Preventing Falls in Hospitals

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Essay on Preventing Falls in Hospitals

Health Problem in the Nursing Environment

Falls are a common and devastating concern in the United States healthcare system, particularly in the postoperative patients. A patient fall by definition refers to the unintended descent to the floor with or without harm to the patient (Cameron et al., 2018). Statistics from epidemiologic studies present a fall occurrence rate of 3-5 falls per 1000 bed-days (Ramasamy, 2019). Ramasamy added that the agency for Healthcare Research and Quality provides an estimated value of 700,000 to a million fall incidences among hospitalized patients yearly. Postoperative nursing wards, in the first 24 post-surgical hours, are proving to be centered for falls, as evident in Hialeah Hospital. In the post-surgery nursing environment, the typical causes of falls include anesthesia effects, pain medication, blood loss, and dehydration. Falls may result in internal bleeding, fractures, lacerations, and in some extreme cases like a head injury can lead to death (Cameron et al., 2018). The impact of fall cases in a health facility is increased utilization of healthcare services as the patient is set to receive additional treatment.

Fall prevention has attracted intensive research works and quality improvement efforts, which have helped in defining successful prevention programs (Cameron et al., 2018). The typical prevention mechanism is patient-centered, with the focus on assessing the risk to fall for each patient. Nonetheless, there is a need to have programs that target the healthcare providers, especially the nurses, to top up the patient-centered interventions. This presentation will focus on a preventive plan that involves the training of staff on safety precautions for postoperative patients to help mitigate the incidence of falls during the first 24 post-surgical hours. The assessment compares the incidences before training and after training.

PICOT Question

Does training of the hospital staff at Hialeah Hospital reduce the incidence of falls during the first 24 post-surgical hours in postoperative patients compared to incidences before rolling out the training program?

P (population). The people targeted in this study are the hospital staff, and the sample population is reduced to focus on the team working at Hialeah Hospital.

I (intervention). The intervention is rolling out a training program for staff on safety precautions for the postoperative patients during the first 24 post-surgical hours.

C (comparison). The study compares the incidents of falls, during the first 24 post-surgical hours in postoperative patients, on those handled by staff after the training trained and the incidences before the training program.

O (outcome). The outcome from the intervention should be reduced incidences of fall during the first 24 post-surgical hours in postoperative patients.

T (time). The time of review for the incidences is 24 hours after surgery for six months.

Healthy People 2020 Preventive Services

The traditional health care system focused on health improvement measures that identify and treat health problems that are symptomatic and have identifiable complications. The traditional system focused on treating the resulting injuries from falls and not having the environment safe to prevent falls from occurring. Preventive services, as outlined in Healthy People 2020, present measures that help in the prevention of health problems from occurring. Preventive services focus on diagnosis problems before visible symptoms or complications when there are high chances of recovery. The prevention measures are essential in improving overall health and reduce the cost of providing healthcare. Healthy People 2020 outlines preventive services for fall prevention for the groups identified as the high risk groups. Healthy People 2020 provides the Preventing Falls guideline developed by CDC for the high risk group targeting adults aged above 65 years. Postoperative patients within 24 post-surgery hours, and the aged population are among the high risk group.

Policy for Preventive Services

Fall in hospitals and especially in the high risk groups like the postoperative patients are on the rise. The falls are not all unavoidable as most can be prevented if the necessary strategies are put in place to prevent them from happening. Public health policy developers work in support of measures that aim at improving the health of persons and communities. Robust public health policy on preventing falls is one that focuses on maximizing care and structure of the hospital to be conducive for postoperative patients and the other high risks groups like the aged population. The successful development of public policy to safeguard the safety of patients in the postoperative care units is dependent on six key areas. They include; innovation that seeks to develop the evidence ground for action, effective performance management that is through real-time monitoring, evaluation, and measures for improvement.

