Reducing Fall in a Nursing Home in Crete, Illinois
Introduction
A fall is an event in which one unintentionally comes to the ground, not due to a push or an intrinsic event, i.e., a stroke. The old guys are adversely affected by unintentional falls. As such, their life is highly at threat, since fall affects the senior population’s independence and quality of life. Fall often signals the ‘beginning of a new end’ of an older person’s life. With the fear of falling, the senior population often restrict their movement. Sadly, this weakens muscle strength, which is an attributing factor of falling (Tricco, Thomas, Veroniki, Hamid, Cogo, Strifler & Riva, 2017).
This paper focuses on quality management initiatives to reduce falls in a Nursing Home in Crete, Illinois. Through the research findings, it will assist in achieving quality improvements along with clinical goals, thus making this report both timely and professionally important.
Problem statement
Falling is the leading cause of injury and even death in adults over the age of 65 years. Nonetheless, 24% of those who fall sustain significant injuries, and 6% of those who fall get fractures(Pahor, 2019). When we talk about cost, the US government department of health, falls had cost them more than $19 billion as of the year 2000, and the number is expected to increase to around $54.9 billion as of 2020 (Melin, 2018). When a person falls, they may, in due course, experience pain, admission to a nursing home, hospitalization, require surgical intervention, decreased overall functionality, poor quality of life, or even have a fear of falling (Quigley, Barnett, Bulat, & Friedman, 2016). While addressing this problem, the researcher will use evidence-based management to show that it has a practical benefit for older hospitalized patients with injury-related admissions and at Crete Nursing Home. Thus, providing proven guidance in connection with in-hospital prevention and management of patient falls.
State of the situation
Figure 1: The data is derived from the percentage of inpatients falls Vs. Overnight bed days for six months.
Areas contributing to the problem.
The likelihood of one falling can be categorized based on two risk factors. Thus be either extrinsic(external to the individual) or intrinsic(within the person) -age-related physiologic changes(Melin, 2018).
Intrinsic Extrinsic
Intrinsic Extrinsic
Age-related changes Footwear
Acute illness Medication
Cognitive deficits Supports from caregivers
Chronic conditions Home/neighbourhood features
Behaviours/Choices Assistive devices
Gait, strength, or balance deficits
Table 1: Interaction between the intrinsic and extrinsic leads to falls, in which these factors may be combated with proper interventions.
Table 2: The table shows some physiological changes that increases the chances of one falling.
Organ System Physiologic change
Nervous System
Balance Slowed righting reflexes
Increased postural sway
Gait Decreased proprioception
Decreased step height
Muscular system Decreased muscle strength
Vision Thickening and loss of elasticity of the lens
Reducing papillary response to light variation
Proposed a solution
Though there is little data to support better fall prevention practices, multi-component and comprehensive strategies are highly recommended (Pahor, 2019).Some of the strategies include ongoing surveillance, intermediate and distal outcome measures to capture the effects on patients, clear delineation of proximal, clear documentation of the environment, healthcare costs, and social costs (Gray-Miceli, Mazzia, & Crane, 2017). Implementation of universal strategies such as frequent patient contact, support toileting assistance and hydration, non-skid footwear and limited use of restraints(Quigley et al., 2016). In the same context, nursing procedures can also be introduced to reduce the number of falls at the nursing home, i.e., use of reminder/education signs while entering the patient’s rooms and use bracelets or armband identification patients risk.
The resource to implement the proposed solution
This report proposes implementing a multidisciplinary, multidimensional approach i.e., developing a fall prevention program(FPP). The development of FPP includes purchasing of hi-lo beds to reduce the distance of potential falls, an ergonomic patient chair that will ensure patients or older adults have greater security when out of bed, electronic alarm mats which will be used to alert the staff when a high-risk patient is out of bed, removal of neutral colored shower curtains with brighter one for the visually impaired, modification of patients bathroom, i.e., removal of foot-stools from the bathroom, increasing staff level in wards with high-risk patients, adding patient walking aids, creating posters and newsletter articles and development of the flagging system – ID bracelets which will be given to high-risk patients or the older people, pharmacy alert system and Electronic Health Management Information System(EHMIS).
Costs Benefit Analysis
At Crete nursing home, it is estimated at least 1800 in patients falls within a year. The medical cost of falls is estimated to be $7000 per patient receiving multiple falls. With the FPP program, it is estimated that 40% of inpatient costs related to falling will reduce the medical cost. The researcher will use this data to calculate the cost-benefit analysis of the FPP program.
