Essay on Assessment of a Clinical Issue: Prevention of Patient Falls in Hospitals

Introduction

Today, patient falls is an occurrence that frequently lead to many complications in healthcare facilities. Although not all falls are harmful, some of them cause severe injury while others result into death. Patient falls is a serious concern especially after a consideration that patients come for help by medical practitioners, thus, additional body harm through falls is an adversity to their physical and psychological wellbeing. As we put in a lot of effort to minimize patient falls, we seek to answer a critical question, “what are the best evidence based approaches that the management can install to reduce the patient fall frequency within the healthcare facility?” This project aims to improve the quality of services within the hospital setting. The project focuses on challenges that cause patient falls, analysis of these causes, and addressing them using the best possible evidence-based intervention.

Evaluation of the Current Condition

This research has analyzed the current state in the hospital. An officer had placed a notice on doors for all patients that seem to be at high risk for a fall. The officer did that after getting a fall victim from the previous shift. It was unfortunate that those in the care section had no idea that there was a new notice on the door. Also, the team does not understand this inter-shift communication, and information flow from the nurses to their assistants. This mix has necessitated that the care department is up to determine the best mechanisms that can prevent patient falls in the inpatient sections. Falls in the inpatient sections occur possibly as a result of five key agents: fellow human beings, environmental aspects, materials and equipment. In most cases, people tend to blame those nearby a fallen patient. It is good to know that sometimes it occurs due to errors from an incompetent nurse, staff complications, poor hand-offs between officers on duty, inadequate support from other officers, lack of proper risk management practices or improper assessment of strategies that could avert the fall.

There are other inherent physiological conditions that can cause a fall. Such aspects include; poor eyesight, impairment in the cognitive functioning, and impaired mobility. Another critical cause is the environmental state in the fall surroundings. Other causes include poor room organization, poor storage systems, inadequate lighting, washrooms that are far away from nursing rooms, dangerous working conditions like spills or slippery food remains on the floor, and room designs that do not comply to standards. In some cases, materials contribute a significant percentage towards falls. The surface patterns on floors create false impressions hence a person may think his steps will cause them trouble. We may also find unsafe materials such as shoes that lack anti-slip gadgets and those with extremely high heels.

Most people attribute falls to errors in the assessment technique and grade fall risks. These errors include inadequate or lack of communication on fall risks, poor assessment of fall risks, and inadequate safety guidelines that prevent falling. While considering approaches to fall prevention in a hospital, the most critical predictors are fall assessment and communication. Lack of or inappropriate application of monitoring techniques like hourly rounds or sounding bells (alarms) are likely to raise risks associated with falls. Finally, we can also blame equipment for some fall cases. Some officials do not apply safety modes on the equipment, or they inappropriately handle them. Some equipment do not have enough fall-protection gadgets while others fail to function normally in the middle of the operation. Beds and chairs meant for patients ought to have alarms. Some do not have these safety gadgets, while others are smaller to accommodate the patient.

SWOT Analysis related to the quality improvement process.

Strengths

• The hospital will achieve a strong devotion to its mission.
• The installation of safety gadgets such as grills, and lifts for patients with mobility issues will allow the hospital to have magnificent facilities.
• The level of hospital effectiveness will be higher.
• Patients will have confidence in the hospital since they will dispel their earlier fear.

Weaknesses

• If the hospital has inadequate facilities, it will get financial strain as it budgets on extra mechanisms to install.
• There will be a need to have a team that is tasked with making a follow-up of interventions to determine its functionality. It means the hospital may have to employ more workers (experts)

Opportunities

• There will be the realization of better care management.
• The hospital will be the best and preferred care center thus serve many clients in the region.

Threats

• There will be a reduction on reimbursements from the government.
• The use of new safety feature such as elevators, lifts and others may cause more severe falls than before because of lack of knowledge on their usage.