Technical set of a restricted number of high-priority interventions like the training program that is based on evidence. Policy development requires partnerships and coalitions of both the private and public sectors in designing the relevant training on fall prevention. The process requires effective communication of accurate and timely information to the various stakeholders, including the caregivers, the healthcare providers, hospital management, the legislators and the experts who offer the trainings. The sixth pillar in prevention services policy development is getting a political commitment that will help in obtaining resources and support for the training programs on fall prevention.

Steps in Developing Primary Health Plan

Primary health care is an integrated and people-centered approach to care that goes beyond the basic set of services (Owen et al., 2019). The PHC starts with individuals, the immediate family members, and the community, which forms the foundation of a health system. Robust primary health care addresses a good percentage of the populace’s health needs and improves the healthcare provision by ensuring access to comprehensive and high-quality care. The adoption of training program for staff handling postoperative patients within the first 24 hours after surgery on fall prevention as a primary health plan can be through the below steps.

Step 1: Situational Analysis

The first stage involves gathering reliable information on the various causes of fall in the postoperative patients within the first 24 hours after surgery. Explore the existing interventions aimed at preventing falls within the hospital and the group tasked with the implementation (Owen et al., 2019). Establish how best the existing interventions have been effective in preventing falls and consider how to engage the staff and hospital management in resolving the current requirements.

Step 2: Identify the Problem (fall in the postoperative patients within the first 24 hours after surgery)

A problem in the healthcare system refers to a perceived gap between the existing situation and the ideal situation (Owen et al., 2019). This step involves gathering the necessary information on the prevalence of falls in the postoperation wards within the first 24hours and their route causes. Besides, the step encompasses identifying the people who will benefit from training program.

Step 3: Prioritizing Needs for the Postoperative Patients

This step involves prioritizing the care needs and making a strategic choice on the criteria and order for implementation. The process of prioritization is vital in determining the most crucial problem to focus on first (Owen et al., 2019). The most effective system for prioritization is establishing a standard of measure. Some of the measuring rubrics on the effects fall of postoperative patients within the first 24 hours include the prevalence of cases, the resulting injuries and the negative effects on operations and finances.

Step 4: Setting Goals and Objectives for the Training Program

Developing an effective primary health plan needs clarity on what the training program is set to achieve. The relevant teams have to review what needs to be completed and determine the priorities (Owen et al., 2019). Setting objectives for the training programs is essential in creating a definite plan and enable the evaluation of results.

Step 5: Review the Set Objectives for the Training Program

This step is necessary for keeping the project team, both the staff taking part in the training and the trainers, in check by ensuring the set objectives not only prevent falls from occurring but also guarantee the objectives are met. The critical question at this stage is whether the goals are being met by the means taken to solve the cases of fall in the postoperation wards within the first 24 hours.

Step 6: Classify and Sequence the Activities during Staff Training

After identifying the objectives to be achieved by the training program, there is a need to list the activities and have them in the correct sequence according to their relevance and timing. This stage is essential in identifying the dependencies between the events to determine which ones come first to enable the other to be completed. Besides, it is critical to identify the activities that can be undertaken concurrently.

Step 7: Identify the Resources to be used in the Staff Training Program

After identifying the activities to be completed and the sequence for undertaking the activities, the next stage is calculating the necessary resources to complete the activities (Owen et al., 2019). The relevant resources in actualizing a primary health plan include staff, equipment, materials, power, and accommodation.

Step 8: Action Plan Preparation and Scheduling for the Training Program

This stage involves the creation of the practical action plan concerning the objectives of the program and the schedule of activities. The action plan must be actionable by the resources available.

