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The goal of this project is to develop techniques that the hospital can utilize to avoid or reduce the number of falls among older patients. The investigation will also identify critical hurdles to fall prevention program implementation. As a result, the project's findings will assist many healthcare professionals in improving their service quality and reducing the number of injuries or deaths caused by falls.
Clinical Governance's Importance in Your Project
Clinical governance is the involvement of all persons in enhancing health quality.
The governance will apply to this project in various ways. First, it will promote development of risk management strategies critical to preventing falls. Risk management involves identification of how nurses and physicians provide poor health services, factors that influence the increased number of falls, proper actions that can prevent falls, and measures for reducing the risks. Second, clinical governance will facilitate a clinical audit to determine criteria used by health care providers to evaluate the quality of services offered. The performance is compared against a standard, changes proposed and implemented. Third, the governance will promote education and training of team members to enhance their professional development. The staff needs to acquire skills and knowledge that can help them develop strategies for monitoring elderly patients to prevent their falls. Fourth, through clinical governance, it will be easy for the project to provide evidence based care. Fifth, it offers a chance to involve patients in their own treatment plans. Therefore, it will be easy for the project implementation team to identify priorities and formulate policies that other staff members should follow to minimize falls. Lastly, clinical governance will help in proper management of the team. For instance, by adhering to the recommended guidelines, it will be possible to identify a qualified and competent team to manage the project and address all needed raised by the medical staff and patients.
Evidence that the issue / problem is worth solving:
According to Ambrose, Paul and Hausdorff (2013, pp. 52), falls are common among older adults admitted to hospitals and they lead to injuries and death. For instance, one out of three adults aged 65 and above suffers from falls annually (Ambrose et al. 2013, pp. 52). About 30% of the patients sustain moderate to severe injuries, which makes it difficult to lead a healthy life. Such patients require an urgent and prolonged hospitalization. At the same time, the injuries increase the patient’s risk of death (Ambrose et al. 2013, pp. 52). Besides, Chang and Do (2015, pp. 521) state that falls lead to multiple psychological problems such as anxiety, fear, and depression. Some of the consequences include poor social life, development of new diseases and increased risk of falling in future (Chang and Do 2015, pp. 521).
In another study, Bunn et al. (2014, pp. 01) reveal that elderly patients with mental illness encounter the highest number of falls. For instance in England, health care facilities for mental illness record an approximate of 36,000 falls among the aged patients annually (Bunn et al. 2014, pp. 01). The risk of falling is high for patients suffering from anxiety, depression, mania, and dementia. Bunn et al. (2014, pp. 01) identify adverse effects of such falls to include a prolonged stay in hospital, physical injuries, development of mental disorders, and increased treatment costs. Furthermore, in a systemic review on hospital fall prevention, Hempel et al. (2013, pp. 483) state that many hospitals worldwide encounter increased cases of falls. However, they have failed to reduce or identify strategies for minimizing the incidences.
The increasing cases of hospital falls occur due to poor prevention strategies. Many healthcare providers are reluctant to invest their resources in establishing quality measures that can protect elderly patients. On the other hand, the number of aged patients seeking for medical care is rising daily. Since ageing is associated with numerous physical and mental health issues, it is difficult for hospitals to eliminate the aged from their health programs. This implies that the falls will continue to rise unless preventive measures are taken. Unfortunately, most of the recommended programs are complex, require experienced personnel and a massive financial support (Hempel et al. 2013, pp. 484). For this reason, it is necessary to have this project, which seeks to provide a simple and permanent solution.
Hospital administrators – They include the board of trustees, chief executive officer, chief finance officer, chief executive nurse, and nurse managers. Administrators develop policies and oversight the project implementation process. Besides, they allocate finances and provide leadership in all phases of the project.
Healthcare providers – Their role is to prevent falls by implementing the quality or safety measures according to the project’s recommendations. They include physicians, nurses, pharmacists, and paramedical personnel. Since nurses always spend much of their time with patients, they will bear the greatest responsibility for protecting them against falls.
