Fall Prevention Project at the SNF
Global statistics indicate that in a healthy population, one out of every three people aged 65 and above, and one out of two people aged 85 and over, fall annually (NICE guidelines, 2017). These odds are significantly reduced for patients at the nursing home care facilities, as their probability of falling is three time more, and that of sustaining injuries is even ten times more (Cooper, 2017). Cooper assert that 40 percent of nursing home admissions are related to falls, and this might be further contributed to by the common myth that falls are inevitable.
The occurrence of falls, particularly in older people at nursing homes is a common event that may lead to other adverse health effects injuries, loss of independence, and further exacerbate the existing health conditions. The high level of exposure of this group of individuals to falls at health care facilities can be attributed to several reasons. Some of the reasons include unstable gait or balance, poor muscle tone, impaired vision, certain medications, conditions such as dementia, stroke, hypotension, Meniere’s disease etc., poorly maintained patient environment, and use of poorly fitting shoes (Alert, 2015). According to NICE guidelines (2017) there are more than 400 risk factors related to falls. These factors vary from one individual to another, therefore the development of appropriate and effective interventions to prevent falls is imperative in maintaining the quality of health in these individuals. A multifactorial method of risk assessment allows for targeted interventions on individual risk factors which contributes to prevention of future falls (NICE guidelines, 2017). Patient safety being one of the organizational priorities, it is critical to implement interventions that will ensure minimal risk of fall among patients while they are receiving therapy.
Investigation of the problem
Patients experiencing falls in skilled nursing care facilities is not an uncommon occurrence. According to WHO (2018), falls are defined as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.” WHO (2018) establish that it comes second among the leading causes of accidental injuries and deaths globally, particularly among adults aged 65 and above. Globally, 646, 000 individuals are estimated to succumb to death as a result of falls every year, and four fifths are from low- and middle- income nations (WHO, 2018). World Health Organization further contend that of the falls experienced annually, 37.3 million are serious enough to warrant medical attention. Cooper (2017) establish that compared to the general population outside the care facilities, those in nursing homes have three times higher chances of falling, and ten times higher chances of sustaining injuries. According to Cooper (2017) falls account for 40% of admissions to skilled nursing care facilities.
One of the stakeholders to Alabama SNF is the Alabama Department of Public Health. According to their statistics, falls are “the second leading cause of spinal cord and brain injury” among adults aged 65 and over. The Alabama Trauma Registry establish that 3627 cases of traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) reported nationwide between 1998 and 2001 were associated with falls (Alabama Department of Public Health, n.d). 1,795 cases, which account for 49% were established to be Alabamian aged 60 years and older, which is a significantly high number (Alabama Department of Public Health, n.d). These high numbers accentuate the need to address falls through prevention strategies that underscore education, creation of safer patient environments, and institution of effective policies aimed at minimizing risks.
Analysis of the state of the situation
Several studies and systematic reviews have been conducted to establish the factors contributing to increased number of falls in skilled nursing facilities. Datta, Datta and Elkins (2019) contend that with more than one million nursing homes patients in the U.S., falls are now a significant health issue. Statistics indicate that 60% of nursing home residents fall annually, resulting in adverse fatal and not fatal injuries (Datta et al., 2019).
Factors contributing to increased risk of falls can be classified into intrinsic and extrinsic factors. The extrinsic factors are the external ones. They include environmental factors such as poor lighting, loose rugs, unstable furniture, loosely fitting shoes, floor clutter, and patient beds without handrails (Alert, 2015). According to Datta et al. (2019), environmental factors are responsible for 16 to 27% of falls in SNFs. Out of four nursing home residents, three fall annually as a result of environmental causes (Datta et al., 2019).
Intrinsic factors include unstable gait and posture, cognitive impairment, age and sex (Datta et al., 2019). Older adults who have cognitive impairment are more likely to experience falls than their counterparts due to decreased awareness on safety. At least 50% of individuals in nursing homes have a diagnosis of cognitive impairment, and several others have undiagnosed mental health conditions such as dementia (Datta et al., 2019). NICE guidelines (2017) indicate that those diagnosed with dementia are 4 to 5 times more likely to experience falls. Almost one third of the nursing home patient population are diagnosed with dementia (Datta et al., 2019). Certain psychotropic medications also interfere with one’s cognitive judgement; however, these effects are reversible once the medications are discontinued. Some of the common side effects of these medications include unstable balance, sedation, and decreased level of coordination.