Evaluation of Primary Health Plan to Prevent Falls in Hospital

Criteria for Evaluation

Primary healthcare plan evaluation defines the critical, rigorous, systematic, and ethical assessment of whether it meets the set objectives. The aspects of the training program as a healthcare plan to be assessed include its effectiveness, efficiency, equity, and acceptability. Evaluating the effectiveness of the training program for the staff evaluates its benefits measured by the amounts of improvements it accrues in preventing falls in hospital (Williams, Sevdalis & Gaughran, 2019). Efficiency evaluation compares the cost involved in the training programs to the benefits gained. Acceptability assessment evaluates the social, psychological, and ethical appropriateness to the postoperative patients and to the hospital community. Equity evaluation concern the fair distribution of healthcare amongst persons, groups, and communities (Williams, Sevdalis & Gaughran, 2019). The dynamic nature of the living environment necessitates redesigning the healthcare system to respond effectively to new and complex health needs such as demographic transition, the evolution of technology, epidemiological development, and the increase in social expectation on matters of healthcare.

The staff training programs as a primary health plan is aimed at achieving three fundamental objectives, including improved healthcare standards, guaranteed financial impartiality, and improved responsiveness to the target population. The level of realization of the plan objectives provides the ultimate reflection of the performance of the plan as a whole. The framework for evaluating primary healthcare encompasses four main functions of a healthcare system, including access to services, comprehensiveness, continuity of care, and coordination of care (Williams, Sevdalis & Gaughran, 2019). Access to healthcare refers to the ease with which the postoperative patients can get assistance. Besides, access to healthcare defines the ability of a patients at risk of falling to receive care when and where it is required.

Continuity of services is the access to health services over a more extended period and in successive episodes of care. Coordination of services in a primary healthcare plan is essential in determining the responsiveness of health services. Cross-sectional coordination of services refers to the synchronization of information and services with a chapter of care. Comprehensiveness refers to the extent of the full range of care services either directly by the primary care physician or by other providers (Williams, Sevdalis & Gaughran, 2019). In the primary care system, comprehensiveness defines the fact that services include curative, rehabilitative, and supportive care.

Measures for Evaluating Primary Health Plans

An evaluation process trails the changes on the training program over time by gathering data at the first training, during subsequent training and on completion. The choice of an evaluation measure for the training package should be based on the program’s focus, the needs of the financiers or the audience, the time frame set for the program, and the available training for the implementers (Robert et al., 2019). The commonly used measures include; population data, program process measures, and participant outcome measures. Participant data comprises an assessment of the various qualifications of the staff and the roles they play in the hospital. Besides, participation data include evaluation of health concerns, feedback on the program, and the perceived risk.

Programs process measures evaluate the number of staff who complete the training, the number of participants in the wellbeing training, number of members enrolled, and the extent of implementation and the cost needed to complete the training program (Williams, Sevdalis & Gaughran, 2019). Participant outcome measure evaluates the prevalence of risk factors for falling, prevailing environmental conditions both social and physical, and the knowledge and skills of the teams on fall prevention.

Types of Evaluation

Different types of evaluation can be used in assessing the training program on fall prevention. The different types include process evaluation, impact evaluation, outcome evaluation, and summative evaluation. Process evaluation measures the various activities of the training program, the quality, and the people it reaches. Impact evaluation is used in measuring the immediate effect of the training program and must be aligned with the objectives of the preventing falls in postoperative patients (Williams, Sevdalis & Gaughran, 2019). The impact evaluation gives detail on how best the goals and sub-objectives of the training have been achieved. Outcome evaluation targets the long term effects of staff training on fall prevention. Outcome evaluation is used in measuring the program goal and how well the purposes of the program have been realized. Summative valuation is done on completion of training duration where the team considers the entire program cycle and help in decision-making.

Evaluation Tools

The data used in the evaluation the effectiveness of the training programs can be collected through various tools. The main tools used include surveys, observation, key informant interviews, focus groups, and case studies (Robert et al., 2019). Surveys refer to the systematic sampling of a population through a set of questions that are to be answered in a specified set of responses (Williams, Sevdalis & Gaughran, 2019). The sample population could be staff members who took part in the training, the caregivers, or the community members. Focus group refers to a small group of people in different classes who spend time in guided discussions of the predetermined set of questions on the effectiveness of the training.