Patients – The project aims at protecting the patients. Their primary contribution will be to identify circumstances that lead to their falls. Besides, they will determine if the project has been successful.
Government – Its role is to finance health care programs to ensure the provision of quality services and enhanced patient safety. Therefore, in this project, the government will provide the required funds and monitor the implementation process.
The preferred CPI tool is the Continuous Quality Improvement (CQI) program. The purpose of CQI is to enable members to understand the progress of the projects, identify challenges, suggest possible improvement measures, and predict the outcome. Therefore, this tool is effective in ensuring the project meets the desired quality from the initiation to the completion phase. The project manager will have to meet specific requirements to enhance the success of the tool. First, he or she should select an effective quality improvement (QI) model. Secondly, the manager should identify metrics for assessing the improvements made and outcomes. Thirdly, staff members should be trained on the defined parameters to ensure they work to achieve the desired success. Lastly, the hospital should involve other stakeholders such as patients, their families, and healthcare providers in all the activities geared towards quality improvement.
The major components of the CQI tool are the structure, process, output, outcome, and feedback (McFadden, Stock and Gowen 2015, pp. 03). In this project, the structure will involve human, technological, and financial resources. For instance, the project will have qualified personnel, who understand some of the common physical factors that lead to falls. Besides, there will be technologies for collecting and storage of data as well as monitoring patient movements within the hospital. On the other hand, the process will include activities and the general workflow. Each of the team members will have responsibility for ensuring the project achieves the desired outcome. Then, the major output will be an immediate reduction in the number of falls within the first 2-4 weeks of project implementation. Comparatively, the outcome will be determined after six months. The metrics will include the elimination of all risks that contribute to patient falls, reduction in a number of hospital-acquired injuries and deaths among the elderly patients, reduced length of hospital stay and a reduction of weekly falls to only 1-2 incidences.
The team will adopt the Plan-Do-Study-Act (PDSA) model that has a seven-step cycle. First, is the formation of a team consisting of all stakeholders (McFadden et al. 2015, pp. 09). The second step is setting the aims such as measurable goals for the project. The third phase is establishing measures that determine if the outcome has been achieved. Selection of changes is the fourth step, and the team will have to consider several ideas on how to improve the project. At the fourth stage, the changes are tested to determine if they can achieve the desired objectives. The final step requires implementing the changes after proper evaluation.
Summary of proposed interventions:
Prevention of hospital falls among the elderly patients should involve a multicomponent intervention (Karlsson et al. 2013, pp. 749; Bunn et al. 2014, pp. 03). The first intervention is training the staff (DuPree, Fritz-Campiz and Musheno 2014, pp. 99). Physicians and nurses have to acquire knowledge on how to care for the elderly patients, help them move around, restrain them on hospital beds without causing injuries and maintaining their physical health. Bunn et al. (2014, pp. 10) state that trained nurses can quickly implement new changes for enhancing patient safety. Thus, this project will identify effective training methods, such as hands-on training and computer simulation models to equip nurses with the right information on providing quality care to patients.
The second intervention is developing physical training programs (Karlsson et al. 2013, pp. 750). The best physical activities should focus on strengthening the muscles and balancing the body. Karlsson et al. (2013, pp. 750) report a reduction in the number of falls by 22% when a supervised group training is used. On the other, training individual patients leads to a 23% decrease in the risk of falls. Karlsson et al. (2013, pp. 13) also support that physical activities help to stabilize the elderly patients, thereby reducing the fall rates.
Third, assistive technologies are the best approaches for minimizing the falls (Karlsson et al. 2013, pp.12). An example is the virtual sitter technology that helps in monitoring the movements of patients. With software and a linked video, this technology collects 3D motion pictures of the patients and warns when a fall occurs. Other assistive technologies with sensors can help patients with mental disorders, particularly dementia, to move within the hospital.
