safety guides need to be put into nursing care training soas to gain knowledge and expertise on patient care and also providethe much-needed protection for vulnerable patients to falls.Companions provide continued surveillance on the patients to check onthe incidence of falls.

Patientgroups classified to have histories of falls, those with poor vision,body weakness, osteoporosis, dementia, and confusion should first beconsidered for allocation of safety companions. Research to prove theefficacy of this recommendation has been conducted. Study findingsindicated that patient falls were considerably reduced by thepresence of a safety companion. The study estimated that fallsreduced by between 15.5 and 14.5 per 1000 of occupied bed days (Gileset al., 2010).

Secondly,nursing homes should be fitted with alarm systems that will notifythe nurses of patients who are awake and require close attention fromcaregivers. Beds in the care facilities should also be designed insuch a way that they meet the different specific needs of eachpatient. The one size fits all approach has proved ineffective assome patients are assigned beds that are high above the ground evenwhen they cannot support themselves carefully out and into the bed.This recommendation can help reduce patient falls in nursing homes byalmost 60 percent (Breimaier et al., 2015).

Lastly,educational program has also proven useful in addressing the problemof falls. Caregivers should be trained on the essence of routinechecks in the care units to ensure that all safety precautions are inplace to prevent patient falls. Studies have confirmed that thenumber of patient falls in care units with highly educated andtrained nurses were significantly much lower than that in care unitswith nurses who had less education, experience, and training (Neyenset al., 2012). Implementation of all these measures will go a longway in helping reduce patient falls in nursing homes and alsosignificantly bring down the costs associated with patient falls.

ImplementationPlan

Forsuccessful implementation of the program, it is very vital thatsynergistic efforts of both the management and the staff are activelyharnessed. The recommended solutions are to be implemented in phases(Leland, 2012). The safety companion is the most feasible alternativeand for this reason, it should take the first slot in theimplementation phase. Feasibility studies conducted to this effecthave consistently pointed that this solution will help salvage a lotof resources (Teresi, 2013).

Trainingof the staff and caregivers is planned to take place withinhealthcare facilities with the demonstrations being the primary pointof focus. Alarm systems will also be installed on the beds in anelaborate manner in the short term since they require minimal budgetsand are easy to operate (Leland, 2012). All recommendations, ingeneral, will be speedy, smoothly and carefully implemented withminimal disruptions, if any, to the typical hospital routine. It isimportant above everything else that financial resources and supportare given all the consideration they require before the finer detailsof the implementation plan are embarked on. This review will helpevade any financial setbacks as far as successful implementation isconcerned.

Thetheory incorporated in the implementation of the recommendedsolutions will be the Nurse Intellectual Capacity Theory. Thisapproach is selected based on the fact that knowledge has been proventhrough studies that there is a correlation between knowledge andskills of nurses with patient falls (Teresi, 2013). The theory alsoseeks to establish the connection between the knowledge of nurses andthe current as well as future scientific research to the problem offalls. Also, the theory suggests that increased knowledge ofcaregivers is vital for the improvement of service quality in healthcare systems including nursing homes (Morse, 2010). Incorporationwill be the subject of an assessment of the nurses on their knowledgeand skills concerning patient falls.

EvaluationPlan

Alloutcomes of the suggested recommendations must indicate success in sofar as the specific aspects of the care plan are concerned (Mubashir,2013). In other words, the proposed solutions must work to ensurethat patient falls are reduced significantly in the nursing homes forthe plan to be deemed a success. An assessment will be conducted ateach phase of the implementation and also after six months followingfull implementation of the project to determine the effectiveness ofthe solutions implemented (Mubashir, 2013).

