Risk Assessment
Teaching Plan
A Model of Care Delivery to Reduce Falls in a Major Cancer Center
Teaching Outline
Objectives of Teaching Plan
The person who will read this teaching plan will be able to:
Describe falls
Describe risk factors for falls
Implement effectual interventions for prevention of falls
Appropriately respond to the hazards of falls
The Lesson
This will be a learning guide for the colleagues and interdisciplinary team members. This guide will have all the necessary information like patient issue, risk factors, statistics, prevention and suggestions related to falls. This could help in fall prevention.
Preventing Falls in a Major Cancer Center
Patient Issue
Falls are the topmost cause of patient injuries during the time of their hospitalization (Henriksen et al., 2008). Because of the nature of their basic medical condition, the injuries sustained by the patients as a result of falls can be quite severe. They are the leading cause of death of the geriatric patients or the ones over 65 years of age (Henriksen et al., 2008). Falls can lead to uncontrollable bleeding from thrombocytopenia or fractures because of bony metastases or the bleeding from medications which prevent deep vein thrombosis. In case of serious injuries (like, hip fractures), the patients are sent to rehabilitation centers (Kline et al., 2008). This leads to increase in the cost of hospital stay and the quality of life is adversely affected too.
Risk Factors
The following are the risk factors for the fatal falls:
Cognitive impairment
History of falls
Impaired mobility, gait, balance or strength
Parkinson’s Disease or Stroke
Musculoskeletal disorders such as deformity, joint replacements, arthritis or foot pain
Chronic ailments such as lung disease, cardiovascular disease, diabetes or osteoporosis
Medications
Nutritional deficiency
Visual problems
Urinary incontinence
Bad/cluttered environment
Statistics associated with the cause of the Fatal Falls among cancer patients (Campbell, 2016):
Overall Statistics on falls
Falls are the second most leading cause of the deaths caused by unintentional or accidental injuries, worldwide (Campbell, 2016).
Globally, about 424 000 individuals die of falls worldwide, maximum in middle and low income countries (Campbell, 2016).
The chances of falls increase as the patient gets older (Kline et al., 2008).
About 37.3 million falls require immediate medical attention (Campbell, 2016).
The most effective prevention strategies are comprised of patient education, nurse training, creating safe and uncluttered environments for the patients, research studies associated with falls and formulating and implementing fall related policies to reduce the risk of falls (Campbell, 2016).
Fall Prevention
Addressing all the following four areas among the patients can help prevent falls in cancer centers and other health care organisations as well (Kline et al., 2008):
Medications: Nurse must review the medication and its possible side effects (dizziness, disorientation, lack of coordination etc.) on the patient and assist them while movement.
Environment: Reducing the clutter and cleaning spills help a lot in preventing falls. The room must be well lit.
Senses: These relate to addressing of sensory issues that cause fall. Keeping eye glasses clean, teaching patients to slowly rise from bed or chair to avoid dizziness. Make the surroundings familiar to the patients.
Strength: Mild exercise (if prescribed) help the patients improve their strength, balance and flexibility. A strong and well balanced body is less likely to fall.
Suggestions
Human Factors
Human factors are required to comprehend the characteristics of the patients through their activities, instead of their clinical situations and provide solutions based on observations.
Human factors are required to design the environmental settings to support and facilitate patient’s activities. For example, a goal oriented visit to balcony or a bathroom instead of just wandering here and there (Henriksen et al., 2008).
Mapping of the overall system keeps into consideration the patients as active recipients of health care.
Never Events
Falls are in the list of never events. Never events are rare but when they happen they are devastating for the patients.
They are preventable and can be completely eliminated. It is important to go for root cause analysis of the ‘never event’ if it is happening in the center.
Risk Analysis Model
Swiss Cheese Model: When the defensive barriers (represented by cheese) in a health care system changes its course or aligns together (as holes align together in stacked cheese), then accidents are likely to happen. These safety barriers can be policy and procedures, staff and environment barriers. For example, a high risk cancer patient is left unattended in the bathroom is a staff barrier. Risks must be analysed from time to time highlighting the needs for safer practices (Kline et al., 2008).
Risk Assessment Tool and Benchmarking
STRATIFY is the risk assessment tool that is made up of five sub scales of mobility, vision, history of falls, toileting and agitation (Henriksen et al., 2008).
The objective is to ensure that the cancer center uses a standard scale to assess potential risks for the patients.
Quality Improvement PDCA cycle for Falls
Plan: Bring a small change and design the settings accordingly for the patients.
Do: Measure the result of change.
Check: Study about the result and learn from the conclusion.
Act: Decide whether change should be adopted, adapted or abandoned.
Remember, fall is preventable and it should be prevented.
References:
Campbell, B. (2016). Patient falls: Preventable, not inevitable. Nursing made Incredibly Easy, 14(1), 14-18.
Henriksen, K., Battles, J. B., Keyes, M. A., Grady, M. L., Kline, N. E., Thom, B., & Dowling, M. (2008). A model of care delivery to reduce falls in a major cancer center
Kline, N. E., Thom, B., Quashie, W., Brosnan, P., & Dowling, M. (2008). A model of care delivery to reduce falls in a major cancer center.
