How to stop falls in the hospital
Patient safety is one of the most important parts of giving people good health care. Today, healthcare groups are striving to provide safe, effective, and patient-centered care. Patient falls are one of the safety problems that healthcare groups have to deal with to keep people from getting hurt. About 700,000 people fall each year in the United States, which can cause broken bones, cuts, internal bleeding, or even death (Hopewell et al., 2020). There is proof that falls can be stopped by figuring out what makes a person more likely to fall and putting together a multidisciplinary clinical team. The goal of this conversation is to figure out why patients fall at my school and what can be done to fix the safety problem.
Falls are the most common safety problem that my healthcare group hears about. The inpatient rooms say that a lot of patients fall each year, and even though they try different things, the problem keeps happening. People over 65 seem to be most affected by this problem, as there have been reports of falls during entry and care in the wards afterward. The biggest problem is that people don’t follow the rules for preventing falls in the facility.
Most falls in hospitals are not true accidents, but instead are caused by a mix of the patient’s own actions and those of people around them. For instance, the healthcare group encourages patients to move around, especially when they are in the hospital for a long time. But the exercise can cause patients to trip and fall, which can hurt them more. The main reason people fall in this facility is that there isn’t a step-by-step, diverse plan to stop them. People have noticed that the nursing team takes on more of the duty for keeping an eye on patients, when all members of the healthcare team should be involved.
Most healthcare groups focus on age as the risk factor for falls leaving other gaps unresolved. Most of the falls I see at my school are caused by people moving around too soon and not getting the right help. For example, older people with long-term health problems find it hard to move around the hospital, and most of them fall even while standing next to their hospital beds. Other risk factors for the bad result are cognitive impairment, being a woman, and being a patient recovering from anesthesia. Even though standardized evaluation and intervention tools are used, people still fall in hospitals.
Explaining the Problem
It is a known fact among healthcare professionals that falls in the hospital are a major concern and preventing patient falls is of the utmost priorities. Even though we can’t stop everyone from falling, we can stop most of them with specific patient-centered treatments and assessment tools that let us know when someone is at risk. But if patients are part of the prevention, doctors can cut them down even more. One way to make sure this bad thing doesn’t happen is to avoid falls by using a multidisciplinary approach. The practice is not well-known among the people who work in health care, especially the nurses. The nursing team is observed to be reluctant to properly implementing the set rules on fall prevention. Other members of the healthcare team also think that it is up to the nurses and the patient’s family to make sure that patients don’t fall.
When a patient falls, it can cause anything from small problems to big health problems like broken bones or even death. The problem of patients falling needs to be fixed because it affects the level of care in many ways. First, when a patient falls, they have to stay in the hospital longer, which can be expensive for them. When people stay in the hospital for a long time, they stop trusting the group to keep them safe and help them get better. The end result is that patients aren’t happy and the business loses money because there aren’t enough new patients. The healthcare group needs to do something about patients falling because it is their job to make sure everyone is safe. Sometimes the organization can be sued due to negligence in ensuring the safety of patients while getting healthcare. For example, if there isn’t a “wet floor” sign in the rooms, a patient could slip and hurt themselves very badly. On this grounds, any adverse result means the hospital will have to take responsibility including treating the individual.
Explanation of Causes
There are both internal and external reasons that can cause a patient to fall in the facility. Most patients who fall in the hospital are just out of surgery and haven’t fully recovered from the drugs yet. Most of them wake up puzzled, which makes it hard for them to move. Nearly half of the people who fell in the hospital last year were in the surgical and medical units. Not keeping an eye on the patients, especially at night, is another reason why they fall. The nursing team’s report on the likely reasons for falls said that not having enough staff at night was a factor. Since the COVID19 spread, there are also fewer family members to help take care of patients, which is against the rules of the hospital. As a result, the number of falls has gone up.