Toevaluate the outcome of the project, two variables will be assessed.The first variable will be the number of patient falls. The proposedsolutions that include the introduction of safety

partners,training of nurses and fitting of alarms beds of patients would beassessed to determine

howbest they have been when it comes to the reduction of patient falls.For example, through the proposed solutions, it should be possible towitness a decrease in the number of those who fall in the hospital(Hempel et al., 2013). The other variable will be time. The frequencywithin which falls are experienced following admission of patients oreven in the process of receiving treatment is an important variableto consider. As a variable, time will help establish the frequency ofpatient falls after the introduction of the proposed solutions. Theincrease or decrease in the number of falls for a given period oftime after implementation of the solutions is indicative of thesuccess or failure of the project.

Effectiveevaluation relies on the efficiency of tools developed to see thisstage through. One of the tools that will employed is theestablishment of a teaching facility for all participants. Healthcarefacilities will set up halls where nurses and care givers can beeducated on the best way to deal with patient falls and also the bestway to prevent them. Tools such as computers, projectors, boards andwriting materials are important education tools and will need to beavailable (Mubashir, 2013).

Toolswill also be developed to assess the outcome of the project. The mosteffective tool that will be used to assess outcome is screening ofoverall patient falls within the health facility. To mention, afterfull implementation of the solution package, a team will be appointedto monitor the rate of patient falls within the hospital (Karlsson,2013).Any number suggesting reduction in the number of falls will indicatethat the project has been a success. Anything else will indicate thatthe project was a flop. The outcome of the project can also be gaugedby the response of patients and care providers.

Educationis an important component and the hospital management shouldundertake to educate their staff on ways of dealing with patientfalls (Karlsson,2013).The health facility can set up a training program that will see allhospital staff enrolled and trained. The area of focus in thetraining will be on skills that help in the identification ofpatients most likely to experience falls. Further training can beadvanced to patients through the introduction of support programs.

Afterintroduction of the safety companion, evaluation can be done todetermine their attitude and enthusiasm in helping bring the problemof patient falls under control. Tools of assessment will includemeasurement of compliance to the health facility policies (Karlsson,2013).Assessment can further be made through determination of how thesafety companions interact with the patients. Responses provided willbe used as a bench mark for the institution to develop an alternativestrategy.

Evaluationof the safety companion can be done through assessment of theireducation levels. Their role is to identify patients with thegreatest risk factor to fall and so their degree of knowledge is animportant consideration factor for evaluation (Hempel et al., 2013).The amount of knowledge they have determines how much they areprepared to deal with cases of falls if they were to occur in ahealthcare set up. Their willingness to assist patients who arelikely to fall should also be assessed.

Survey(Safety Companion)

  1. How often do you experience the patient falls at the institution?

  1. Once

  2. Twice

  3. Rarely

  4. Many times

  1. Do you think the hospital administration can do more to help address the situation?

  1. Yes

  2. No

  3. Maybe

  1. Do you feel you have the needed education to deal with the patient falls?

  1. Yes

  2. No

  3. Not sure

  1. How prepared are you to deal with the case if a patient falls if it was to happen within your vicinity?

  1. Prepared

  2. Well prepared

  3. Uncertain

  4. Cannot deal

  1. Should more training be introduced to help improve level of preparedness?

  1. Yes

  2. No

  3. Maybe

Assessmentto be used on Staff and Support Companions

HEALTHY MEDICAL CENTER

Patient Falls Reduction Implementation Program Assessment

Pre- and Post-Test

1. Patient falls significant losses to the healthcare institutions

True

False

2. Over, the last decades, patient falls reported cases have been on the rise, and it has been giving management hard times in seeking for sustainable solutions to the problem.

True

False

3. 15-20% of all elderly people are at risk of experiencing a fall.

