Implementation Plan
Implementation Plan
This Capstone Project focuses on the fall of elderly patients in hospitals. The intervention proposed by this researcher is proper assessment and customizing fall prevention, and the measured outcome is decrease in fall rates. Below are details on how this project is going to be implemented.
This capstone project requires approval from the Institutional Review Board (IRB) of the Grand Canyon University. This researcher acquires information for the documents needed in the application process and the procedures for review. Constant communication is maintained with the professor and adviser to ensure that the study is done according to the standards of the university.
Description of the problem
Falls are a major factor in the death of elderly people in the United States, and statistics show that 70% of deaths of those aged 75 years and above are attributed to falls (Mussi et al., 2013). According to Rhalimi, Helou & Jaeker (2009), half of the incidents of falls take place during the first week of the older people’s confinement in hospitals. Those admitted are three times more likely to experience falls compared to those in community dwellings. These incidents lengthen the patients’ stay in the health facilities and translate to additional costs. In the UK, costs from falls are estimated to be at least 92 million pounds annually (Da Costa et al., 2012). Other countries, like Canada, Australia, and the US also report substantial figures attributed to elderly patients’ extended stay resulting from subsequent falls in hospitals.
Falls take place because of the interaction of various risk factors. Aside from age, chronic diseases and the intake of medications for such diseases also contribute to falls of older patients. Since falls are a common occurrence even among inpatients, hospitals implement a fall prevention protocol in their facilities, although in some departments, not all elderly patients undergo fall assessments (Miller et al., 2009). This is frequently a case in the emergency departments where elderly patients only see a nurse or physician and are not referred to other specialists. In Miller et al.’s study, a portion of the elderly who are treated for falls come back within the next six months for treatment of a fall-related incident. In most cases, such patients did not have thorough fall assessments during their initial visit to the emergency department.
Fall prevention protocols include fall prevention guidelines, assessment procedures and utilization of certain fall prediction devices. However, the implementation of a one size fits all fall prevention policy is insufficient in preventing fall incidents in hospitals. This researcher proposes that it is necessary to conduct a proper fall assessment upon admission and based on the results of such assessment the hospital staff needs to customize a fall prevention intervention for elderly patients.
Proposed solution
The researcher proposes that a proper fall assessment be given to elderly patients upon admission a fall prevention intervention be customized for such patients. This means that the fall risk of the elderly patients is thoroughly assessed using both objective and subjective measures. In contrast to a one size fits all design, the intervention will take into account specific conditions of the patient to customize a fall prevention intervention that is feasible and appropriate to the elderly patient.
Rationale for proposed solution
A customized fall prevention intervention is appropriate to elderly patients because this population have different combinations of chronic diseases. Despite similarities in age, the elderly patients’ fall history, their current medical condition, the types of medication they are using, and their emotional health would result in variations of success if a uniform fall prevention intervention is implemented. Designing customized fall prevention interventions for elderly patients is a more patient-centered approach. Such an approach is beneficial also to the nursing staff because they are able to provide a specific care for the elderly patients. Since patients are provided with care appropriate to their needs, they are expected to respond more positively to their care givers.
Evidence from literature
Studies about the elderly population all agree that falls is a common occurrence among this population, and that such incidents contribute to morbidity and mortality rates of elderly patients. Since such situation happens frequently, both patients and doctors tend to overly trivialize these occurrences (Bloch et al., 2011). However, there is a possibility that patients who experience falls once would be experiencing falls again in the future. Thus, it is not enough to rely on fall prediction devices that alert bedside nurses of potential falls. It is important to look into factors that can be modified to limit such falls, too. In the study of Sirkin & Rosner (2008) among hypertensive elderly patients, they concluded that an individualized treatment plan is necessary to address both the requirements of hypertension management and this group’s fall risks. Da Costa et al. (2012), after assessing fall prediction tools, such as STRATIFY, DOWNTOWN, and PJC-FRAT, concluded that the main strategy to prevent falls is to identify and modify risk factors. The majority, if not all, of elderly patients in hospitals suffer from chronic diseases and are taking in medications for such illnesses. The fallers among the elderly patient population are most often those suffering from stroke, dementia, epilepsy, and Parkinson’s disease (Homann et al.,2013). Studies have also found out that certain medications contribute to fall incidents. An example is the research done by Rhalimi, Helou & Jaeker (2009) which identified the drugs zolpidem and meprobamate as medications associated with increased falls among elderly patients. In the research of Mamun & Lim (2009), the fallers were the ones taking fewer medicines; however, these drugs were cough medications, antiplatelet drugs, and hypnotics. There are always combination of factors, such as age and mobility. In the study of Nabeshima et al. (2007), the patients who experienced most fall incidents where the ones who were not bedridden, had dementia, and received tranquilizers. All these studies provide evidence that despite showing characteristics of fallers, elderly patients would have different combinations of risk factors. Thus, it is important to carry out a thorough assessment of inpatients so that the intervention applied would be customized according to the individual needs and capacities of the elderly patients.
Implementation logistics
The following are among the key activities in this research project. Each activity is defined and the persons tasked for its completion is described below.
Meeting with hospital leaders and administration. This researcher will discuss with the management and officials of the hospital the rationale for the proposed intervention. In this meeting, the researcher will solicit their approval of the project and request for the participation of key individuals, particularly in defining a customized fall prevention plan.