The use of medicines and the health of patients, especially the elderly, can cause falls in hospitals. (Guirguis-Blake et al., 2018) say that drugs like painkillers and sedatives can make people feel dizzy, which can cause them to fall. Lack of information can make it hard for patients to understand how these drugs work, which can lead to falls. Statistics from the hospital also show that people with medical conditions like dementia are more likely to fall because they move around a lot and don’t take care when using the bathroom. In another hospital medical unit, it was seen that people often slipped and fell because there were no signs to say the floor was wet.
Healthcare groups are moving toward using approaches from different fields to make sure patients are safe and secure. Patients can fall in the facility because nurses and other health care workers don’t work well together or get along well. The only people in the hospital who really care about patients who fall are the nurses. A program to teach other health care workers about the value of preventing falls will be very helpful. There are problems with preventing falls in the school because there are no clear rules about what each member of the healthcare team should do. There is also not enough information about how important it is to keep people from falling in the building, so people don’t pay enough attention to making sure people don’t fall.
Stakeholders Needed to Be Found
In hospitals and other health care facilities, preventing falls needs a multidisciplinary approach that includes getting people involved in their care. The people who will be most important in preventing falls are registered nurses, nursing trainers, hospital management, doctors, and patients.
Nurses are very important to improving the standard of healthcare. Nurses are also responsible for preventing falls, since they spend more time with their patients. The nursing team will be in charge of making changes that will make it less likely for patients to fall in the hospital. During education and training, they will be involved members and learn more about the health care issue. In the second team is a clinical nurse educator who is in charge of making educational plans to improve quality. The nurse educator will make sure that the staff is educated and trained on how to avoid falls.
In any health care center, the hospital administration is a key part of making things better. The administrators make sure that new changes are made in line with hospital policy and that they are good for the company and the patients. The suggested change to stop falls in all hospital units will need to be approved by the department in charge of administration. The process will also need financial help, which will be taken care of by the administration. The doctor’s team will also be important to the new change. As involved members of the healthcare team, they will be educated and trained on how to keep people from falling. The doctors will work with the nurses to make sure that drugs are checked properly before they are given to patients. Lastly, the patients will be taught how to reduce the number of times they fall. Strategies will be taught, such as using walking tools and taking care when the floor is wet.
Talk about Stakeholders
The registered nurses will take part in the exercise to avoid falls by getting more education and training. Because nurses spend most of their time with patients, they will be the main focus of the new change to stop falls. The nursing team can decide whether to accept or reject a new change based on how it will help improve quality. The nurses can change the way patients are watched in the facility and work with other workers to keep patients from falling. The nursing team wants to make sure that patients are safe and that they get the best care possible. How doctors and other health care workers respond to the new tactics for preventing falls can depend on how well patients accept the new changes.
The nurse trainer is the second most important person in making sure that patients don’t fall. The clinical nurse educator will help workers and other important people understand how important the new change is. The nurse educator wants to make healthcare professionals more aware of how to avoid falls so that patients have better outcomes. The new change is also interesting to the nurse educator because it will give the hospital a chance to use evidence-based practice. If the nurse educator backs the project, it’s possible that other key players, like the nurses and the hospital administration, will be more likely to join in.
The third important stakeholder is the management department, which is in charge of making sure that the new change is in the patients’ best interests. The new change is important to the administration because it is part of an effort to improve quality and safety in the facility. The new change will also have a big effect on money, which will be good for the group if less patients fall. Because of its part in the organization, the administration has the power to decide whether to accept or reject the new change. The suggested change must show how patient falls will get better and what the long-term and short-term effects of the change will be. How well fall prevention tactics work in the facility will depend on how well the administration likes the new change.
Patients and their families are the last people on the team for the new change. These people will be directly affected by the new change, so giving them a chance to weigh in on how it’s put into place will help protect their interests. The patients will have no power or say over how the new change is put into place. But the patients are interested in the project because if the plans are done right, there will be fewer falls. Patients will want to know how healthcare costs related to falls will be cut and how doctors and nurses will work together to make their stay in the hospital safer.
