The number of patient falls has increased tremendously over the past few decades leading to high costs of healthcare. Finlayson, Peterson, and Matsuda (2014) argue that falls not only compromise the quality and inflate the cost of healthcare. Therefore, a sound program intended to reduce patient falls is needed. The implementation of such a program would be a great milestone in the improvement of care and the reduction of costs. Nurses are expected to avoid budget deficits. The introduction of a Fall Prevention Program in the orthopedic unit will reduce the problem of cost overruns and improve the quality of healthcare.
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Change Model Overview
The evidence presented in this paper revolves around the John Hopkins Nursing Evidence-Based Practice Process (JHNEBP). The JHNEBP offers nurses the necessary support and training to facilitate research as a way of promoting the use of evidence-based practices in health care (Finlayson et al., 2014). The model is based on three major steps termed as PET, which represents practice question, evidence, and translation.
Step 1: Recruit Inter-professional Team
The first step in the implementation of the program will revolve around establishing a team of professionals that will assist in research to support the program. The author of this paper shall assume the role of the team leader, which will involve guiding the team members through the process of conducting the relevant research as well as overseeing the implementation of the program. The team shall be comprised of Registered Nurses drawn from a cross-section of the American orthopedic unit nurses.
Step 2: Develop and Refine the EBP Question
This paper proposes the implementation of a fall prevention program in the orthopedic unit with a view of extirpating patient falls. The program shall be guided by the hypothesis that the implementation of a fall prevention program within the orthopedic unit will reduce the overall healthcare costs. The program is better understood through the PICO analysis described hereafter:
Patient refers to the population or the participants of a study conducted to investigate a certain scenario. The author shall conduct a research to investigate the effectiveness of the proposed program in averting falls among patients from the unit. The study population shall be recruited from a cross-section of patients admitted to the orthopedic unit across the US hospitals. The participants shall be inpatients.
Intervention refers to the strategies adopted by the concerned group to mitigate an identified problem. For the purpose of this paper, the first strategy centers on increasing the number of nurses to seal the gap in the healthcare sector. The second strategy involves increasing the number of daily ward rounds to facilitate patient monitoring with a view of reducing falls. Lastly, the paper recommends the placing of the patients’ gadgets close to their beds to facilitate easy access. Research indicates that most fall cases result from the wrong placing of the patient’s items (Stevens, Mack, Paulozzi, & Ballesteros, 2008).
C- (Comparison with other treatment/current practice)
One of the strategies employed by the contemporary nurses in mitigating falls is the creation of rough floors in the wards. The strategy is informed by the view that the slippery floors are to blame for the increased number of falls. Next, patient education has grown tremendously with nurses offering free training to the patients about fall prevention. However, the listed fall prevention strategies are ineffective as evidenced by the increasing trend in the number of patient falls. Research indicates that about 25,000 of the elderly people die annually due to injuries caused by falls (Finlayson et al., 2014). The figure is illustrative of the ineffectiveness of the contemporary fall prevention programs.
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O- (Desired outcome)
The primary objective of this strategy is to reduce the number of patients’ fall from the current daily 50 persons to about six per day. The highlighted list of mitigation measures will help achieve that objective in the next 6 months following its implementation. The secondary objective is to reduce the overall cost of health against the backdrop of the intensified campaigns by the government agencies for nurses to adopt EBPs to cut healthcare costs.
Step 3: Define the Scope of the EBP
Patient fall is one of the leading causes of death among the elderly population. Statistics indicate that about 20% of the falls result in broken bones or serious head injuries (Hauer, Lamb, Jorstad, Todd, & Becker, 2006). Such injuries cost the US government about $34 billion annually in the treatment of fall victims. Research further indicates that about 2.5 million older people are treated in emergency units due to falls (Wilson et al., 2016). One of the reasons that lead to increased number of annual falls is the lack of proper monitoring of the inpatients. Monitoring of patients would go a long way in extirpating the problem since nurses would identify the various causes of such falls and mitigate them before their occurrence.
Steps 4 and 5: Determine Responsibility of Team Members
The team members shall work collaboratively to gather evidence that supports the implementation of the proposed strategies. The group shall seek to gather enough evidence to substantiate the proposed new methods for the prevention of falls. Additionally, the group shall support each strategy with the evidence available in the currently available literature.