Action Plan

After installing mechanisms that will prevent falls, the key target will be to lower fall rates in the facility. The research shall use baseline metrics to establish the present causes of fall. The results will be critically significant in minimizing the number or chances of falling within the hospital premises. There will be a daily check, and record to determine any slight improvement. Secondly, there will be a fall prevention team comprising departmental nurses. This committee reports to the risk management team responsible for collecting and verifying whether institutions are compliant with fall prevention main indications. The management team offers advisory services on aspects or areas that still some further improvement. This team also puts together strategies that supposedly cause or contribute to the occurrence of falls. Finally, the risk management team collects, and analyzes data to ensure there are adequate interventions in place and a reduction in fall counts.

An assessment of the Clinical Issue in this Study

Research reports from the Agency of Healthcare Research Quality (AHRQ) reveals that more than 700,000 persons from hospital settings fall each year (Avanecean et al., 2007). Some falls are harmless, others cause smaller injuries, while others result into either major injuries or death. From past hospital records, we notice that most of these injuries are injuries on body soft tissue, bone fracture, injuries on heads, reduced movement, anxiousness and death (Avanecean et al., 2017). According to Lizarondo (2016), approximately 36% people who get serious injuries are likely to lose their lives in a year. Also, it is worth noting that patients who fall in hospital also of cases that result in serious, major injuries can stay about 13 days longer than their expected duration. This prolonged stay translates to an increase in medical bills. These are partly the reasons why Centers of Medicare & Medicaid Services (CMS) continually consider falls and injuries as a serious occurrence.

An analysis of key causes and the search for the best evidence-based approach requires a clear understanding of falls. It is also necessary for this paper to display a clear research question. According to the World Health Organization (WHO), a fall is “an event that results in a person coming to rest inadvertently on the ground, floor, or other lower level” (n.d.). While trying to come up with the best evidence-based approach, the paper developed a research question using the PICO system. The study sample comprised adult patients that had stayed in the hospital for more than a month, and particularly from the surgical department. Through literature perusal and searches, there was no single intervention that would work independently to avert falls. The research took a dimension in which it is better to consider prevention techniques as the best evidence-based approaches to prevent falls.

Stakeholders and Decision-makers

Is worth noting that hospitals operate in complicated environments. Therefore, these stakeholders must pursue technics that align with particular demands of workers, target patient category, government arms, and members of the society. It implies that there exists some stakeholder groupings that the management should handle with ultimate care. This practice shall enable the hospital to remain relevant, attain its goals while transforming experiences the patients’ experiences. In this quality improvement project, there are a group of internal stakeholders that the project consider all along. They include the hospital board members, trustees, the research team, health experts, the HRM department, health directors, and officers in charge of communication, nurses and physicians (Stelfox et al., 2015).

Secondly, a group of external stakeholders dictates what should follow the current project. This group will encompass clients, incoming patients, groups with special interests, the newsman, and any possible funder or sponsor. Both the internal and external stakeholders are critical in any issue that arises within the hospital. They should be aware of the quality improvement process and any input from them would work well towards positive results.

Another critical aspect is decision-making process. Everybody regards it as the central feature for any organization that aspires to be effective. It is worth noting that the healthcare sector (hospital), is one of the most sensitive sectors in the world, thus it becomes necessary for decision making to go through all persons within the hospital premise. It begins from the patients. They should present their input about the project; how do they feel about it? How best do they want the falling issue solved? Do they have any other input or comment? These category does not have much input. Another category is the nurses. They give reports of daily falls and their causes. These reports inform the direction the quality project will take. At a slightly higher level are the technical persons that deal with design, engineering, and instrumentation. They also have a lot to say in the quality improvement project. Generally, decision making calls upon all employees in the hospital including the gate keeper.

Resources and Time for the Project

This project requires a number of resources. The first resource is human resource. There must be adequate staff in the hospital to provide eservices efficiently and reduce service time per patient. One of the causes of patient falls could be fatigue as a result of queuing for many hours. Additionally, one of the mechanisms of fall reduction could be training of patients as they wait for medication. It would be insensitive if the quality team installs quality improvement mechanisms yet they fail to induct fall victims. Therefore, it is a necessity that the management recruits more personnel to lower the patient-doctor ratio. Some of the staff will form a monitoring team to check the effectiveness of the laid down mechanisms over time.

