Capstone Project: Falls Prevention and Risk Assessment of the Elderly Population while in Long Term Care facility Evidence Based Practice – NUR 4775L Dr. Susan Poole, DNP, CNE November 22, 2015 Capstone Part I: Falls Prevention and Risk Assessment of the Elderly Population while in Long Term Care facility Introduction to Problem According to Centre for disease Control (CDC) more than 1.4 million people 65 and older live in nursing homes. If current rates continue, by 2030 this number will rise to about 3 million (CDC, 2014). Nursing home residents are at an increases risk for falls depending on the acuity of their illness and their mental state.
Falls of critically ill patients admitted to the ICU routine should be avoided developing certain strategies used outside this area, such as prevention of displacement, promote stability, elimination of sliding hazards routinely ensure that the patient is oriented to the environment and the bell is at the fingertips, keeping the beds in the lowest position and braking, providing adequate lighting, and provide anti-slip footwear and technical assistance in lifting patients bed. The response time of the call prolonged ringing patient or family is just one of the potential causes of falls, firstly because if the response time is greater serve their needs later, and partly because no response to the patient may start feeling agitated. Shift schedules nurses can be particularly effective in preventing falls, as they allow the staff to anticipate and address the needs of each patient. The tubing, drains and cables must be securely to prevent tripping when lifting or embody patients. Although falls can happen without warning, subsequent falls can be avoided if the etiology of them is
This research proposes a nurse-led rounding program in an acute care context, with an implementation based on the Iowa Model, to decrease patient falls. The Iowa Model's first stage is to determine the problem for the change in practice. The necessity to reduce patient falls is the trigger in this circumstance.
In a recent article published in the MEDSURG Nursing journal it discussed the effects of hourly rounding to prevent falls for patients in acute care. Falls not only cause harm to patients, they cost hospitals money. In 2012 “the Joint Commission identified reduction of harm from patient falls as a national patient safety goal” (Hicks, 2015). In attempts to reduce falls, studies have been conducted on hourly rounding. “The main components of hourly rounds include reducing anxiety by using key words, addressing the four Ps (pain, potty, position, possessions), assessing the environment for safety issues and telling the patient when staff will return” (Hicks, 2015).
These interventions included educating patients consistently about the important of getting assistance to get out of bed and go bathroom, providing information to increase patient knowledge about fall precaution, the reason why he or she was risk for falls and what specific actions they should avoid. The most important that, the nurse should to let the patient know that calling for help is not a bother to the nurse. They also found out that fall risk assessment, fall prevention, closer supervision of patient and hourly rounding were not performed or done as its policies. The findings in case reviews suggested that despite use of multiple fall prevention intervention, all falls are not preventable, but they also highlighted the need for consistent implementation of fall prevention intervention. In current evidence based fall prevention intervention recommendation, they mentioned a multicomponent approach to fall prevention can reduce fall rates by 30% (Miake-Lye et al., 2013).
Change is inevitable not only in the hospital setting but also in all other organizations that put the safety of stakeholders at hand. It is, however, sometimes challenging to have all stakeholders adopting a proposed change since some individuals would rather stick to the old ways of doing things as opposed to trying out new interventions (Guse, Peterson, Christiansen, Mahoney, Laud, & Layde,, 2015). Nevertheless, positive change is essential, especially when such a change is expected to positively impact on the safety of patients (Johnson, Veneziano, Green, Howarth, Malast, Mastro, Moran, Mulligan, & Smith, 2011). The purpose of this paper is to critique the adoption of hourly rounding as a nursing intervention for preventing falls.
Present the Evidence: Prevention of Patient Falls According to the Centers for Disease Control (CDC), each year, one third of those who are 65 and older fall (2013). These falls contributed to $34 billion in direct medical costs in 2013 (cite). With these statistics, it is apparent that health care professionals and health care settings need to make fall prevention a priority in their facilities. The aim of this paper is to explore a fall prevention policy and practice guidelines to evaluate recent evidence and offer recommendations.
This act created a major revision of standards of care for nursing homes. This legislation also changed the expectations and the quality of care that patients should receive in long term care facilities. This Nursing Home Reform Act passed by congress specifically stated “that each residents have the right to be free from any physical or chemical restraints imposed for purposes of discipline or convenience and not required to treat the resident’s medical symptoms”. While there may be some benefits to using restraints in nursing homes, however, studies have shown that using restraints in nursing homes negatively impacts patients and for the most part does not prevent them from falling or from other incidents that may occur. There are very high levels of risks associated with the use of restraints (Lapane,150).
(Joint Commissions, 2014).It is important for nurses to explain how to use the call light to the elderly patients, and also to ask for help before getting out of bed. Vulnerable patients should be placed close to the nursing station for close monitoring. It is very important to educate health care workers on the approaches used to prevent falls. The measures used to prevent falls in the elderly could include; carrying out a risk assessment during admission, placing colorful stickers outside their doors, stopping the use of psychotropic medications, teaching them the best way to use their assistive device, placing their call light and belonging within their reach, placing their beds in the lowest position with brakes /wheels locked at all times, removing throw rugs from their surroundings, making sure that they are wearing non-skid shoes/socks before ambulating and also giving them their prescribed Vitamin D supplement as well as encouraging them on the use of their corrective glasses or hearing aids. It is very important to educate health care workers on the approaches used to prevent
It also provided the use of critical thinking and clinical judgment on how to prevent falls, support, and be accountable for a client professionally. The practical knowledge I have learned helped me become aware of assessing and assisting a client. As a nurse, our job is to provide “safe, compassionate, competent and ethical care” (p.8) and collaborate as an interprofessional team to deliver safe care and prevent risks from happening while offering quality nursing care (CNA, 2017). I will always provide the professional care under the code of ethics to promote health and wellness for an older adult and prevent risks from happening. As well as following the plan of care, use communication strategies, be aware, acknowledge, and accommodate individuals with different diseases such as with dementia, to promote fall prevention strategies (RNAO, 2017).
Research suggests that each year an estimated 1 in 3 older adults fall. Many older adults lose their lives from falls. Fall related injuries are responsible hundreds of thousands of hospitalizations each year. With the main focus on universal fall precautions and environmental safety, traditional fall prevention and fall management programs have been less than fully effective. A large problem that continues in acute care is the lack of an injury risk screening tool.
This helps your balance and agility, and can help prevent falls at older
This program, called the Nijmegen Falls Prevention Program, included one hundred thirteen elderly clients with a history of falls. Exercise sessions were held twice a week for five weeks with fall monitoring done before and after the experiment. Control assessments were also done continuously thru the study to determine client changes in standing balance, balance confidence, and obstacle avoidance skills. The results of the Nijmegen Falls Prevention Program showed that the number of falls within the exercise group dropped by a significant forty six percent! Not only less falls, but obstacle avoidance skills dramatically improved as did balance
Adventure into Indiana Grandma is bruised. Grandma is in the hospital. Grandma fell.
The study looked into focusing on starting hourly rounding for fall prevention. They felt there was a good opportunity to reduce fall and injury rates by initiating hourly rounds. This study focused on the change initiative they could make by implementing
