Clinical Practice Improvement: Educating Patients and Staff on Fall Prevention Strategies

Project Title:

Educating the patients and hospital staff on strategies that can be used to prevent falls

Project Aim:

To develop Health Falls Prevention Programs/education that aims to prevent or reduce falls risk by 50% in both hospitals and communities ssettings.

The relevance of Clinical Governance to your project

Clinical governance is described as a term that is issued to all activities that inspire, evaluate, measure and display the quality of patient care. The literature defines it as “the system whereby the governing body managers, clinicians and staff use the same responsibility and accountability for the quality of care, continuously improving, reducing risks and creating an environment of excellence in care for clients”. 

There are four on which clinical governance is built and this is

• Workforce effectiveness. Every staff should apply suitable skills and information needed to achieve their roles and responsibilities within the organisation. It also includes the recruitment of best healthcare professionals, ethics, skills updating, occupational health and safety, code of conduct, continuous of professional development and competency.
• Clinical performance and evaluation. It ensures clinical effectiveness by achieving the proper care, at the right person, proper time, with a responsible clinician using the appropriate way. It involves : evidence-based practice, clinical care pathways, clinical outcomes, clinical models of care and cost-effective care
• Clinical risk management. All health service should have an organisation- wide risk management system so that they will be able to manage the integration of organisational, financial, clinical risk, equipment, plant and workplace environment. It involves accreditation, audits, adverse events monitoring, clinical investigations and root cause analysis, incident management systems and ongoing quality development.
• The participation of consumer. It ensures that health care is distributed in ways in which the public and consumer’s expectations are encountered. It consists of satisfaction of the consumer, consumer queries, consumer rights and their privacy, permission, open disclosure and their data.

Clinical governance is important because it describes the status of governing clinical care and quality as well as the same rigour to cooperate governance. Clinical governance consists of four key principle, and this includes:

• Key indicators of organisational and clinical presentation is assessed and answered to,
• Beyond compliance, organisational obligation to continuous improve is raised,
• A trust and honesty of culture is formed through open disclosure together with customers,
• Implementation of systems that are rigorous is used to recognise, following and paying attention to incidents.

it is very important in my project because all health service organisations have governance assemblies and systems available to minimise falls and to reduce harm from falls. It helps in avoiding falls and harm from falling because its prevention methods are always available for all the patients who are at risk of falling. It allows communication between staff and patients because it informed them all the recognized risks from falls and allows them to engage in the development of falls prevention strategy.

Evidence that the issue/problem is worth solving:

Falls are defined as an event which is untoward and can result in the patient having unintentionally rest on the ground or other lower surfaces (Gu et al 2016, pp. 7-10).

They are very common and mainly occurs in a hospital setting but can be prevented. Falls can lead to complications like fractures, lacerations and significant internal bleeding (Gu et al 2016, pp. 7-10). Therefore, it causes the risen of all overall healthcare utilization in a hospital system, they drive up costs and will affect patient results when they are admitted to a hospital (Gu et al 2016, pp. 7-10). Nurses are health care providers, therefore, they are the key components to falls prevention due to the therapeutic relationship they have with the patients. (Gu et al 2016, pp. 7-10).

Falls prevention programmes are important because they deliver an attractive target to maximise the quality of care and to decrease the cost of all medical treatment (Hughes et al. 2018). The Introduction of formal falls prevention program is highly suggested because common themes occurs in successful implementations. The use of assessment is important as it helps to identify patients who are at high risk of fall. Procedures that allows communication in different people on patient’s care should be applied (Hughes et al. 2018). All hospital staff should be given the appropriate training or education to identify patients who are at risk of falls and should be given the autonomy to implement and look at the profits of different preventative procedures. (Hughes et al. 2018)

Assessment tool needs to be used to establish which of the patients is at risk and this should be used on admission, on transfer, following a change in status. Planning should be patient specific and should address their needs to mitigate the risk. Educating and training among staff is important in preventing falls because education is the best way of reducing the opportunity for falls to occur (Hughes et al. 2018)

Key Stakeholders:

Nurses: they are responsible for delivering care that is direct to all patients and for achieving hospital no falls goals (SA health, 2018), they document the falls risk status, they undertake a risk assessment, they make sure that the patient is wearing appropriate footwear, they familiarise the patients to their surroundings, should know the medication that poses a risk fall.

Patient: is responsible for wearing the best shoes that fit and is comfortable for them to walk around with

Pharmacist: they screen to recognise patients at risk of fall, they assess to find modifiable risk factors like the use of medication, they intrude to apply effective clinical and community strategies to ensure that all falls risk is reduced.

Doctors: they are involved in a patient’s care. They are known as the valued members of the team. They have a major role in outlining the parameters of team activation. They recognise changes in patient’s risk of falling

Family: in many cases, they are the ones who spend most of the time with the patients than any nursing staff. Therefore, they are the ones who mainly discover the changes in patient’s condition

Government bodies: they are there to supply required procedures to declining parameters for activation of all health care team in hospitals and communities.

Hospitals: to provide hospital-wide reductions in patient mortality rates, all hospitals must be willing to implement depending on the results, not to only give information to help with implementing of the project.

