As an individual grows older, neuromuscular deficits become a reality and may affect the physical performance leading to increased dangers of falls, especially in the hospital environment. According to the Center for Disease Control, the number of older adult falls in the US alone was 46 million in the year 2014 and is projected to increase to 74 million by the year 2030 if hospitals do not improve on their fall prevention programs (Carande-Kulis, Stevens, Florence, Beattie, & Arias, 2015).
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The most common intrinsic risk factors such as lowered physical strength, reduced ability to balance, and general decline in cognitive capacity affect the elders and often result in falls. The slip and trip falls prevention program proposed at the Bartow Regional Medical Center concentrates on improving balance, cognition, self-efficacy, and psychosocial well-being of the old patients in the hospital.
Since most falls for elderly patients are caused by interaction with internal and external risk factors, it is important to draw an intervention list that addresses these factors. Among the notable risk factors that this intervention plan intends to address are lower body weaknesses, poor vision, challenges in maintaining balance, effects of using psychoactive medication, and hospital hazards.
Addressing lower body weakness
It is important for the Bartow Regional Medical Center to consider close and constant supervision of the elderly patients by providing equipment that can support them whenever they want to make any movement. According to Carande-Kulis et al., (2015), simple equipment such as walking stick or scratches would reduce fall injuries in old patients by up to 60%. For instance, the hospital makes draw a policy of proactive equipping the environment where elderly patients are with such equipment. In order to make this policy more effective, there is need to assign full time nurses to physically monitor how the elderly patients are using such equipment to minimize cases of human errors.
Addressing poor vision
It is necessary for the Bartow Regional Medical Center to create a policy for proper lighting of all areas or rooms that elderly patients are visiting or staying in. Proper lighting of areas within the hospital visited or occupied by elderly patient may significantly reduce the number of falls (Bongue, Hugues, Achour, Colvez, & Sass, 2016). Proper lighting should be accompanied by vision aiding equipment on a necessity basis. Despite being a simple intervention mechanism, lighting of rooms occupied by elderly patients has the potential of reducing the number of injuries from such falls.
Addressing the challenge in maintaining balance
The Bartow Regional Medical Center should develop a policy for aiding elderly patients in moving around because of their challenge of maintaining balance in movement. It is necessary for the policy to integrate the important aspects of exercise for the elderly patients to improve on their balance, especially for the patients who can walk on their own or with minimal support (Singh & Okeke, 2016). For instance, the hospital should integrate the static steady-state balance through tandem stance, bipedal stance, and monopedal stance among others. During the exercise, it is necessary to monitor progression and variation to ensure that muscle power training is promoting proactive and reactive balance (Fuzhong, 2016).
Addressing the effects of using psychoactive medication
Psychoactive medication is known to cause dizziness or compromise cognitive capacity of a patient, especially elderly person. Adopting safety standards such as fitting movement detection alarms in rooms occupied by these patients, providing physical support through on-site nurse, and scheduling the medication to ensure that their effects are felt when the client is sleeping (Fuzhong, Harmer, & Fitzgerald, 2016). It is also necessary to monitor the behavior of the patients taking these medications to avoid preventable instance of falls as a result of uneasiness.
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Addressing hospital hazards
There are several hospital hazards that may result in the fall of elderly patients. Among the notable hazards there are slippery floors, lack of stair hand rails in some areas accessed by old patients, poorly placed bathroom grabs, uneven surfaces such as stairs with no clear marking, and unguided use of assistive equipment. Improvement of the physical environment in a hospital would help to prevent frequent falls and injuries from such incidences by a large margin and reduce the potential cost to such a hospital (Danielsen, Olofsen, & Bremdal, 2016).
For instance, installing proper and visible stand hand rails, bathroom grabs and visible staircases would reduce incidences of fall among elderly patients. In addition, proper training on the use of assistive devises would significantly reduce the number of falls.
The basic resources that would be needed to affect this fall awareness program include training videos, fall prevention systems, awareness posters, whiteboard, notebooks, pens, and projector. Besides, there is need to hire training personnel.
Items Needed to Initiate and Keep the Program Running
The items needed to initiate and keep the program running are policy statement, clear framework for duty and responsibility allocation, systematic fall evaluation schedule, post-training response plan, inspection checklist, and hospital environment standards/ corrective maintenance procedures. The checklist will include important elements to track and record changes that are made in relation to the hospital hazards mentioned before. The duty and responsibility evaluation plan will review elements such as communication, proactive training progress, tracking irregularities and regularities, and systematic maintenance of progress that has been made. In addition, it would be prudent to include posters and illustrators as a form of direct communication with the elderly patients.
Estimated Cost of the Program
Though the program is comprehensive, the actual cost attached to its implementation is relatively affordable, considering the benefits that the hospital might gain if adopted. The table 1 below summarizes the cost implications of implementing the proposed program.
|Direct training and exercise of patients||$50 per patient* 200 ($10,000)||Physical training and evaluation targeting 200 patients|
|Equipment||$50,000||Scratches, sticks and other assistive equipment targeting 200 patients at a time.|
|Posters, lighting, and environmental improvement||$10,000||Supporting the program implementation|
|Direct training cost||$5,000||Hiring training personnel, posters, notebooks, and other seminar requirement|
|Progress tracking||$1,000||To accommodate modifications that might be necessary.|
|Miscellaneous||$2,000||To take care of other potential hidden costs|
Benefits or Outcome/Goals of the Program
The potential benefits that the hospital will directly and indirectly gain from implementation of the proposed fall prevention program include reduced legal cases, improved patient environment, increased client admission, and compliance with the global fall prevention strategies. The benefits of the program are summarized in the table 2 below.
|Reduced costs from legal cases||Reduced expenditure from direct compensation of injured patients||Better insurance rating as a result of reduced claims.|
|Improved patient environment||Promotion of well-being of the hospital and the patients||Reduced costs of equipment and administration|
|Compliance with the global fall prevention strategies||Improved hospital rating at local and regional levels.||ISO certification in line with the set government and global fall prevention standards|
Bongue, B., Hugues, J., Achour, E., Colvez, A., & Sass, C. (2016). Improving fall prevention in the elderly. Europe PMC, 21(120), 24-29.
Carande-Kulis, V., Stevens, J., Florence, C., Beattie, B., & Arias, I. (2015). A cost- benefit analysis of three older adult fall prevention interventions. Journal of Safety Research, 52(9), 65-70.
Danielsen, A., Olofsen, H., & Bremdal, A. (2016). Increasing fall risk awareness using wearables: A fall risk awareness protocol, Journal of Biomedical Informatics, 63(9), 184-198.
Fuzhong, L. (2016). The public health benefits of Tai Ji Quan-Addressing the unmet needs of aging populations in the 21st century. Journal of Sport and Health Science, 5(3), 304-321.
Fuzhong, L., Harmer, P., & Fitzgerald, K. (2016). Implementing an evidence-based fall prevention intervention in community senior centers. American Journal of Public Health, 106(11), 2001-2026.
Singh, I., & Okeke, J. (2016). Reducing inpatient falls in a 100% single room elderly care environment: evaluation of the impact of a systematic nurse training program on falls risk assessment (FRA). BMJ Open Quality Journal, 3(19), 89- 102.