True

False

4. Approximately 25% of patients falling develop other medical complications

True

False

5. Various conditions are attributed to cases of patient falls

True

False

6. The symptom of a patient fall manifests as soon as one arrives at the hospital

True

False

7. Patients at risk of falling can be identified before experiencing a fall.

True

False

8. Support staff and coordination between different patients needed to reduce cases of patient falls.

True

False

DisseminationPlan

Themost viable technique to relay the findings of the study to allinvolved stakeholders will be through the use of the PowerPointpresentation. This will be conducted in the facility boardrooms. Thefocus of the discussion will be the analysis of results from theimplemented project and after the implementation to reflect thepositive progress (Vogel et al., 2013). The choice of the method ofpresentation is so that the stakeholders are given an opportunity toraise any concerns they may have about the findings of the study.Further, an internal memo will be used to communicate the findings tothe caregivers and suggest the course of action in the nursingpractice within the facility (Vogel et al., 2013). The results willalso be made known to the greater nursing community through journalpublications.

Conclusion

Studieshave been able to determine that patient falls happen more often innursing homes than within the community. This indicates that nursinghomes have conditions that make patient falls more likely to happenand therefore emphasizes the need for the issue to be addressed.Falls are mostly reported in the elderly people and are a leadingcause of their admission in to nursing homes. The risk factorsinclude medical, muscle weakness and environmental factors. Fallsoccur in 13% of the population and 40% in people older than 65 years.Environmental factors were pinpointed as the major causes of fallsconstituting 31% followed by weaknesses at 17%. Intervention by allstakeholders through deliberate efforts can help address the problemof patient falls and reduce the costs associated with patient falls.

Theprogram to facilitate the reduction of patient falls has beendetermined. The suggested solutions that will be implementedsystematically and carefully include: education of care givers toenable them know how to deal with patient falls and also how toprevent them, introduction of safety companions and installation ofalarm systems. These recommendations will be implemented following aclear laid down procedure and assessment made at different stages ofthe implementation stage to determine the effectiveness of theproject. Dissemination will be made to all key stakeholders byPowerPoint presentation and also to the larger nursing communitythrough journals. Staff within the health facility will be notifiedof the findings through an internal memo.

Theproblem of patient falls can be managed effectively if the suggestedrecommendations in this module are carefully implemented. This willgo a long way in helping prevent the injuries, deaths and associatedcosts of patient falls.

References

Breimaier,H. E., Halfens, R. G., &ampLohrmann, C. (2015). Effectiveness ofmultifaceted and tailored strategies to implement a fall-preventionguideline into acute care nursing practice: a before-and-after,mixed-method study using a participatory action research approach.BMCNursing,14(1),1-12. doi:10.1186/s12912-015-0064-z

Giles,C. Et al. (2010). Can volunteer companions prevent falls amonginpatients? A

feasibilitystudy using a pre-post comparative design. BMCGeriatrics

Hempel,S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., …&amp Ganz, D. A. (2013). Hospital fall prevention: a systematicreview of implementation, components, adherence, and effectiveness.Journalof the American Geriatrics Society,61(4),483-494.

Leland,N. E. (2012). (2012). Falls in Newly Admitted Nursing Home Residents:A National

Study,Journalof The American Geriatrics Society,60(5), 939-945 7p.

doi:10.1111/j.1532-5415.2012.03931.x.

Neyens,J., Dijcks, B., van Haastregt, J., de Witte, L., van den Heuvel, W.,Crebolder, H.,

&ampSchols, J. (n.d). Thedevelopment of a multidisciplinary fall risk evaluation tool for

dementednursing home patients in the Netherlands.Bmc Public Health, 6

Teresi,J. A. (2013). Comparative effectiveness of implementingevidence-based education and

bestpractices in nursing homes: Effects on falls, quality-of-life andsocietal.

InternationalJournal of Nursing Studies,50(4), 448-463 16p

Vogel,J. P., Oxman, A. D., Glenton, C., Rosenbaum, S., Lewin, S.,Gulmezoglu, A. M., &amp Souza, J. P. (2013). Policymakers’ andother stakeholders’ perceptions of key considerations for healthsystem decisions and the presentation of evidence to inform thoseconsiderations: an international survey. HealthRes Policy Syst,11,19.

doi:10.1016/j.ijnurstu.2011.07.003.

Brown,C. J., &amp Flood, K. L. (2013). Mobility limitation in the olderpatient: a clinical review. JAMA,310(11),1168-1177.