Certain medical conditions, which are also common among the residents of nursing homes, also significantly contribute to falls. These conditions include Meniere’s disease, which affects the middle ear and causes feelings of vertigo, leading to falls. There is also Parkinson’s disease which affects the part of the brain controlling gait and posture. Arthritis which is also common, affects the bone which are the primary support systems of the body, in terms of maintaining balance. These conditions are common in older individuals who are the residents of nursing care facilities, thus contributing to the high numbers of falls in this population.
Proposed solution for the problem
Several studies indicate that more than one factor contribute to falls in skilled nursing homes. As a result, the proposed interventions need to target not only the risk factors in the patients’ group but also in the care givers group, with the intention of improving the quality of care. According to Cooper (2017), implementation of multiple-component interventions has demonstrated significant improvement in terms of reduction of the number of falls in the hospital.
The first solution would be the conduction of a risk assessment to determine the risk of a patient to falls. This can be obtained from an extensive patient history which can include a history of falling in the past one-year, orthostatic hypotension, cognitive impairment, the use of psychotropic medications, unstable gait etc. the assessment is then followed by an individualized plan to address each patient’s need.
One of the most effective intervention in minimizing falls is keeping a 30-miniute check monitor list for residents with fall risk. The list contains the critical parts or elements that prevent falls and injury in high risk patients, and for every check, the nurse has to ensure that they are in place. Close to this intervention is the use of bed/chair alarms, particularly for patients diagnosed with dementia, or the critically ill. Any slight change in the patient’s position triggers these alarms, which alerts the nurse on call. Secondly, the use of appropriate assistive devices to address physical and sensory impairment has demonstrated significant reduction in the number of falls. Some of the effective assistive devices include handrails on both sides of stairways, use of high-friction treads for bare-wood steps, use of a raised toilet sear with armrests etc.
Client education also goes a long way in preventing falls. NICE guideline (2017) recommend that patients to be educated on falls and interventions for preventing them. Datta et al. (2019) confirm that this significantly increases safety awareness among the patient population and reduces their fear of falling. Alert (2015) contend that nurses should consider factors that affect the ageing process and the use of learning materials recommended for the elderly population.
Recommended sources for the implementation of the solutions
To implement the proposed interventions, the program will need a period of one-month, financial resources, and interdisciplinary involvement. Additionally, a change agent will be required to introduce the new practices to the SNF, and this also requires collaborative effort. The management and other staff members are also needed for the successful implementation of the proposed intervention practices.
There are extensive financial costs associated with fall-related injuries. According to WHO (2018), the mean health system cost for every fall-related injury is US$3611 and US$1049 in the Republic of Finland and Australia respectively. Additional evidence from Canada suggest a 20% reduction in the number of falls among children below ten years, upon effective implementation of appropriate prevention strategies. Consequently, there has been a net savings of more than US$120 million annually. Clearly, the economic costs related to falls are greater than the cost of implementing the proposed interventions. Additionally, the benefits from implementing the interventions highlight the significant need to implement them in SNFs.
The significance of each stakeholder
Collaborative effort is required for the successful implementation of the proposed strategies for fall prevention. Input from members such as the director of nursing, MDS, resident care manager, nurse practitioners, physicians, and physical therapists would be significant in achieving the desired outcomes. The professionals in the administrative arm will assist in evaluating the readiness of the nursing homes for implementation of the interventions, and the development of the required clinical pathways for accomplishment of the activities (Datta et al., 2019). The nurse practitioners will contribute in the provision of education to patients and healthcare providers.