The quality project shall require safety equipment and gadgets such as lifts, elevators, guard rails, wheelchairs, transfer devices and many more. These devices and equipment are costly and this research recommends an allocation of 5000 US Dollars toward the purchase of these equipment. The team may not realize an improvement in the quality over a short period. There is a need for patience and keen monitoring to attain quality. On average, this project researchers estimate that it would be complete after two months from the time the research is complete. Tangible results are likely to show up in the third week after the installation of all fall intervention controls.

Implementation and evaluation Strategies

Critical aspects that will avert patient falls include the installation of safety devices and other strategies to minimize falling numbers. It is also essential to undertake a fall risk screen once in a week. There will be implementation of fall prevention techniques to result into fall prevention mechanisms. There is also a need to monitor falls and assess them to establish their causes and impacts as this move will help in improving fall prevention. The management shall institute a fall prevention team whose key role would be to ensure all employees and patients comply with best practice procedure (Agency of Healthcare Research Quality, 2017).

Research findings reveal that there are several factors that limit fall prevention in a hospital setting. These factors include motivation, presence of supportive officers, and availability of fall prevention facilities, patients’ health, staff and patient induction. Fall prevention will extent to issues such as culture change, training, use of equipment and gadgets, and many related aspects (Koh et al., 2008). Therefore, the quality team shall contract fall prevention technicians to educate the employees and patients. On the other hand, the hospital management must assess the staffing scenario. That will not be enough. The management must seek relevant funding to acquire safe patient handling gadgets.

Conclusion

This research identifies causes of inpatient falls in a hospital setting. Some of the causes are due to human error, equipment deficiencies, while others are as a result of the patient’s physiological problems. It further highlights major hospital stakeholders connected to quality control, the decision-making process, the resources and the time frame for the project. The research also identifies the best evidence-based practices that hospitals could use to avert such accidents. It ends by highlighting critical implementation and evaluation strategies that can avert patient falls in hospitals. In doing these, the research aims at instilling a quality improvement project in a health facility with numerous cases of patients falling as they walk, sleep or doing any other minor tasks.

References

Agency of Healthcare Research Quality. (2017). Module 5: How to measure fall rates and fall prevention practices. Training guide. Retrieved from

https://www.ahrq.gov/professionals/systems/hospital/fallpxtraining/workshop/module5/

Agency of Healthcare Research Quality. (2018). Preventing Falls in Hospitals. Retrieved from http://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.htm

Avanecean, D., Calliste, D., Contreras, T., Yeogyeong, L., & Fitzpatrick, A. (2017). Effectivenes of patient-centered interventions on falls in the acute care setting compared to usual care: a systematic review. JBI Database of Systematic Reviews and Implementation Reports, 15(12), 3006-3044. doi: 10.11124/JBISRIR-2016-003331

Centers for Medicare & Medicaid Services. (2018). Hospital-Acquired Conditions. Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service- Payment/HospitalAcqCond/Hospital-Acquired_Conditions.html

Koh, S. S., Manias, E., Hutchinson, A. M., Donath, S., & Johnston, L. (2008). Nurses’ perceived barriers to the implementation of a Fall Prevention Clinical Practice Guideline in Singapore hospitals. BMC health services research, 8(1), 1-10.

Lizarondo, L. (2016). Fall Assessment and Intervention: Acute Care Setting. JBI Recommended Practice. 1-5.

Stelfox, H. T., Niven, D. J., Clement, F. M., Bagshaw, S. M., Cook, D. J., McKenzie, E., … & Critical Care Strategic Clinical Network, Alberta Health Services. (2015). Stakeholder engagement to identify priorities for improving the quality and value of critical care. PLoS One, 10(10), e0140141.

World Health Organization. (n.d.). Falls. Retrieved from http://www.who.int/violence_injury_prevention/other_injury/falls/en/