Items Details Program Cost
High- lo beds 20 @ $ 1100 22,000
Ergonomic patient chair 45 @ $ 900 40,500
Electronic alarm mart 40 @ $ 8,200 328,000
Development of flagging system eHMIS @ $30,000
ID bracelets 500 @ $250
Pharmacy alert System @ $12,000 54,500
Brighter Curtains 25 @ $ 80 2,000
Patient walking aids 80 @ $10,000 80,0000
Removal of foot-stool $500 500
Recruiting additional nurses 4 additional nurses @ $5,400 per month 21,600
Posters and Newsletter $5000 5,000
Staff awareness program -Promotions campaign @ $20,000
-Staff development @ $100,000 120,000
Total $ 674,100
Table 3: Estimated cost to be incurred while developing the FPP program
Benefit Estimated net FPP savings and ROI
40% reduction of the medical incurred through falling Medical cost 1800 patients: (1800 *7000) = $12,600,000
Benefit = 12,600,000 – $ 674,100 * 0.4 =$ 4,770,000 per year
Total $ 4,770,000 per year or $2 return for each US dollar spent
Table 4: Estimated benefit of the FPP program for 1800 patients.
Timeline
Figure 2: FPP development stages
Engagement with Stakeholders
During the FPP program development, the office of Quality Risk Management (QRM)was involved; the office operates under the manager’s support service’s delegated authority. The QRM provided management decision which aided in creating cost-benefit analysis. The Director of nursing, which works in unison with the Quality/Risk Management Coordinator of the Crete nursing home and the clinicians, will work together to ensure the adoption of FPP and all risk management protocols are adhered to at the point of service.
Implementation and Evaluation of the FPP program
The FPP will be rolled out in stages, from stage 1 to stage 3, as shown in Figure 2. The main way in which FPP will be evaluated is through monitoring clinical indicators data from the time it will be rolled out. This will be done using the eHMIS for satisfactory reporting. eHMIS will be used for monitoring the data according to overnight bed days; this will provide a clear picture of the quality of improvement. The system can identify the patient and also those involved in an incident. By doing so, it will give a clear description of the event. Similarly, the system can provide a judgment of the underlying cause of the incident and also opportunities that can be explored to avoid the same incident in the future (Ogonowski, Aal, Vaziri, Rekowski, Randall, Schreiber & Wulf, 2016). The data will help the QRM team, as it will be reviewed from time to time to ensure that all the issues that cause falling are brought to attention.
Researchers role
The researcher used a scientific approach in identifying the research question and analysis of the state of Crete hospital’s situation. After analyzing Crete medical records of inpatients and finding the most prevalent problem affecting the nursing home, the research question came about. On the other hand, the researcher used a detective approach by conducting a clinical investigation of the causes and effects of falling in the nursing home and proposing suitable strategies to mitigate the problem. In the same context, as a healing environment manager, the researcher tried to understand both the intrinsic and extrinsic factors contributing to falling and providing detailed measures that support both the medical staff and patients. Thus, providing a caring and healing environment.
Conclusion
An initiative like FPP, which uses evidence-based practice when implemented, will help maintain patient safety and encourage healthcare workers to interrogate their practice and seek out best practices in their place of work. It will also encourage them to work with other nurses to ensure the well-being and safety of patients collaboratively to ensure the well-being and safety of patients collaboratively. Having a better understanding of the causes of falling by using FPP and eHMIS will substantially reduce the number of patients experiencing multiple falls within one episode of hospitalization.
References
Gray-Miceli, D., Mazzia, L., & Crane, G. (2017). Advanced practice nurse-led statewide collaborative to reduce falls in hospitals. Journal of nursing care quality, 32(2), 120-125.
Kruschke, C. (2017). Fall Prevention for Older Adults. Journal of gerontological nursing, 43(11), 15-21.
Melin, C. M. (2018). Reducing falls in the inpatient hospital setting. International journal of evidence-based healthcare, 16(1), 25-31.
Ogonowski, C., Aal, K., Vaziri, D., Rekowski, T. V., Randall, D., Schreiber, D., … & Wulf, V. (2016). ICT-based fall prevention system for older adults: qualitative results from a long-term field study. ACM Transactions on Computer-Human Interaction (TOCHI), 23(5), 1-33.
Pahor, M. (2019). Falls in older adults: prevention, mortality, and costs. Jama, 321(21), 2080-2081.
Quigley, P. A., Barnett, S. D., Bulat, T., & Friedman, Y. (2016). Reducing falls and fall-related injuries in medical-surgical units: one-year multihospital falls collaborative. Journal of Nursing Care Quality, 31(2), 139-145.
Tricco, A. C., Thomas, S. M., Veroniki, A. A., Hamid, J. S., Cogo, E., Strifler, L., … & Riva, J. J. (2017). Comparisons of interventions for preventing falls in older adults: a systematic review and meta-analysis. Jama, 318(17), 1687-1699.