Describe the Project
Using evidence-based practices in healthcare has helped to improve the level of care that patients get. Patient falls have been a problem in healthcare for a long time, and they still cause problems even though many solutions have been tried. The goal of this project is to suggest a change in practice that is based on data and looks at how nurses can help keep patients from falling. When the project is done, the school will be able to improve patient safety by making sure they don’t fall. When the project is done, there will also be a synthesis of key professional skills in the areas of communication and building relationships, knowledge of the healthcare environment, leadership, teamwork, and organizational business administration.
The Solution Suggested
Patients falling down are the most common safety problem in hospitals that needs to be fixed with the right protection programs. Preventing falls in hospitals is not a single person’s job. Instead, it takes the work of teams from different fields. Doctors of all levels and fields should work together to keep patients from getting hurt when they fall. There is evidence that not all falls can be stopped, but Morris and O’Riordan (2017) found that assessing risks and acting quickly can avoid 20–30% of falls. Nurses can play a key role in reducing falls by quickly assessing patients who are at risk and involving other members of the healthcare team in taking care of patients who are at risk.
Use of purposeful hourly rounding has been suggested as a way to stop falls in the company. Nurses often do hospital rounds to check on the health of their patients and find out what they need. (Schuchman & Graziano, 2020) There is more and more proof that most falls can be avoided if risk factors are found quickly and action is taken right away. Purposeful rounding to avoid falls will focus on patients who are most likely to fall so that quick steps can be taken. In the hourly rounding plan, nurses will use a checklist to help them find patients who are likely to fall. This method is meant to build a culture of openness that encourages the care team and their patients to take part. Also, nurses making hourly rounds will support collaborative practice, such as making good decisions to keep patients from falling.
Summary of the Proof
The Weight of Care Falls
Patient safety is an area of healthcare that has gotten more attention in recent years as the number of patients who get hurt in hospitals has gone up. The World Health Organization (WHO) says that one of the top 10 major causes of disability and death in the world is the occurrence of adverse events (WHO, 2019). Even though medication errors cause 80% of patient harm, patient falls cause a large number of bad things to happen in acute care centers. Morris and O’Riordan (2017) say that 20 to 30% of patient falls in hospitals can be avoided by using the right screening methods. According to a study by the Agency for Healthcare Quality and Research (AHRQ) (AHRQ, 2018), about one million patients fall each year in the United States. These falls raise the cost of caring for people and can hurt them in ways that can’t be fixed.
Risk Factors for Hospital Falls
Patients falling in the hospital can be caused by things that are both inside and outside of the patient. One study (Najafpour et al., 2019) shows that patient falls are linked to things like age, being male, having fallen recently, having trouble walking, being confused, and having problems with the heart and blood vessels. Other studies have looked at how things outside of the patient can cause them to fall. For example, a problem with the amount of staff can make it more likely for patients to fall. When there aren’t enough workers, it’s hard to keep an eye on the patients, so people don’t pay attention. Most patients will try to wake up at some point, which can cause them to fall because they are not solid. Wet floors, longer hospital stays, and moving patients by hand are also factors.
Ways to stop people from falling
There isn’t a lot of clear information about how to stop falls in healthcare, so there isn’t much evidence to go on. But studies have tried to come up with ways to stop people from falling. Morris and O’Riordan (2017) say that there is a lot of proof that routine assessments of a patient’s mobility, toileting, and continence needs can help reduce the chance that they will fall. The use of purposeful hourly rounding is another technique that has been shown to work well. (Linehan & Linehan, 2018) A study done in a long-term care facility in Baltimore, Maryland, found that hourly rounds are important for finding out what the patients need and where they are, which helps prevent falls. Other studies have backed the use of multifactor interventions like walking aids, routine rounds, wet floor signs, and teaching staff about patient safety (Lee & Hayter, 2019). Even though these methods exist, no one has found a surefire way to stop patients from falling.
Plan of what to do
The first step is to meet with the project managers to talk about the healthcare problem and the best way to fix it. At the meeting, nurse managers from different units will talk about what happens when patients fall and how a new plan can help improve the health of patients. During this meeting, the health benefits of growth will be talked about and a list of the key people involved will be made. These people will be told about the change that is being suggested and how their power and influence will be important to getting good results.
