Falls in Hospitals: Leading Causes and Prevention Strategies

Falls in the Elderly in the Hospital Setting: A Quality and Safety Issue

• Falls are “the second leading cause of accidental or unintentional injury deaths worldwide” (WHO, 2012, para. 1).
• In the US, 20-30% of falls in the elderly lead to injuries (WHO, 2012, para. 1).
• Falls in hospitals remains a very common occurrence: up to 60% of all reported incidents (McDonnell & Kerr, 2014, p. 17).
• Falls in hospitals lead to adverse psychological (primarily stress) and psychological outcomes for patients and healthcare professionals; they are costly for hospitals (Fitzpatrick et al., 2011).
• Key reasons for hospital falls lack of observation and faulty risk assessment (McDonnell & Kerr, 2014, p. 17).

Proposed Change

• Establishment of a continuous system of monitoring and improving safety with respect to falls in the elderly in the hospital environment.
• Key areas: fall risk assessment practices, environment improvement, training, and patient education training (Boltz, 2012; CDC, 2016; Fitzpatrick et al., 2011; McDonnell & Kerr, 2014).
• It is impossible to suggest a detailed plan without the involvement of the multidisciplinary team with their individual experiences and knowledge (Boltz, 2012, p. 291). The resulting program is to be customized.

Change Theory

• Organizational change is typically required for healthcare safety and quality improvement (Sutherland, 2013).
• The key aspect: managing the change (Cameron & Green, 2015; Sutherland, 2013).
• Kotter’s Eight Steps Model: a very popular change model (King & Gerard, 2013).

Change Model to Be Applied: Justification and Application

• The following steps constitute Kotter’s Eight Steps model (Cameron & Green, 2015, pp. 100-101).
• Establish a sense of urgency.”

  • A preliminary step.
  • Key role: allows realizing the need for change.
  • Involves the evaluation of the existing practices; defines if they are deficient.
  • It provides the basis for the rest of the change and thus is justified.
  • Tools: data gathering and its presentation in leaflets or posters; meetings.
  • Responsibility: volunteering members.
• Form a powerful guiding coalition.”

  • It provides the center for change management and thus is justified.
  • Tools: meetings of the interested members of the multidisciplinary community of the hospital, department, ward.
• “Create a vision.”

  • Provides the vision, mission, and strategy for the change; aligns it with the hospital’s mission, vision, and strategic goals.
  • It provides the plan for the change and thus is justified.
  • Tools: data gathering, knowledge development, meetings; surveys for stakeholder involvement is a possibility.
  • Responsibility: the coalition.
• “Communicate the vision.”

  • Highlights the importance of communication between stakeholders.
  • Ensures the dissemination of the plan and thus is justified.
  • Tools: leaflets, posters, meetings.
  • Responsibility: the coalition, managers, supervisors; ultimately: everyone.
• “Empower others to act on the vision.”

  • It requires providing tools and removing obstacles.
  • Involves communication with the stakeholders for ideas on implementation and complaints on obstacles.
  • Change cannot be carried out without empowerment. The step is justified.
  • Tools: a problem-reporting system; meetings, funding of the project.
  • Responsibility: the coalition (as decision-maker) and every stakeholder (reporting, suggesting, and implementing.
• “Plan for and create short-term wins.”

  • Presupposes advertising noticeable improvements and rewarding successful workers.
  • Necessary for motivation and thus is justified.
  • Tools: data gathering; rewards (can be monetary).
  • Responsibility: the coalition.
• “Consolidate improvements and produce still more change.”

  • Improvements are celebrated; problems are identified, reported, and eliminated.
  • Enables customization and sustainable improvement; thus, is justified.
  • Tools: a problem-reporting system; meetings, funding.
  • Responsibility: every stakeholder.
• Solidify the change

  • Solidify the resulting practices as the hospital’s policies.
  • Required for meaningful change. Justified.
  • Responsibility: coalition and management.

The Need for Change: Professional Collaboration

The first step establishes the need for change via professional communication and collaboration in data gathering, analysis, and dissemination.

Aligning the Model: Mission, Vision, and Values

• Step three is specifically concerned with the hospital’s mission, vision, and strategic goals.
• Required to ensure the integrity of change and the appropriateness of outcomes.

Aligning the Model: Collaboration and Change Customization

• The steps one and three are based on customization.
• Steps four-seven involve further customization.

Applying the Model: Professional Collaboration of the Multidisciplinary Team

• Communication and collaboration are required throughout the change.
• Collaboration is needed between the disciplines: falls are affected by medications, environment, supervision, education, and training (Fitzpatrick et al., 2011).

Dissemination Strategy and Justification

• Continuous dissemination of information is required for Kotter’s Model.
• Dissemination is to be involved at different stages of the project, and the strategies can be multiple depending on the purpose.
• For the final plan, awareness and understanding are to be raised with the help of meetings, discussions, and learning.
• After the initial success, action research can be carried out, and an article about it can be published.

Proposed Budget

• The plan requires minimum funding, but the majority of costs are unclear at the moment. The detailed budget is to be developed during stage three.
• Posters and leaflets are likely to require funding. Internet research shows that it is possible to buy good-quality posters for $30 per unit; brochures can be purchased for $80. Depending on the quantity, store, and specifics of the order, the price can change.
• Incentives. Depending on the efforts required of the coalition members, they can be working as volunteers or not.
• Training. Depending on the training program chosen, funding may be needed.
• Rewards. It can be monetary or not, token (for example, writing tools) or more significant and costly.
• New equipment might be required for environmental improvement (Fitzpatrick et al., 2011). However, it is impossible to predict their costs at the moment.

Desired Outcomes

• The desired outcome is a practically implemented model for a sustainable improvement of safety and quality in the field of falls in the elderly in hospital settings.
• Key aspects: the practices of risk assessment, continuous improvement of the environment, and training and patient education training programs.

References

Boltz, M. (2012). Evidence-based geriatric nursing protocols for best practice. New York: Springer Publishing.

Cameron, E. & Green, M. (2015). Making sense of change management. London: Kogan Page.

CDC. (2016). Older Adult Falls. Web.

Fitzpatrick, M.A., Jorgensen, J., Forte, J., Kulik, C., Payson, C., Currier, A.,…Cardente, R. (2011). Special supplement to American Nurse Today – best practices for falls reduction: A practical guide. American Nurse Today, 6(3). Web.

King, C. & Gerard, S. (2013). Clinical nurse leader certification review. New York, N.Y.: Springer Publishing.

McDonnell, T. & Kerr, A. (2014). Interventions to prevent falls in an inpatient hospital setting. Age And Ageing, 43(1), 17. Web.

Sutherland, K. (2013). Applying Lewin’s change management theory to the implementation of bar-coded medication administration. Canadian Journal of Nursing Informatics, 8(1-2), 1-6. Web.

WHO. (2012). Falls. Web.