Coote,S., Hogan, N., &amp Franklin, S. (2013). Falls in people withmultiple sclerosis who use a walking aid: prevalence, factors, andeffect of strength and balance interventions. Archivesof physical medicine and rehabilitation,94(4),616-621.

Karlsson,M. K., Vonschewelov, T., Karlsson, C., Cöster, M., &amp Rosengen,B. E. (2013). Prevention of falls in the elderly: a review.Scandinavianjournal of public health,41(5),442-454.

Mubashir,M., Shao, L., &amp Seed, L. (2013). A survey on fall detection:Principles and approaches. Neurocomputing,100,144-152.

.

APPENDIXA

Assessmentto be used on Staff and Support Companions

HEALTHY MEDICAL CENTER

Patient Falls Reduction Implementation Program Assessment

Pre- and Post-Test

1. Patient falls significant losses to the healthcare institutions

True

False

2. Over, the last decades, patient falls reported cases have been on the rise, and it has been giving management hard times in seeking for sustainable solutions to the problem.

True

False

3. 15-20% of all elderly people are at risk of experiencing a fall.

True

False

4. Approximately 25% of patients falling develop other medical complications

True

False

5. Various conditions are attributed to cases of patient falls

True

False

6. The symptom of a patient fall manifests as soon as one arrives at the hospital

True

False

7. Patients at risk of falling can be identified before experiencing a fall.

True

False

8. Support staff and coordination between different patients needed to reduce cases of patient falls.

True

False

APPENDIXB

Survey(Safety Companion)

  1. How often do you experience the patient falls at the institution?

  1. Once

  2. Twice

  3. Rarely

  4. Many times

  1. Do you think the hospital administration can do more to help address the situation?

  1. Yes

  2. No

  3. Maybe

  1. Do you feel you have the needed education to deal with the patient falls?

  1. Yes

  2. No

  3. Not sure

  1. How prepared are you to deal with the case if a patient falls if it was to happen within your vicinity?

  1. Prepared

  2. Well prepared

  3. Uncertain

  4. Cannot deal

  1. Should more training be introduced to help improve level of preparedness?

  1. Yes

  2. No

  3. Maybe

DEFINITIONOF TERMS

Morbidity:Disease incidence

Mortality:A death factor

Patientfall: An unplanned slip to the floor by a patient which may result ininjury or death.

Safetycompanion:A nursing assistant assigned to patients to monitor and prevent fallsin patients with the greatest likelihood to fall.

APPENDIXA

CASA GRANDE REGIONAL MEDICAL CENTER

CAGE Questionnaire

The CAGE is a brief questionnaire for detection of alcoholism. It is to be administered to all patients with a documented or verbalized history of alcohol abuse, or to all patients exhibiting early signs of alcohol withdrawal.

Score 0 for NO and 1 for YES.

A total score of 2 or more is considered clinically significant

and requires further assessment, using the CIWA-Ar.

Score

1 Point

Score

0 Points

1. Have you ever felt you should cut down on your drinking?

YES

NO

2. Have people annoyed you by criticizing your drinking?

YES

NO

3. Have you ever felt bad or guilty about your drinking?

YES

NO

4. Have you ever had a drink first thing in the morning to steady your nerves to get rid of a hangover? (eye-opener)

YES

NO

POINTS

TOTAL =

APPENDIXC

CASA GRANDE REGIONAL MEDICAL CENTER

Alcohol Withdrawal Protocol*

(Patient Sticker)

* Requires bedside assessment and/or written orders

by the physician for implementation.

1. Complete CIWA-Ar assessment every 1 hour until score is less than 10, and then reassess every 4 hours.

2. For CIWA-Ar score of 10-20:

Give Lorazepam 1 mg___ orally intramuscularly intravenously

every 1 hour until score is less than 10.

3. For CIWA-Ar score greater than 20:

Give Lorazepam 2 mg___ orally intramuscularly intravenously

every 1 hour until score is less than 10.

