Discussion of the Practice
The risk of falling in people after 65 is a significant concern in healthcare practice. Since the issue is omnipresent and exposes numerous older patients to injuries due to falling, it is imperative to find an effective solution and ensure valid preventative measures application. Many research studies, preventative plans, and programs have been developed, tried, and implemented over the years in both community-based and hospital settings to minimize falls in the elderly.
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The Agency for Healthcare Research and Quality (AHRQ) has introduced an On-time Falls Prevention program aimed at providing all necessary theoretical and practical implications for helping patients mitigate falling risks in a nursing home setting (“AHRQ’s safety program for nursing homes: On-time falls prevention,” 2017). According to the program, nursing homes need to be equipped with electronic medical record-based tools for continuous monitoring of patients’ falling risks.
On-time Falls Prevention was developed on the basis of the information collected by healthcare professionals who observed patterns and risk factors of falls in older patients. The overall implementation of the program is carried out through a system of multidisciplinary measures based on four regular electronic reports about resident fall incidents, risk factors, pre-fall, and post-fall conditions (“AHRQ’s safety program for nursing homes: On-time falls prevention,” 2017).
Such reports are used as a foundation for proactive preventative measures implementation. Apart from the reports samples, healthcare workers are provided with materials contained in the self-assessment worksheet for falls prevention. In addition, the program ensures continuous support of a facilitator throughout the nurses’ training process.
Practice Implementation Assessment
The identified program is being implemented in nursing homes for its target population. The fall prevention program is carried out through a set of thoroughly defined steps with particular goals set forward. The staff of a nursing home is guided by a facilitator and uses a self-assessment worksheet for falls prevention to identify the currently used methods of detecting patients with high risks of falling. Then the staff implements the electronic tools and creates reports to register the observations on a day-to-day basis (“AHRQ’s safety program for nursing homes: On-time falls prevention,” 2017).
It takes a long time to get acquainted with the program specifications, complete self-assessment, and utilize the reports. Ultimately, the development of preventative measures is being postponed. Moreover, it was determined that psychological features and the overall fear of falling contribute to the risks of falling (Young & Williams, 2015). The program does not specifically identify psychological issues as a way of measures development. Also, the reports are based on generalized data concerning the risk factors and provide the foundation for the application of standardized fall prevention strategies.
However, the implementation of the program is characterized by positive aspects. As Casey et al. (2017) state, only the development of multifactorial interventions involving diverse stakeholders might guarantee the effectiveness of preventative measures. In this regard, AHRQ’s safety program provides a solid background engaging different specialists in the process of creating useful safety measures on the basis of multiple factors. The electronic framework only facilitates the process of data analysis and application validation. Nonetheless, the smooth implementation of the program into practice requires overcoming some significant obstacles.
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As any other program aimed at fall prevention in older patients, the On-time Falls Prevention program has its barriers to practice implementation. As Li et al. (2016) emphasize, the obstacles in the way of evidence-based practice implementation of fall prevention include “lack of evidence of the transferability of efficacy trial results to clinical and community settings, insufficient local expertise to roll out community exercise programs, and inadequate infrastructure to integrate evidence-based programs” (p. 425).
The elimination of such general-scale obstacles, as well as more specific ones, is the basis of ensuring older patients’ safety. Indeed, the problems with the ultimate integration of research findings into practice due to the barriers imply continuous exposure of home-dwelling and hospitalized patients after 65 to injuries, immobility, or death (Pinzon et al., 2019). Therefore, it is crucial to identify specific barriers to program implementation into practice.
AHRQ’s safety program implementation might encounter a problem of the limited positive outcomes number due to the generalized measures developed on the basis of multiple risk factor observations. The electronic reports allow for collecting a sufficient amount of data; however, they fail to provide specific measures for a particular patient. Indeed, the individual differences concerning patients’ physical parameters, mobility level, and other particularities are not significantly concerned in the process of preventative measures development. Furthermore, it was found that culture-specific features are great contributors to fall prevention measures’ effectiveness (Pinzon et al., 2019).
Since the On-time Falls Prevention program does not explicitly address the cultural issues, the multicultural population might be an obstacle to its implementation in practice. Also, budgeting might be a barrier to the practical application of the planned intervention due to the training and equipping costs. Therefore, it is important to find ways of overcoming the identified barriers to achieve the most beneficial results.
Proposed Ways to Overcome the Barriers
In order to deal with the problem of generalized preventative measures, it is important to encourage patient-centered interventions where the needs of a particular individual will be the basis for prevention application. According to the study carried out by Ory et al. (2015), older patients are very likely to drop out of standardized practices, which leads to the diminished quality of results. It is implied that standard procedures might not be equally effective for all patients. Therefore, the program must be diversified on the basis of cultural particularities, age differences, and physical features to provide better patient outcomes. As for the problem of the costs, it might be overcome by means of attracting funds from diverse stakeholders and sponsors. It is vital to raise awareness about the issue of fall risks in the elderly to ensure sufficient budgeting on both national and local levels.
Resources to Inform Translation
Conclusively, the translation from theoretical evidence-based research to practice in a community or hospital setting requires specific materials and tools. AHRQ presents a set of resources aimed at helping staff and stakeholders in their attempts to integrate the program into practice. The resources include the description of the four electronic reports with samples, a menu of implementation strategies, self-assessment worksheet, and implementation steps and timeline (“AHRQ’s safety program for nursing homes: On-time falls prevention,” 2017).
Also, the organization’s website introduces facilitator training materials aimed at helping the healthcare units manage their staff in the process of the program implementation. As an additional resource, a functional specifications file is presented to discuss all issues concerning the process, goals, and overall practical implications of the proposed program. Overall, the analyzed fall prevention program is a valid, evidence-based measure, which might bring significant results in fall reduction among patients older than 65 if the barriers are successfully overcome.
Casey, C. M., Parker, E. M., Winkler, G., Liu, X., Lambert. G. H., & Eckstrom. E. (2017). Lessons learned from implementing CDC’s STEADI falls prevention algorithm in primary care. The Gerontologist, 57(4), 787–796.
Li, F., Eckstrom, E., Harmer, P., Fitzgerald, K., Voit, J., & Cameron, K. E. (2016). The Journal of the American Geriatrics Society, 64(2), 425-431.
Ory, M. G., Smith, M. L., Parker, E. M., Jiang, L. Chen, S., Wilson, A. D., … Lee, R. (2015). Fall prevention in community settings: results from implementing Tai Chi: Moving for Better Balance in three states. Frontiers in Public Health, 2, article 258, 1-6.
Pinzon, M. M., Myers, S., Jacobs, E. A., Ohly, S., Bonet-Vázquez, M., Villa, M., … Mahoney, J. (2019). “Pisando Fuerte”: An evidence-based falls prevention program for Hispanic/Latinos older adults: Results of an implementation trial. BMC Geriatrics, 19(258), 1-12.
Young, W. R., & Williams, A. M. (2015). How fear of falling can increase fall-risk in older adults: Applying psychological theory to practical observations. Gait & Posture 41(1), 7-12.