Falls among older patients is a common and severe healthcare practice challenge with complex consequences for the population. The challenge is a crucial practice issue in the context of elderly individuals because the increased incidence of falls is often combined with the increased susceptibility to injury after falls (Abraham & Cimino-Fiallos, 2021). Therefore, the increased likelihood of the elderly to experience falls results in the increased occurrence of accompanying conditions.
More than 30% of individuals over the age of 65 years fall each ear, and in half of the cases, the falls are repeated (Sharif et al., 2018). As a result, one in ten falls leads to severe consequences such as hip and other fractures, traumatic brain injury, and subdural hematoma (Abraham & Cimino-Fiallos, 2021). Importantly, regardless of older individuals’ overall health status, falls are linked to lower mobility, limited capability to perform various everyday activities, as well as increased risks of being admitted to a nursing home. Thus, it is imperative to develop an evidence-based solution to address the practice problem of risks among older patients and facilitate an improved quality of life for the defined target population. The current quality improvement project will focus on fall reduction among elderly patients within a Medical-Surgical (MS) unit.
Analysis of Evidence
Scholars have extensively studied the issue of falls among older adults because they represent one of the main causes of the elderly’s disability and morbidity. Falls constitute the second-leading cause of unintentional deaths after road-traffic incidents (Alshammari et al., 2018). Individuals are more likely to experience falls if they suffer from gait impairment. The more severe the impairment is, the higher is the likelihood of an older person suffering a fall (Talarska et al., 2017).
For instance, in osteoporosis patients, the management and prevention of falls should include not only bone-strengthening but also an increased focus on individuals’ muscle function and balance, which are closely related to the disease (Dionyssiotis et al., 2014). In addition, it is notable that the higher rates of fall occurrence are among individuals with walkers than those with other walking aids as 72.5% of the elderly who use them had a history of falls (Dionyssiotis et al., 2014).
It should be noted that the history of falls among the target group has shown to be strongly related to issues associated with movement, medication side effects, poor vision, mental impairment, consistent pain, as well as environmental dangers that impact the functioning of different joints (Talarska et al., 2017). It was also found that chronic conditions that reduce older adults’ health outcomes contribute to the increased risks of falls (Dionyssiotis et al., 2014). Polypharmacy, which is characterized as taking more than five different medications daily (Masnoon et al., 20176), also increases the risks of falls among elderly individuals.
When a healthcare team in a medical-surgical unit is tasked with treating older patients, they must assess the risks of falls using evidence-based measurement tools to prevent the events from occurring. According to Park (2018), using a combination of several tools, such as the Berg Balance Scale and Mobility Interaction Fall chart. Different tools are needed for measurement because falls among elderly patients occur due to different risk factors, which maximize the benefits of each measurement for predicting fall occurrence. Therefore, fall prevention in elderly adults is a complex and multi-faceted healthcare practice problem that requires quality improvement steps to be implemented consistently and effectively in order to alleviate the burden on patients and their health providers.
Quality Improvement Process
A comprehensive and multi-dimensional evidence-based quality improvement program is necessary to implement within the primary care healthcare setting to prevent falls and fall-related injuries in the elderly. The quality improvement plan entails the special responsibility of a Clinical Nurse Leader (CNL) to establish a diverse team to work together to reduce the rates of falls in an MS unit. The plan’s purpose is increasing the days lasting between the instances of patient falls by improving the effectiveness of the intentional processes of rounding and catering to patients’ needs.
The suggested plan of intervention is concerned with testing the success of the intentional rounding process through patient interviews and direct staff observations. It is expected to facilitate an environment of safety within the MS setting and prevent injuries from the occurrence of fall events. The role of the CNL is essential because they will complete a comprehensive microsystem assessment to identify the quality gap in the care processes that results in patient fall events. The rationale for the recommended quality improvement program is concerned with the possibility to integrate the entire team, ranging from shift nurses to hospital leadership, to collaborate and facilitate change implementation.
Using the Institute for Healthcare Improvement (IHI) Model of Improvement, it is possible for the diverse team involved in the care processes to point out main fall causes. A plan-do-study-act cycle (PDSA) will be used for testing changes in the unit to improve fall rates (Park, 2018).
Relevant steps include measuring the current rates of falls, evaluating causes and risk factors, implementing problem-specific solutions, as well as maintaining improvements. Specifically, the MS unit team will develop informative posters that will remind patients to ask for assistance before going out of their wards to use facilities. A daily monitoring tool will aid in capturing the usefulness of the informative poster in raising elderly patients’ awareness of falls and considering calling for help if they are not confident about their capacity to avoid falling on their own.
To monitor the effectiveness of the proposed quality improvement measures, several measures should be monitored. The data to be collected during the quality improvement program includes baseline and current falls data obtained from facility quality databases and patient chart reviews. Pre- and post-intervention outcome measures will be compared to determine whether the rates of falls have lowered. In addition, the number of days between the cases of fall occurrence in elderly patients will be measured.
Summary
To conclude, falls among the elderly is a healthcare practice issue that reduces the target population’s quality of life while also increasing the burden of care for healthcare providers. The research on falls among elderly individuals showed that the presence of accompanying conditions and co-morbidities increase the risk of falls. In addition, age-related factors such as reduced bone strength or poor vision contribute to falls occurrence. In an MS setting, it is recommended to implement a quality improvement initiative to combine standardized rounding, interprofessional team collaboration, and patient education. It is expected to enhance patients’ experience in the care setting while also allowing the team to carry out their duties effectively.
References
Abraham, M., & Cimino-Fiallos, N. (2021). Falls in the elderly: Causes, injuries, and management. Web.
Alshammari, S. A., Alhassan, A. M., Aldawsari, M. A., Bazuhair, F. O., Alotaibi, F. K., Aldakhil, A. A., & Abdulfattah, F. W. (2018). Falls among elderly and its relation with their health problems and surrounding environmental factors in Riyadh. Journal of Family & Community Medicine, 25(1), 29-34. Web.
Dionyssiotis, Y., Skarantavos, G., & Papagelopoulos, P. (2014). Modern rehabilitation in osteoporosis, falls, and fractures. Clinical medicine insights. Arthritis and Musculoskeletal Disorders, 7, 33-40.
Masnoon, N., Shakib, S., Kalisch-Ellett, L., & Caughey, G. E. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics, 17(1), 230. Web.
Park S. H. (2018). Tools for assessing fall risk in the elderly: A systematic review and meta-analysis. Aging Clinical and Experimental Research, 30(1), 1-16. Web.
Sharif, S., Al-Habri, A., Al-Shihabi, A., Al-Daour, S., & Sharif, R. (2018). Falls in the elderly: assessment of prevalence and risk factors. Pharmacy Practice, 16(3). Web.
Talarska, D., Strugala, M., Szewczyczak, M., Tobis, S., Michalak, M., Wroblewska, I., & Wieczorowska-Tobis, K. (2017). Is independence of older adults safe considering the risk of falls? BMC Geriatrics, 66. Web.