The second step will be to get approval for the idea from the hospital administration and any other relevant groups. The administrators can accept, reject, or change the proposal so that it fits with the goals of the company. In order to get approval, the project team will show proof of how many patient falls there are in the school, who falls, what health risks are linked to falling, and how the new change will help the organization. The study department will be called to give numbers and facts about the health problem and how the current solutions haven’t worked as planned.
In the third part of the project, the evidence-based recommendation change will be studied, and the best practices will be shared with the stakeholders. There will be a thorough review of the literature to make sure that the best practice change to stop falls in the facility is picked. The plan will be shared with the government and other important people. Nurses, doctors, the administration department, and patients are all important people who need to know about the plan. The nursing instructor will be a part of the team that is putting the project into action. Their job will be to teach healthcare providers about the new change and get their feedback.
After the plan is accepted, the last step will be for the nurses to get educated and trained. The clinical nurse educator will be very important to this process because she will be in charge of getting materials together and teaching the staff. The nurses will learn how important it is to avoid falls and what to think about when doing the hourly rounds. When this step is done, the next step will be to put the idea into action. During shifts, rounding will be done every hour in each unit, and the results will be written down every day. The number of falls will be written down and shared every week. The execution team will put together the monthly reports so that they can be used as a guide during benchmarks.
Five weeks will be enough time to make the change in the organization that was suggested. In the first week of the project, the nurse managers will be met with and the healthcare problem will be talked about. During this phase, data will be taken on how often patients fall and how bad it is when they do. The key stakeholders will be found and told what their roles are in putting the idea into action. In the second week, we will tell the office about the new change and ask for permission. The study department will be used to show facts about the healthcare problem and why the new change is important. After the project is approved, nurse managers will talk to the different parts of the hospital about it.
During the third week of the project, we will look at the material and talk about the new change. At this time, the steps for implementation and the resources that are needed will be set. The nurse educator will make plans for how nurses will be taught and trained to do meaningful hourly rounds. During the fourth week, nurses will be brought together, educated, trained, and tested on the new change. During week five, the new change will start to be put into place. The nurse manager will make sure that the execution team gets daily reports on patient falls. These reports will be used as a measure of success during benchmarking.
For goals to be met, the suggested change will need both material and human resources. With the new change, the group will need a computer system to track and store information about patient falls. As part of the new project, nurses will be taught and trained to do hourly rounds. For education, there will be a room with seats for staff, extras like monitors and mics, notebooks for taking notes, and attendance sheets to make sure that everyone shows up. For the training classes and weekly meetings of project stakeholders to talk about the project’s progress, money will be needed. The clinical nurse educator and other important people will be there to talk about how important the new change is for the group.
Proposed Theory of Change
To keep up with how quickly healthcare is changing, there needs to be a change. Organizations that can handle change do well, while those that can’t adapt to new changes may have to close or go out of business. Change management is different for different kinds of organizations, and there are different ways to explain it. The change management model by Kurt Lewin is one theory that shows how businesses can adapt to new changes in three easy steps. The model talks about change in terms of three stages: “unfreezing,” “moving,” and “refreezing.”
The beginning of change management in a business can be seen in the unfreezing stage. This stage is all about making sure the organization is ready for change by getting the staff ready to understand and accept the need for a new change. (Wojciechowski et al., 2016) This means breaking down the status quo and pushing the way things are done now to create a sense of urgency for new changes. Lewin said that it was important to get support from the management and other important people in the company because they have the power and influence to change the process. During the unfreezing stage, it’s important to talk to people so that they can be persuaded to accept the new change.
People are in the changing or moving stage when they have accepted the need for change and are going toward the new ways of doing things. During this time, there is some uncertainty in the organization, which means that the new ways need to be watched and changed. Change should be put into action at this point in a methodical way with consistent communication. Leaders and the management team can help change go more smoothly by showing support and letting workers know why they need to change. Lewin said that quick steps to help with the new change will include showing employees how to act, making quick plans, and reminding employees.