How I intend to work with the stakeholders
First, it is noteworthy that this project can only be successful through interdisciplinary collaborative efforts. Therefore, I intend to include every stakeholder at every step of project implementation. First, I would use the administrators’ and managers’ (director of nursing, MDS, resident manager) input to assess the readiness of the SNF for the interventions. We would assess if the hospital beds are in good condition to allow for installation of handrails and bed alarms. We would assess the environment and consider factors such as lighting and additional treads. I would involve physicians in the review of psychotropic medications contributing to falls. I would involve nurse practitioners in patient education to increase their safety awareness and minimize the fear of falling.
Education of nurse practitioners
The most significant intervention is education of nurse practitioners since they play a significant role in the prevention of falls in SNFs. First, they should be educated on how to use fall risk assessment tool on admission and after a fall (Cooper, 2017). They should be educated on the various individualized interventions for each patient based on the fall risk assessment results. They should also be aware of the predisposing and the triggering factors for falls and the related injuries, and understand the role of every healthcare provider in the interdisciplinary approach to addressing falls (Alert, 2015). Lastly, they should be able to comprehend and implement environmental adjustments which are part of the fall prevention strategies.
Before implementation of the program, it is critical to obtain baseline data for the purpose of comparison with the results so that any difference can be noted. The current baseline data include the history of falls in the hospital and the most common risk factors. By comparing the baseline data and the results of the program, concrete feedback will be generated, and this will have a significant impact the desired outcome.
At the end of the program, evaluations will be conducted to determine if the expected goals have been achieved. According to Cooper (2017), the effectiveness of the program is determined through evaluation. For this program, the evaluation will be based on the outcomes, such that the benefits can be identified in individual clients- the patients and healthcare providers.
Fulfilment of various roles during proposal development
First, assuming the role of a scientist, I identified a research problem, which is the high prevalence of falls among patients in SNFs. I came up with the relevant research questions which are: “what is the prevalence of falls among patients in SNFs?”, and “what is the role of stakeholder in preventing falls among patients in SNFs?”. Also, I conducted the study through systematic review of various scientific studies that have been done previously, and the finding guided me in coming up with a solution to the problem and how to implement it. Second, in the role of a detective, I used my imagination and critical thinking skills to generate a strategy for implementation of the program. To note any difference, it is critical to compare baseline data with the results of the program. In this case, the baseline data includes historical trends of falls, cognitive impairment, and functional dependency among others. Third, in my role as a manager of the healing environment, I was able to perceive how the patients’ environment can contribute to their reduced safety, and that of healthcare providers. As such, I was able to suggest strategies for improving patient environment to minimize falls. These strategies include the use of bed alarms, handrails on the beds and stairways, and adding more treads on smooth wooden floors.
Alabama Department of Public Health. (n.d). Injury Prevention Plan of Alabama. Falls in the Elderly. Retrieved from https://alabamapublichealth.gov/injuryprevention/assets/FallsinElderly.pdf
Alert, S. E. (2015). Preventing falls and fall-related injuries in health care facilities. The Joint Commission, 55, 1-55.
Cooper, R. (2017). Reducing falls in a care home. BMJ Open Quality, 6(1).
Datta, A., Datta, R., & Elkins, J. (2019). What factors predict falls in older adults living in nursing homes: a pilot study. Journal of Functional Morphology and Kinesiology, 4(1), 3.
NICE guidelines. (2017). Falls in Older People. Retrieved from https://www.nice.org.uk/guidance/qs86
World Health Organization, WHO. (2018). Falls. Retrieved from https://www.who.int/news-room/fact-sheets/detail/falls
- NUR-495: Baccalaureate Capstone: Synthesis and Evaluation Capstone Project Overview
- Nursing Capstone: Debriefing Research Variables
- Capstone Project: Problem Description
- Debriefing After Codes Capstone
- Capstone Project: SBAR
- Capstone Project Topic Selection and Approval
- Professional Capstone and PracticumReflective Journal and Scholarly Activities
- Project proposal (On Oncology and Palliative Nurses Burnout for my future capstone.)
- Capstone Change Project Resources
- Capstone change project Evaluation
- The Impact Of Nursing Informatics On Patient Outcomes And Patient Care Efficiencies