The persons in a focus group are typical of given common characteristics or may have diverse features (Robert et al., 2019). The questions presented to the focus group can be responded to in any way they choose. Key informant interviews are set of questions to selected individuals or miniature groups chosen because they have specific experiences, have taken part in the training, or are good experience in dealing with post-operative patients (Williams, Sevdalis & Gaughran, 2019). Observation can be used in getting information on the health facilities by experts making visits to postoperation wards and getting a picture of the situation.

Prevention Intervention

Postoperative nursing wards, in the first 24 post-surgical hours, are proving to be centered for falls. Falls in hospitals and especially in the postoperative patients, not only derails their recovery but also put them at the risk of getting new complications. Moreover, there is a negative effect on the hospital in increasing the cost of healthcare. Therefore, it is paramount to develop effective prevention interventions. There are three levels of preventive care, including primary prevention, secondary prevention, and tertiary prevention.

Primary Prevention

Primary prevention is a measure aimed at creating an environment that limits the cases of fall amongst patients (Heard, Mutch & Fitzgerald, 2020). The intervention aims at eliminating the likely risk factors that can cause falls. Training programs for the healthcare provider on the necessary precautions and care procedures for preventing falls is part of a primary intervention to prevent falls in hospitals. The additional primary intervention is identifying the high-risk patients like the postoperative patients and keeping them in safer environments and with the necessary support (Gu et al., 2016) Adequate staffing of the care units and ensuring the ration of the nurse to the postoperative patient is significant in preventing falls by providing sufficient attention.

Secondary Prevention

Training the hospital staff on secondary prevention of falls in the postoperative care centers should aim at early discover of the likely causes and managing the condition from worsening. Some of the key interventions in preventing falls in hospitals includes keeping the bed position at a low spot when the patient is resting and adjusting the bed level to a comfortable height when the patient needs to leave the bed (Cameron et al., 2018). Postoperative patients need safety companions to provide continuous observation and aid to prevent falls. Increased safety rounds are essential in the postoperative wards to ensure the precautions necessary for preventing falls are in place. The hospital needs to install handrails on the patient walkways to help the patient hold onto when they feel faint.

Tertiary Prevention

Tertiary prevention involves restoration and rehabilitation. Training on tertiary intervention include measures set in place to reduce the negative impact of a fall incident and reestablishing normal functions and reducing fall-related complications (Ortelli, 2018). The intervention aims at improving the quality of life for the patient after falling. Tertiary intervention in preventing falls involves dealing with an aftermath of a fall incident by ensuring no such repeats and the patient is treated. The intervention includes treatment of any injury resulting from the fall, prescribing pain relievers in case the patient experiences pain from the fresh injuries (Ortelli, 2018). Besides, nurses can manage the psychological wellbeing of the patient and conduct repeat training on how to avoid falling another time.

Create social and physical environments that promote good health for all (Healthy People 2020)

The environment an individual resides in plays an important role in their health and wellbeing. Creating a social and physical environment is key in promoting the good health of the patients both during and after a hospital stay. The prevalence of falls in hospitals mainly links to the social and physical environment of the post-operation care units (Van Cauwenberg et al., 2018). The hospital management needs to ensure the environment is safe for postoperative patients. They are at high risk of falling, due to the confusion and weakness caused by the medications. The training programs for the hospital staff handling postoperative patients should include measures for creating a good physical and social environment for the patient to preventing falls. Some of the elements are discussed below.

Social Environment

Provide Safety Companion

There is a need to have increased numbers of safety companions during the 24 hours after the operation (Van Cauwenberg et al., 2018). The safety companion can be a member of the family of the patient or caregivers assigned by the hospital. For cases where the safety companion is provided by the hospital, their ratio of patient to caregiver must be checked for adequate monitoring.

Safety Rounds

During the first 24 hours’ post-operation, the nursing needs to increase the frequency of visiting the patients to ensure all the safety precautions are in place to prevent falls.

