Problems with the Fall Prevention Project at the SNF

Problems with the Fall Prevention Project at the SNF
Statistics from around the world show that one in three people over 65 and one in two people over 85 fall each year in a healthy community. (NICE guidelines, 2017). These odds are much lower for people who live in nursing homes, where the chance of falling is three times higher and the chance of getting hurt is even ten times higher. (Cooper, 2017). Cooper says that falls are the cause of 40% of nursing home admissions, which could be made worse by the general belief that falls are inevitable.

Falls are widespread, especially among older people in nursing homes. They can lead to injuries, loss of independence, and make health problems worse. There are several reasons why this group of people is more likely to fall at health care facilities than other groups. Some of the reasons are an unstable gait or balance, weak muscles, poor vision, certain medicines, conditions like dementia, stroke, low blood pressure, Meniere’s disease, etc., a bad patient environment, and wearing shoes that don’t fit well (Alert, 2015).NICE recommendations from 2017 say that there are more than 400 things that can make someone more likely to fall. These things are different for each person, so it is important to come up with suitable and effective ways to keep these people from falling to keep their health in good shape. A risk rating that takes into account more than one factor lets people get help for specific risk factors, which helps stop people from falling again. (NICE guidelines, 2017). Since keeping patients safe is one of the organization’s top goals, it is important to take steps to make sure that patients who are getting therapy don’t fall.

The problem was looked into.

In skilled nursing care centers, it is not unusual for patients to fall. WHO (2018) says that a fall is “an event in which a person unintentionally comes to rest on the ground, floor, or other lower level.” WHO found in 2018 that it is the second top cause of accidental injuries and deaths around the world, especially for adults aged 65 and up. Globally, about 646, 000 people die from falls every year, and about 80% of those deaths happen in low- and middle-income countries. (WHO, 2018). The World Health Organization also says that of all the falls that happen every year, 37.3 million are bad enough to need medical help. Cooper (2017) found that people in nursing homes have three times more chances of falling and ten times more chances of getting hurt than the general community outside of care facilities. Cooper (2017) says that 40% of people who go to skilled nursing care homes are there because they fell.

The Alabama Department of Public Health is one of the groups with a stake in Alabama SNF. According to their statistics, falls are the second top cause of spinal cord and brain injuries in adults 65 and older. The Alabama Trauma Registry found that falls caused 3627 cases of traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) that were reported across the country between 1998 and 2001. (Alabama Department of Public Health, n.d). 49% of the cases, or 1,795 of them, were found to be Alabama residents aged 60 and up. This is a very high number. (Alabama Department of Public Health, n.d). These high numbers show how important it is to avoid falls by focusing on education, making patient environments safer, and putting in place effective policies that try to reduce risks.

An analysis of how things are going

Several studies and thorough reviews have been done to find out why the number of falls in skilled nursing facilities is going up. Datta, Datta, and Elkins (2019) say that falls are now a major health problem in the U.S. because there are more than one million people living in nursing homes. Statistics show that 60% of nursing home residents fall each year, causing serious injuries, some of which are deadly. (Datta et al., 2019).

There are both internal and external factors that can make someone more likely to trip and fall. Extrinsic forces are those that come from the outside. They include things like bad lighting, loose rugs, shaky furniture, shoes that don’t fit right, too much stuff on the floor, and patient beds without handrails. (Alert, 2015). Datta et al. (2019) say that 16–27% of falls in SNFs are caused by things in the surroundings. Every year, environmental factors cause the falls of three out of every four nursing home patients. (Datta et al., 2019).

Intrinsic factors include an unstable gait and stance, cognitive impairment, age, and sex. (Datta et al., 2019). People with cognitive impairment are more likely to fall than other older people because they are less aware of safety. At least half of the people in nursing homes have been labeled with cognitive impairment, and many more have mental health problems like dementia that have not been found. (Datta et al., 2019). NICE standards from 2017 show that people with dementia are four to five times more likely to fall. Almost a third of the people who live in nursing homes have been identified with dementia. (Datta et al., 2019). Some psychoactive drugs also make it hard to think clearly and make good decisions. However, these effects go away when the drugs are stopped. Some of the most common side effects of these drugs are loss of balance, drowsiness, and less agility.

Some medical problems, which are common among people who live in nursing homes, also make it more likely for people to fall. Meniere’s disease, which affects the middle ear and causes dizziness and falls, is one of these diseases. Parkinson’s disease affects the part of the brain that controls walking and standing. Arthritis is also very common. It affects the bones, which are the body’s main support systems and keep it balanced. The high number of falls in older people who live in nursing homes is partly due to the fact that many of them have these illnesses.

The proposed answer to the problem

Several studies show that falls in skilled nursing homes are caused by more than one thing. In order to improve the quality of care, the suggested interventions need to target not only the risk factors in the group of patients, but also the risk factors in the group of care givers. Cooper (2017) says that the number of falls in hospitals has gone down significantly since the introduction of interventions with multiple parts.

The first step would be to do a risk assessment to find out how likely it is that a patient will fall. This can be found out by asking a lot of questions about the patient’s past, like if they have fallen in the last year, if they have low blood pressure when they stand up, if they have trouble thinking, if they take psychotropic drugs, if their gait is unsteady, etc. After the exam, a unique plan is made for each patient to meet their needs.