Lastly, the hospital should use drug therapy and establish a safe environment. According to Karlsson et al. (2013, pp. 752), it is possible to minimize the risk and rate of falls by withdrawing some of the psychotropic medications. Furthermore, some medications can help to stabilize patients. On the other hand, Bunn et al. (2014, pp. 10) suggest that hospitals should establish an environment with a minimum risk of falls. For instance, the hospital floor should always remain dry while beds must have protective features. In addition, each bed should have an alarm that can warn nurses when the patient makes risky movements that could lead to falls (Miake-Lye, Hempel, Ganz and Shekelle 2013, pp. 350). The patients can also use the alarm to request assistance from the medical staff, in case they want to get off the bed.
Barriers to implementation and sustaining change:
First, unsupportive staff or management could make it difficult to implement the project (Williams, Perillo and Brown 2015, pp. 05). Lack of cooperation by other members could jeopardize any efforts to establish strong teams, thereby making it difficult to share information and ideas. Since the project is significant to the hospital, it is important for all people to participate in its implementation to lead to the desired outcome. Second, lack of resources could prevent completion or slow down the project (Williams et al. 2015, pp. 06). For instance, inadequately trained or insufficiently skillful personnel can affect the project. Lastly, organization culture could make it difficult to attract the necessary support from other stakeholders (Williams et al. 2015, pp. 06). For example, authoritative and dictatorship leadership expressed by some of the managers could demoralize some of the team members, thereby making it difficult to achieve the desired outcomes.
Evaluation of the project:
The metric for assessing the success of the project is a reduction in the rate and risk of hospital falls. The following plan will be used for determining the achievement of the project objectives.
Outcome Goal: To reduce the number of falls among the elderly patients by 50% within the six months.
Train nurses and physicians on how to identify risks for possible falls and protect the patients
Project team and the human resource manager
Ability to identify major risks or factors that cause falls
Observations and questionnaires
Establish a safe environment
Nurse manager, Information technology administrator, and team members
Elimination of all risk factors
Identification and acquisition of the best assistive technologies
Placement of alarm systems on all beds
Reduction of falls by 30%
Observations, questionnaires, and interviewing patients and nurses
Identification of the best physical activities for strengthening the patients’ muscles and enabling them to regain their balance
Project manager and the staff
Reduction of the falls by 20%
Observations and questionnaires
Ambrose, A.F., Paul, G. and Hausdorff, J.M., 2013. Risk factors for falls among older adults: a review of the literature. Maturitas, 75(1), pp. 51-61.
Bunn, F., Dickinson, A., Simpson, C., Narayanan, V., Humphrey, D., Griffiths, C., Martin, W. and Victor, C., 2014. Preventing falls among older people with mental health problems: a systematic review. BMC nursing, 13(1), p. 4.
Chang, V.C. and Do, M.T., 2015. Risk factors for falls among seniors: implications of gender. American journal of epidemiology, 181(7), pp. 521-531.
DuPree, E., Fritz-Campiz, A. and Musheno, D., 2014. A new approach to preventing falls with injuries. Journal of nursing care quality, 29(2), pp. 99-102.
Hempel, S., Newberry, S., Wang, Z., Booth, M., Shanman, R., Johnsen, B., Shier, V., Saliba, D., Spector, W.D. and Ganz, D.A., 2013. Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. Journal of the American Geriatrics Society, 61(4), pp. 483-494.
Karlsson, M.K., Magnusson, H., von Schewelov, T. and Rosengren, B.E., 2013. Prevention of falls in the elderly—a review. Osteoporosis international, 24(3), pp. 747-762.
McFadden, K.L., Stock, G.N. and Gowen III, C.R., 2015. Leadership, safety climate, and continuous quality improvement: impact on process quality and patient safety. Health care management review, 40(1), pp. 24-34.
Miake-Lye, I.M., Hempel, S., Ganz, D.A. and Shekelle, P.G., 2013. Inpatient Fall Prevention Programs as a Patient Safety StrategyA Systematic Review. Annals of internal medicine, 158 (5_Part_2), pp. 390-396.
Williams, B., Perillo, S. and Brown, T., 2015. What are the factors of organisational culture in health care settings that act as barriers to the implementation of evidence-based practice? A scoping review. Nurse education today, 35(2), pp. e34-e41.
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