Physical Environment

Facility Design

Creating a safer physical environment in the post-operation care wards should be taken into account during the design of the facility (Groenewegen et al., 2018). Some of the safety precautions related to the design include lighting, the furniture type and arrangement, way-finding signs, the nature and type of flooring materials, and the location of essential services for the patients.

Good lighting and Clear Pathways

There should be adequate lighting in the postoperative wards. During the day, the facility should be able to get adequate natural lights, and at night, the lights must remain on, especially along the pathways and in the toilets. The lighting switches should be placed at strategic locations where each patient can turn on in their bed space. Improving the physical environment in the post-surgery care wards take in clearing pathways to the toilets and rest areas.

Reduce Risk of Slipping on the Floor, Lock All Wheels, and Install bed alarms.

The floor in the postoperation care area must remain dry at all by having the staff mop up promptly. The spills must be cleaned immediately, and the facility must avail warning signs for the slippery floor to be put up when the floors are being cleaned or when the subordinate deal with spills (Groenewegen et al., 2018). The wheels to the furniture, wheelchairs, toilet chairs and hoists must remain locked at all times in the postoperation care wards. All the beds should have alarms install for instant calls for assistance.

Conclusions

Falls are among the most frequent cases reported in our hospitals today. The inclusion of this topic in Healthy People 2020 underscores the recognition of the growing public health threat this theme represents to the nation. Hospital falls in postoperative patients are preventable and avoided in all sense. It is important to embolden a philosophy of safety realization through incessant learning and feedback to help prevent falls in our hospitals. Hospital staff training in fall prevention programs improves patient outcomes by reducing falls in post-operative patients.

References

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Groenewegen, P. P., Zock, J. P., Spreeuwenberg, P., Helbich, M., Hoek, G., Ruijsbroek, A., … & Dijst, M. (2018). Neighbourhood social and physical environment and general practitioner assessed morbidity. Health & place49, 68-84.

Gu, Y. Y., Balcaen, K., Ni, Y., Ampe, J., & Goffin, J. (2016). Review on prevention of falls in hospital settings. Chinese Nursing Research3(1), 7-10.

Heard, E., Mutch, A., & Fitzgerald, L. (2020). Using applied theater in primary, secondary, and tertiary prevention of intimate partner violence: A systematic review. Trauma, Violence, & Abuse21(1), 138-156.

Ortelli, T. A. (2018). AHRQ Resources for Preventing Falls in Hospitals. AJN The American Journal of Nursing118(5), 63-64.

Owen, R. R., Woodward, E. N., Drummond, K. L., Deen, T. L., Oliver, K. A., Petersen, N. J., Meit, S. S., Fortney, J. C., & Kirchner, J. E. (2019). Using implementation facilitation to implement primary care mental health integration via clinical video telehealth in rural clinics: protocol for a hybrid type 2 cluster randomized stepped-wedge design. Implementation science: IS14(1), 33. https://doi.org/10.1186/s13012-019-0875-5

Ramasamy, K. (2019). Educational Training on Falls Intervention for Elderly Patients in Acute Care Settings.

Robert, E., Ridde, V., Rajan, D., Sam, O., Dravé, M., & Porignon, D. (2019). Realist evaluation of the role of the Universal Health Coverage Partnership in strengthening policy dialogue for health planning and financing: a protocol. BMJ open9(1), e022345. https://doi.org/10.1136/bmjopen-2018-022345

Van Cauwenberg, J., Nathan, A., Deforche, B., Barnett, A., Barnett, D., & Cerin, E. (2018). Physical environments that promote physical activity among older people. In The Palgrave Handbook of Ageing and Physical Activity Promotion (pp. 447-466). Palgrave Macmillan, Cham.

Williams, J., Sevdalis, N., & Gaughran, F. (2019). Evaluation of a Physical health plan for people with psychosis: a protocol for a quality improvement study. Pilot and feasibility studies5(1), 8.

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