4. If CIWA-Ar score has not decreased after 4 consecutive doses of Lorazepam, contact the physician.

5. Call physician stat if there is delirium tremens.

6. Give Thiamine 100 milligrams in 100 ml. NS, to infuse over 1 hour every 24 hours x 3 doses.

7. Multivitamins orally daily.

8. Baseline labs to include: (check all applicable)

CMP with magnesium

CBC with differential

Liver enzymes

9. Complete I&ampO every 4 hours or per unit protocol.

10. Discontinue protocol when CIWA-Ar is less than 10 for 48 hours.

11. Other medications:

a.

b.

c.

Physician Signature:

APPENDIXE

CASA GRANDE REGIONAL MEDICAL CENTER

System Wide

Policy and Procedure Manual

Nursing Department

Chapter

D

Section

H

ALCOHOL WITHDRAWAL PROTOCOL

Issued

6/2009

Revised

Page

1 of 2

I. PURPOSE

The purpose of this policy is to direct the process for identifying the patient at risk for AW and utilizing the AW protocol when initiated via physician order.

II. POLICY STATEMENT

The goal of CGRMC is to minimize the effects of AW in a safe, humane and proactive manner while the patient is hospitalized.

III. DEFINITIONS

AW: Alcohol Withdrawal

CAGE: Standardized questionnaire used to determine possible alcohol abuse.

CIWA-Ar: Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised

IV. PROCEDURE

A. The CAGE questionnaire (attached) will be initiated when a history of alcohol abuse is verbalized or documented. The CAGE questionnaire will be initiated when a previous history of AW is documented or verbalized.

B. The CIWA-Ar (attached) assessment will be complemented when the patient scores 2 or greater on the CAGE questionnaire or manifests early symptoms of AW, including ALOC, tremors, anxiety, diaphoresis, and increased heart rate and blood pressure.

C. The CGRMC AW protocol will be initiated upon a physician’s order when the patient scores 10 or greater on the CIWA-Ar assessment.

D. Assessments and interventions will be completed by a licensed nurse per established protocol (attached).

E. Nursing documentation will be completed on the Alcohol Withdrawal Assessment/Flowsheet (attached) and in Cerner as per policy.

SA GRANDE REGIONAL MEDICAL CENTER

System Wide

Policy and Procedure Manual

Nursing Department

Chapter

D

Section

H

ALCOHOL WITHDRAWAL PROTOCOL

Issued

6/2009

Revised

Page

2 of 2

V. REFERENCES

None

VI. ATTACHMENTS

CAGE

CIWA-Ar

Alcohol Withdrawal Protocol

Alcohol Withdrawal Assessment/Flowsheet

Signature:

Signature:

Signature:

Signature:

APPENDIXF

CASA GRANDE REGIONAL MEDICAL CENTER

Alcohol Withdrawal Education Program

Pre- and Post-Test

1. Alcoholism affects approximately 15 million adults in the United States.

True

False

2. An estimated 20-50% of all hospital admissions are related to the effects of alcoholism.

True

False

3. 15-20% of all hospitalized patients are dependent on alcohol.

True

False

4. Approximately 25% of patients withdrawing from alcohol have seizures.

True

False

5. GI upset, insomnia, tachycardia, or hypotension may be early signs of alcohol withdrawal.

True

False

6. Symptoms of alcohol withdrawal can manifest as soon as 6 hours after the patient’s last drink.

True

False

7. Alcohol withdrawal cannot be confirmed until the patient displays significant agitation, confusion, DT, or seizure activity.

True

False

8. Lorazepam is the drug of choice in treating patients with hepatic compromise.

True

False

9. Symptom-triggered drug treatment regimens are less effective than fixed dose regimens because of the inconsistency of dosing.

True

False

10. Early intervention in alcohol withdrawal can decrease the amount of drugs required in the treatment of alcohol withdrawal.

True

False