Researchers: they are responsible for the collection of date, they implement educational parameters, they deliver the education to health care team and they evaluate the results of the educational falls on the role if the research team 

CPI Tool:

PDSA or Plan-Do-Study-Act is a four-stage problem, solving a model that is iterative and it is used for refining a procedure and can be used to carry out changes. It is a model that is used if you want to test ideas that create improvement. I enable the easy, quick testing of suggestions based on current ideas, research, review, theory, feedback as well as audits that supplies information of the idea working. Simple use of measures is also enabling to monitor the effects of overtime changes and the implementation of small changes is encouraged and can be built into larger developments through cycle changes that are successive and quick. PDSA cycle is fast, cost-effective and very easy. It can be used to collect baseline data for small studies. It is not very complicated or hard. It has been approved to be a tool that is effective for improvements in dynamic organisations especially the small ones.

Summary of proposed interventions:

• Provide free education to the patient and family as to the risk of fall
• Hospital staff should have the patient’s belonging within the reach,
• Clear the area around the bed of potential obstacles
• Ensure the bed is lowered with brakes on
• Minimise the use of bed rails,
• Ensure appropriate use of mobility aids based on mobility assessment
• If the patient is at high risk of fall, available staff should be alert, and the patient should be in a highly visible area and should be supervised all the time
• Ensure the patient is wearing appropriate footwear
• A written summary of education session was delivered to all patients and hospital staff
• A pre and post question yes or no survey was given to all hospital staff and patients to assess their knowledge regarding falls prevention, taking about 10 minutes to complete. The survey contained the same questions but was given in an order that was different and communication for both groups was monitored and excluded

Barriers to implementation and sustaining change:

To have a team of staff who is happy to undertake any changes and is happy to do all they can to ensure the work of implementation is really a key for continuous improvement and success, but sadly this idea is often not available from some organisations. Therefore, ensuring that key staff at all levels need to be included from the outset and trained in required new skills. Valued staff are more likely motivational, and they ensure that changes are done, and aggressive resistance can sometimes be even detrimental. To undertake changes, all staff members should help increase the willingness by communicating regularly, asking, working as a team, listening, valuing each other, respect and should act on staff comments and their concerns. People can be given the aim to support, appreciate, involved in the change if there is an indication that ensures that the difference will bring benefits that are clear and noticeable to all key stakeholders. Achieved through demonstrating, the difference between the current and the incoming process is recognised in the benefits of patients, hospital staff and even the organisation. They talk about these benefits in a way that suits the needs of everyone involved and will result in the increase passion of the project.

 To ensure that the change can remain in the face of current staff, leadership and organisational structures, the project must be flexible. Meaning that the awareness of the potential organisation or change of staff is very useful in supporting the current change. Measurements and communication of the project need to be continued, only if we want to sustain the projects benefits or changes. Staff should to be able to recognise and write down either current improvement or slippage to implement a right action or should bring up the improvements. To ensure that there is a system available in place, it is recommended to keep monitoring the development of the project and this will allow all staff to be kept up to date about progress and any areas that need improvement. Serious flaws in the project may not be seen if there is no feedback. Another issue might be financial barriers because hospital funding may not be able to provide the expenses of supplying education, index cards, posters and yearly cards on education or summary notes to hospital staff. This could be replaced by using a trained hospital staff to undertake the education of a fellow staff.

Evaluation of the project:

Re-check in a 6 months periods to see if there was any progress

Advanced research and the use of PDSA to further assess the effectiveness of education of hospital staff on the improved activation of fall prevention and hence the decrease of hospital-wide mortality by 50% over a period of 6 months

Asked all staff members and key stakeholders regarding how they found the CPI and if they found it useful and effective

Results of CPI are inconclusive and requires more evaluation, because of  some of the barriers regarding personal boundaries in patients and hospital staff even after education sessions

References

• Gu, Y, Balcaen, K, Ni, Y, Ampe, J, & Goffin, J 2016.  Review on prevention of falls in hospital settings. Chinese Nursing Research, vol. 3, no. 1, pp.  7-10.
• Hughes, Z, Moyle, S, Hughes, Z, Hughes, Z, & Moyle, S 2018. Managing and Preventing Falls in Healthcare Settings. Viewed 10 October 2018, Retrieved from <https://www.ausmed.com/articles/preventing-falls/>
• Luk, J, Chan, T, & Chan, D 2015. Falls prevention in the elderly: translating evidence into practice. Hong Kong Medical Journal, vol. 21, no. 2, pp.  165-170.
• Matarese, M, Ivziku, D, Bartolozzi, F, Piredda, M, & De Marinis, M 2014. Systematic review of fall risk screening tools for older patients in acute hospitals. Journal Of Advanced Nursing, vol. 71, no. 6, pp. 1198-1209.
• National library of Australia Cataloguing 2013. A clinical governance guide for remote and isolated health services in Australia/CRANAplus, Alice Springs, NT.
• Reid-Searl, K., Dwyer, T., Moxham, L., & Ryan, J. (2018). Nursing student’s clinical survival guide, 3rd ed, Frenchs Forest, N.S.W, Pearson Australia.
• SA health 2018, Falls prevention, South Australia, viewed 10 October 2018, <https://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/clinical+resources/clinical+topics/falls+prevention>
• World Health Organization 2017, WHO global report on falls prevention in older age, Geneva, Viewed 10 October 2018, <https://www.google.com.au/search?q=who+global+report+on+falls+prevention+in+older+age&rlz=1C1GCEA_enAU758AU758&oq=who+global+report+on+fa&aqs=chrome.0.0j69i57j0l3.15584j0j8&sourceid=chrome&ie=UTF-8>