Quality Improvement Project Presentation

Sample Answer

Problem Statement

Health organizations have a critical role to play in the promotion of the health, wellbeing, and recovery of their patients. They are required to create environments that not only promote healing but also increase the ability of the healthcare providers to offer high-quality care. Health organizations also have to minimize the occurrence of adverse events in their environments. This includes reducing the rates of falls among their patients. Often, patient falls occur during patient transfers, visiting toilets, and having disoriented patients in the unit.

Patient falls have significant adverse health outcomes. They predispose the patients to injuries, increased healthcare needs, extended hospital stays, and high costs incurred in health spending. It also results in job dissatisfaction among the healthcare providers due to poor health outcomes (Anderson, Postler & Dam, 2016). Therefore, the issue should be addressed for the promotion of the health and wellbeing of the patients.

Health organizations have the responsibilities of ensuring that measures as well as policies are adopted to address the issue of patient falls. They have to prioritize the implementation of interventions that will minimize the risk of adverse outcomes in their settings. An example would be training the healthcare providers on risk assessment and management of unforeseen safety issues in the organization.

Several interventions have been explored in studies to determine their efficacy in preventing patient falls. One of them is the use of call lights where system alerts are used to notify the staffs about the patients at risk of falls. The other intervention is the use of lower bed or bed rails to prevent patient falls. Organizations have also increased their focus on improving their existing risk assessment processes for patient falls.

However, most of these interventions have been unsuccessful. This is attributed to a number of factors such as inconsistencies in use in the clinical setting, high workload, lack of sustainable strategies, and low level of awareness among the healthcare providers on their use (Anderson et al., 2016). The use of individual falls assessment and prevention approaches have been shown to be ineffective and not sustainable in addressing the issue of patient falls.

However, the utilization of simultaneous falls prevention strategies can be effective in creating the desired safety culture in a hospital. This includes the use of system alerts, hourly nursing rounds, and improving staff communications to address the issue. Despite the existence of the different methods of preventing patient falls, there has been limited use of them in our hospital, hence, the need for the exploration of effectiveness of simultaneous falls prevention approach in addressing the issue of patient falls.

Literature Review

Patient falls is a prevalent safety problem facing many hospitals globally. It is estimated that the risk of patient falls increases with age. For example, the elderly people living in nursing homes and admitted in the hospitals are highly likely to fall more than those in the community. It is also estimated that between 3- and 50% of the elderly people in long-term care institutions experience falls on a yearly basis.

Irrespective of the age, the risk of any hospitalized patient falling in the hospital setting is about 3-20%. This makes patient falls contribute to about 70% of all the accidents reported in the inpatient settings.

Factors Contributing to Patient Falls

The factors that contribute to the high rate of patient falls in the clinical setting are varied. One of them is intrinsic factors. Intrinsic factors are those that are related to the patient. They include increased patient age, impaired balance, previous history of fall, depression, impaired cognitive functioning, urinary frequency, visual impairment, nocturia, urinary incontinence, and use of medications. The other factor contributing to patient falls is extrinsic factors.

Extrinsic factors focuses on the environmental, organizational, and reason for hospitalization-related factors. One of these factors is the reason for the patient’s hospitalization. It also includes the unit conditions, cluttered environment, utilization of restraints, and lighting. Provider factors also contribute to the high prevalence of patient falls. They include ineffective leadership, failures in inter-professional communication, poor adherence to safety protocols, and inadequate orientation, training, and supervision of the staffs (Gu et al., 2016).

Fall Prevention Strategies

Several strategies have been explored in preventing patient falls in inpatient settings. One of them has been the development of standardized assessment tools that can be used for identifying the patients that are at risk of falls. The tools assist the nurses and other healthcare providers in classifying the risk profile for the patients. However, its use is associated with weaknesses that include inconsistent use in hospital settings and the inability to address unforeseen factors contributing to falls.

The other strategy is the utilization of systematic reporting of incidents of patient falls. This strategy has been shown to result in the acquisition of better insights into the factors contributing to patient falls and ways of preventing them. Fall prevention toolkits have also been developed to address the issue of patient falls. This includes the use of systems such as call lights, bed rails, patient restraining, and healthcare provider training on the identification and prevention of falls (Khalifa, 2019).

However, these methods have been associated with limited success due to their individual or single use in addressing the issue of patient falls.