Keeping a 30-minute check-in list for people who are more likely to fall is one of the best ways to prevent falls. The list has the important parts or elements that keep high-risk patients from falling or getting hurt, and every time the nurse checks, she has to make sure they are in place. Use of bed/chair alarms, especially for people with dementia or who are very sick, is close to this strategy. If the patient moves even a little bit, these alarms go off, which tells the nurse on call. Second, the number of falls has gone down a lot when the right assistive gadgets are used to help with physical and sensory impairments. Some helpful aids include handrails on both sides of stairs, high-friction treads on bare wood steps, a raised toilet seat with handles, and so on.

Educating clients is also a big part of keeping them from falling. The NICE guideline from 2017 says that people should be taught about falls and how to avoid them. Datta et al. (2019) agree that this makes patients much more aware of safety issues and decreases their fear of falling. Alert (2015) says that nurses should think about things that affect how people age and how to use learning tools that are recommended for older people.

Sources that should be used to put the ideas into action

To put the suggested interventions into action, the program will need one month, money, and people from different fields. Also, a change agent will be needed to teach the SNF the new ways of doing things, which will also take teamwork. For the planned intervention practices to work well, the management and other staff members are also needed.

Falls can cause serious injuries that cost a lot of money to fix. WHO (2018) says that every harm caused by a fall costs the health system in the Republic of Finland $3,611 and the health system in Australia $1049. More evidence from Canada shows that the number of falls among children under 10 years old could go down by 20% if the right prevention methods were used. Because of this, more than US$120 million have been saved each year. Clearly, the economic costs of falls are higher than the costs of putting the suggested solutions into place. Also, the benefits of putting the measures into place show how important it is for SNFs to do so.

How important each partner is

For the strategies to avoid falls that have been suggested to work, people will need to work together. The head of nursing, MDS, resident care manager, nurse practitioners, doctors, and physical therapists would all have important things to say about how to reach the goals. The professionals in the administrative arm will help figure out if the nursing homes are ready to implement the interventions and create the clinical paths needed to carry out the activities. (Datta et al., 2019). The nurse practitioners will help educate both patients and people who work in health care.

How I plan to work with the people who matter

First, it’s important to note that this project can only be successful if people from different fields work together. So, I plan to include everyone who has an interest in the project at every step of putting it into action. First, I would ask the administrators and managers (the head of nursing, the MDS, and the resident manager) how ready the SNF is for the interventions. We would check to see if the hospital beds are in good shape so that bars and bed alarms can be added. We would look at the surroundings and think about things like lighting and extra treads. I would have doctors take part in the review of psychiatric drugs that cause people to fall. I would have nurse practitioners teach patients about safety to make them more aware of their surroundings and lessen their fear of falling.

How nurse practitioners are trained

The most important thing to do is to train nurse practitioners, since they play a big part in keeping people from falling in SNFs. First, they should be shown how to use the fall risk assessment tool when they are admitted and after they have fallen. (Cooper, 2017). They should be taught about the different ways to help each patient based on the results of the fall risk assessment. They should also know what causes falls and the injuries that come with them. They should also know what part each healthcare provider plays in the interdisciplinary approach to dealing with falls. (Alert, 2015). Lastly, they should be able to understand and use the changes to the environment that are part of the strategies to avoid falls.

Before starting the program, it is very important to get baseline data to compare with the results and see if there are any differences. The history of falls in the hospital and the most common risk factors are part of the present baseline data. By comparing the baseline data to the results of the program, real feedback will be made, which will have a big effect on the desired outcome.

At the end of the program, assessments will be done to see if the goals that were set have been met. Cooper (2017) says that assessment is the way to figure out how well the program works. For this program, the evaluation will be focused on the results, so that both patients and healthcare providers can see how the program helped them.

Taking on different roles during the creation of a proposal

First, I put myself in the shoes of a scientist and found a study problem: the high number of falls among SNF patients. I came up with the right research questions, which are “How often do patients in SNFs fall?” and “What role do stakeholders play in keeping patients in SNFs from falling?” I also did the study by doing a systematic review of different scientific studies that had already been done. The results helped me come up with an answer to the problem and how to put it into action. Second, as a spy, I used my creativity and ability to think critically to come up with a plan for how to carry out the program. It is important to compare the baseline data with the results of the program to see if there is a change. In this case, the baseline data includes past trends of falls, cognitive impairment, and functional dependence, among other things. Third, in my job as a manager of the healing environment, I was able to see how the surroundings of both the patients and the people who care for them can make them less safe. So, I was able to offer ways to improve the patient’s environment to keep them from falling. Some of these tactics are using bed alarms, adding handrails to beds and stairs, and putting more treads on smooth wooden floors.

References

Alabama Department of Public Health. (n.d). Injury Prevention Plan of Alabama. Falls in the Elderly. Retrieved from https://alabamapublichealth.gov/injuryprevention/assets/FallsinElderly.pdf

Alert, S. E. (2015). Preventing falls and fall-related injuries in health care facilities. The Joint Commission, 55, 1-55.

Cooper, R. (2017). Reducing falls in a care home. BMJ Open Quality, 6(1).

Datta, A., Datta, R., & Elkins, J. (2019). What factors predict falls in older adults living in nursing homes: a pilot study. Journal of Functional Morphology and Kinesiology, 4(1), 3.

NICE guidelines. (2017). Falls in Older People. Retrieved from https://www.nice.org.uk/guidance/qs86

World Health Organization, WHO. (2018). Falls. Retrieved from https://www.who.int/news-room/fact-sheets/detail/falls

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