Steps 6 and 7: Conduct Internal/ External Search for Evidence and Appraisal of Evidence
The available literature supports the adverse effects of patient falls. The articles used to inform this program were obtained from different healthcare databases such as Medline, Alternative Health Watch, Cochrane Database of Systematic Reviews, and Cumulative Index to Nursing and Allied Healthcare among others. The listed databases contain articles describing different evidence-based nursing practices.
Steps 8 and 9: Summarize the Evidence
Hauer et al. (2006) argue that patient falls often lead to injuries to the concerned patients, which may lead to death. The authors claim that for cost reduction to be achieved, strict measures are needed to support the prevention of patient falls. Hauer et al. (2006) explore the current measures for falls prevention and dispute the effectiveness in achieving the intended purpose. The authors propose the hiring of more health workers to facilitate patient monitoring. Lea et al. (2012) explore the effects of falls and the ways of preventing them. The authors link falls to the current huge costs of health in the US. Wilson et al. (2016) argue that falls are a major cause of injuries and deaths among the hospitalized patients.
Step 10: Develop Recommendations for Change Based on Evidence
Kalula, Scott, Dowd, and Brodrick (2011) argue that the current shortage of healthcare professionals largely contributes to the rising cases of patient falls owing to the gaps in patient monitoring. To seal this gap, the government needs to hire more healthcare professionals to facilitate frequent monitoring of the patients. The nurses would help in detecting an imminent danger and avert it in time before it happens. Next, nurses need to be encouraged to conduct both quantitative and qualitative research works to promote evidence-based practices. The government should implement a continuous nurse-training program to further the education for the practicing nurses.
Steps 11, 12, and 13, 14: Action Plan
The implementation of this program is set to take place in two phases. The first phase will target the unit whereby the team will seek to eliminate falls in the department alone. The pilot program will be implemented exclusively in three major hospitals in the US. The pilot study is expected to take about 6 months. The success of this phase will inform the implementation of the strategies in the other departments.
Steps 15 and 16: Evaluating Outcomes and Reporting Outcomes
The main objective of this program is to reduce the number of patient falls and reduce the cost of health in the long-term. The effectiveness of the program will be appraised through assessing the number of monthly falls while the program is running. The assessment results will be reported to the stakeholders through internal memos and the publication of the results on the Internet.
Steps 17: Identify Next Steps
The pilot program will inform the team members on whether to implement the program to other facilities and departments in the long-term. If the program lowers the number of the falls victims in the selected hospitals, the team will recommend its implementation to other facilities across the US. To ensure that the nurses embrace the program, the team members will offer education about the importance of the program to the entire nursing fraternity.
Step 18: Disseminate Findings
The findings from the research will be communicated to the relevant stakeholders using two types of tools namely an internal memo and a journal. The internal memo will be used to communicate the findings to the nurses while the journal publication will relay the same to the external stakeholders. A journal will be prepared and posted on the Internet for the external stakeholders to review the findings.
Patient falls is one of the leading causes of injuries and death among patients. The current mitigation strategies are ineffective apparently owing to the shortage of nurses. This paper proposes the implementation of a fall prevention strategy based on three measures namely frequent patient monitoring, right placement of the patients’ items, and the establishment of homecare-based treatment.
Finlayson, M., Peterson, E., & Matsuda, N. (2014). Participation as an outcome in multiple sclerosis falls-prevention research: consensus recommendation from the international MS falls prevention research network. International Journal of MS Care, 16(4), 171-177.
Hauer, K., Lamb, S. E., Jorstad, E., Todd, C., & Becker, C. (2006). Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age and Ageing, 35(1), 5-10.
Kalula, S. Z., Scott, V., Dowd, A., & Brodrick, K. (2011). Falls and fall prevention programmes in developing countries: environmental scan for the adaptation of the Canadian falls prevention curriculum for developing countries. Journal of Safety Research, 42(6), 461-472.
Lea, E., Andrews, S., Hill, K., Haines, T., Nitz, J., Haralambous, B.,…Robinson, A. (2012). Beyond the ‘tick and flick’: facilitating best practice falls prevention through an action research approach. Journal of Clinical Nursing, 21(14), 1896-1905.
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Stevens, J., Mack, K., Paulozzi, L., & Ballesteros, M. (2008). Self-reported falls and fall-related injuries among persons aged>= 65 years–United States, 2006. Journal of Safety Research, 39(3), 345-49.
Wilson, S., Montie, M., Conlon, P., Reynolds, A., Ripley, R., & Titler, G. (2016). Nurses’ perceptions of implementing fall prevention interventions to mitigate patient-specific fall risk factors. Western Journal of Nursing Research, 4(7), 105-116.