Areas of Need

It can be seen from the available literature that the existing fall prevention strategies do not focus on the identification of possible predictors of patient falls. The strategies only guide the healthcare providers in reacting to an occurrence or possible occurrence of a patient fall in the hospital setting. Fall prevention in hospital setting also demands multi-professional collaboration for the adopted interventions to be effective.

There is also a need for active involvement of the healthcare providers in assessing the effective interventions that can be used to address the issue. The healthcare providers can provide their subjective experiences with patient falls and ways of addressing them. However, most of the fall prevention strategies fail to incorporate inter-professional perspective due to the one-sided implementation of fall prevention strategies.

Often, hospitals adopt a single method of preventing patient falls (Gu et al., 2016). However, the use of individual approach to preventing patient falls is attributed with the weakness of failing to address the multiple factors contributing to patient falls. As a result, simultaneous interventions might prove effective in addressing the issue of patient falls in the clinical setting.

Intervention Plan

As shown earlier, the use of individual approach to fall prevention in inpatient settings is ineffective in addressing the high rate of patient falls. However, a simultaneous approach to preventing patient falls might be effective in addressing the issue. This is attributed to its focus on the multiple factors that contribute to patient falls. It is therefore proposed that the issue of patient falls to be prevented in all the medical-surgical inpatient settings using system alerts, hourly nursing rounds, and improving the communication between the healthcare providers.

Training will be providers to the nurses since they will be the main implementers of the intervention. The training will aim at raising their level of awareness and understanding of the manner in which the interventions should be implemented.

The data for the intervention will be collected using questionnaires. The questionnaires will be open and closed ended. They will provide the subjective experiences of the nurses with the implementation of the intervention. The nurses will provide their feedback on the strengths, weaknesses, and areas of improvement in the proposed intervention.

Questionnaires are effective since they will allow for the acquisition of detailed information from the participants. Data on the reported rates of patient falls will be obtained during the period of program implementation. The data will be used for comparative purposes to determine the effectiveness of the intervention.

Resources Needed

One of the resources that will be needed is money. Financial resources will have to be spent in training the nurses on the implementation of the intervention. Money will also be required to purchase health information technologies such as system alerts for detecting patients at risk of falls. The other resource that will be needed is time. The implementation of the intervention will require adequate time.

The nurses must also be given time to implement the intervention in their settings. Adequate time is also needed in monitoring, obtaining and analyzing data for this intervention. As shown earlier, there will be the need to buy alert systems for detecting patient falls. The systems will be installed by the bedsides for the patients to use them for notifying nurses should they feel at risk of falling.

Stakeholders and their Roles

One of the stakeholders who will be needed in this project are the nurses. They will be the implementers of the intervention. They will also provide feedback on their perceived challenges in the implementation process. The other stakeholders include nurse managers and leaders. They will lead the implementation process. They will also supervise the use of the interventions in the clinical settings. They will also provide feedback that will be used in adjusting the interventions.

The human resources manager will determine the training needs of the nurses. He will also ensure that the training matches the identified training needs. The finance manager will determine the financial feasibility of the project. This will be based on the available resources in the organization. The IT manager will assist in the selection of safe, efficient, and effective alert systems to be installed in the inpatient settings.

Evaluation Method

The evaluation of the proposed intervention will be done with a focus on process, outcome, and goal measures. In process evaluation, the focus will be placed on the effectiveness in program implementation. Aspects such as stakeholder involvement and use of the assigned resources will be used in the evaluation process. Outcome evaluation will focus on the determination of whether the set results were achieved at the end of the program or not.

This shares close similarities with goal-based evaluation that will be used. Goal-based evaluation will focus on determining whether the goals that were developed in each steps of the implementation process were met or not (Giancola, 2020). Therefore, a combination of these three methods of program evaluation will provide accurate results on its effectiveness in addressing the issue of patient falls

References

• Anderson, D. C., Postler, T. S., & Dam, T. T. (2016). Epidemiology of hospital system patient falls a retrospective analysis. American Journal of Medical Quality, 31(5), 423-428.
• Giancola, S. P. (2020). Program Evaluation Embedding Evaluation into Program Design and Development. SAGE Publications, Incorporated.
• Gu, Y. Y., Balcaen, K., Ni, Y., Ampe, J., & Goffin, J. (2016). Review on prevention of falls in hospital settings. Chinese Nursing Research, 3(1), 7-10.
• Khalifa, M. (2019). Improving Patient Safety by Reducing Falls in Hospitals Among the Elderly A Review of Successful Strategies. Studies in health technology and informatics, 262, 340-343.