(Wojciechowski et al., 2016) The refreezing stage includes making the changes permanent and making sure they are widely accepted, used all the time, and part of the organizational culture. At this point, there should be a clear plan for how to keep the new change going, such as through education and training. Any way possible, the workers should be helped so they don’t go back to the old ways. To support the new change, you can do things like give rewards, set benchmarks, and celebrate the success of the change. For example, after a process improvement, a company can use policies to help keep the change going.
Lewin’s theory on how to deal with change will be used to make plans for preventing falls in the company. During the “unfreezing” stage, I will talk about the gap in the group that is causing more people to fall. Finding out who the important people are, like the administration and the nurse trainer, will make sure that the new change has support. During the stage of changing or moving, it will be important to stay in touch so that comments can be given on time. Staff education and training will make sure that people understand why the new change is important. Regular reviews will make sure that the nurses stay on track and that any changes to the original plan are made. In the refreezing stage, the new change will become the norm in the company. If the new strategies are put into place well, rules will be made about rounding the hours. As part of the plan to keep the new change going, new workers will be taught how to avoid falling.
Problems with Getting Things Done
There are sure to be some problems with the new plan to stop people from falling. First, even though many hospitals have put evidence-based practices in place, falls are still a problem. There could be problems getting the staff and the people in charge of the hospital to agree to the change. Second, it might be hard to fully use hourly rounding because of the problem with hiring. Each unit doesn’t have enough nurses, which will make it hard to do meaningful rounds every hour. Due to time constraints and different shifts, it’s also hard to teach the staff how to keep people from falling. For example, it will be hard to find time for schooling for people who work at night. This means that staff might not understand the health problem very well, which could make it harder to reach the goal.
Agency for Healthcare Quality and Research. (2018). Preventing patient falls: Overview. Retrieved from https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/overview.html#Problem
Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., & Beil, T. L. (2018). Interventions to prevent falls in older adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 319(16), 1705-1716. DOI: 10.1001/jama.2017.21962
Hopewell, S., Copsey, B., Nicolson, P., Adedire, B., Boniface, G., & Lamb, S. (2020). Multifactorial interventions for preventing falls in older people living in the community: A systematic review and meta-analysis of 41 trials and almost 20 000 participants. British Journal of Sports Medicine, 54(22), 1340-1350. http://dx.doi.org/10.1136/bjsports-2019-100732
Lee, A., & Hayter, M. (2019). Evaluating falls prevention strategies in community settings: Marginal reduction on rate of falls with individual risk-based multifactorial interventions compared to ‘usual care’. Evidence-Based Nursing, 22(1), 20-20. http://dx.doi.org/10.1136/ebnurs-2018-102995
Linehan, J., & Linehan, J. (2018). Fall prevention in long term care using purposeful hourly rounding. Journal of the American Medical Directors Association, 19(3), B17. https://doi.org/10.1016/j.jamda.2017.12.056
Morris, R., & O’Riordan, S. (2017). Prevention of falls in hospital. Clinical Medicine (London, England), 17(4), 360–362. https://doi.org/10.7861/clinmedicine.17-4-360
Najafpour, Z., Godarzi, Z., Arab, M., & Yaseri, M. (2019). Risk factors for falls in hospital in-patients: A prospective nested case control study. International Journal of Health Policy and Management, 8(5), 300–306. https://doi.org/10.15171/ijhpm.2019.11
Schuchman, M., & Graziano, J. (2020). Management of frequent fFalls. In Home-Based Medical Care for Older Adults (pp. 49-55). Springer, Cham. https://link.springer.com/chapter/10.1007/978-3-030-23483-6_8
Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A case review: Integrating Lewin’s theory with lean’s system approach for change. Online Journal of Issues in Nursing, 21(2). DOI: 10.3912/ojin.vol21no02man04
World Health Organization. (2019). Patent safety. Retrieved from https://www.who.int/news-room/fact-sheets/detail/patient-safety
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