Presentation of study objectives and proposed intervention. This is a follow-up meeting, but is a more structured one. This researcher will handle the meeting but a memo from the administration is required so that the nursing staff and other related personnel can attend. In this occasion, the team who shall work with this researcher for the project will officially be identified.
Identifying research sample and control group. Research participants are elderly inpatients who will be admitted within a one-month period. A control group will come from those admitted within the last six months who is matched with the current research participants. This researcher shall work closely with the nursing staff to identify research participants and control group.
Seeking consent from research participants. This researcher shall access the research consent form and have it signed by research participants.
Defining the criteria of a customized fall prevention plan. The researcher convenes group discussions with selected individuals to come up with criteria for the customized fall prevention plan. They may use and modify existing measures and utilize fall prediction devices whenever necessary. Inputs from bedside care nurses and assistants will be collected by this researcher. This same group shall enumerate a checklist of indicators that will be used to determine if a fall prediction intervention is customized or not.
Launch of the intervention. The researcher coordinates with the nursing staff for the launch of the intervention. The staffs who conduct assessments upon admission are the primary implementers of the intervention.
Monitoring research procedures. This researcher coordinates with the nursing supervisors for the monitoring of the intervention. Researcher may also carryout participant observation during actual assessment and preparation of plan.
Collection of data. The outcome measure is the number of falls during the patients’ hospital stay. This information along with patient’s characteristics will be collected by this researcher within the one-month period.
Analysis of data. The researcher shall carry out analysis of data. Statistical software will be used to identify relationships between factors.
Validation of research results. When the results have been collated, this researcher shall convene hospital staff, management, and leaders to present results of the study. The validation activity shall also accommodate staff’s perceptions and assessments of the intervention.
Write-up and finalization of research report. This researcher is in-charge of completing the research report and integrating comments and suggestions of the professor.
The implementation of the intervention requires financial, human, and material resources. Funds for meetings, printing expenses, transportation, communication, software cost and other incidental expenses will be required and shouldered by this researcher. Human resources include the time given by staff to attend meetings and customize fall prediction plans, and their inputs during group discussions about the project. Among the persons involved in the project are the nursing supervisor, bedside care nurses, and admitting staff. Material resources are the assessment tools which can be accessed in the hospitals. This researcher negotiates with the hospital to gain free access to these assessment tools. The researcher will also be preparing PowerPoint presentation about the project, information materials about the intervention, necessary forms, and copies for the research report.
References
Bloch, F., Gautier, V., Noury, N., Lundy, J.E., Poujaud, J., Claessens, Y. E. & Rigaud, A.S. (2011). Evaluation under real-life conditions of a stand-alone fall detector for the elderly subjects (Bloch et al., 2011). Annals of Physical and Rehabilitation Medicine, 54 (2011):391–398.
Da Costa B.R., Rutjes, A.W.S., Mendy, A., Freund-Heritage, R. & Vieira, E.R. (2012) Can Falls Risk Prediction Tools Correctly Identify Fall-Prone Elderly Rehabilitation Inpatients? A Systematic Review and Meta-Analysis. PLoS ONE 7(7): e41061. doi:10.1371/journal.pone.0041061.
Homann, B., Plaschg, A., Grundner, M., Haubenhofer, A., Griedl, T., Ivanic, G., Hofer, E., Fazekas, F. & Homann, C.N. (2013).The impact of neurological disorders on the risk for falls in the community dwelling elderly: case-controlled study. BMJ Open; 3(11):e003367. doi: 10.1136/bmjopen-2013-003367.
Miller, E., Wightman, E., Rumbolt, K., McConnell, S., Berg, K., Devereaux, M. & Campbell, F. (2009). Management of fall-related injuries in the elderly: A retrospective chart review of patients presenting to the emergency department of a community-based teaching hospital. Physiotherapy Canada, 61 (1): 26-37.
Mussi, C., Galizia, G., Abete, P., Morrione, A., Maraviglia, A., Noro, G., Cavagnaro, P., Ghirelli, L., Tava, G., Rengo, F., Masotti, G., Salvioli, G., Marchionni, N. & Ungar, A. (2013). Unexplained Falls Are Frequent in Patients with Fall-Related Injury Admitted to Orthopaedic Wards: The UFO Study (Unexplained Falls in Older Patients). Current Gerontology and Geriatrics Research,2013. Doi. org/10.1155/2013/928603.
Nabeshima, A., Hagihara, A., Hayashi, K., Nabeshima, S. & Okochi, J. (2007). Identifying interacting predictors of falling among hospitalized elderly in Japan: A signal detection approach. Geriatrics Gerontology International, 7:160-166. doi: 10.1111/j.1447-0594.2007.00391.x
Rhalimi, M., Helou, R. & Jaeker, P. (2009). Medication Use and Increased Risk of fall in Hospitalized Elderly Patients: A Retrospective, Case-Control Study. Drugs Aging, 26(10): 847-852.
Sirkin, A.M. & Rosner, N.G. (2008). Hypertensive management in the elderly patient at risk for falls. Journal of the American Academy of Nurse Practitioners, 21:402-408. doi:10.1111/j.1745-7599.2009.00418.x
