NURS2006 Clinical Practice Improvement Project Report

Project Title:

Falls prevention education among elderly patient during and after hospitalization

Project Aim:

This Project aims to provide concise strategies, educational interventions, and plans which is necessary to address so that fall related episodes among elderly people before and after their discharge could be prevented within 6 months of time and will be compared to their understanding of this situation at the commencement of application of intervention. The project interventions or strategies are relevant as it is feasible to apply those in geriatric ward for fall prevention education.

Relevance of Clinical Governance to your project

Clinical Governance is the aspect, which helps to promote upgradation of healthcare service by reviewing, promoting, measuring and monitoring the quality of care which is received by patients. It compares the existing standards or interventions with the modified versions so that the improvement and upgradation could be understood and continuous improvement to the quality of service could be achieved (Heyrani et al. 2012). In this project related to fall prevention education among elderly people while receiving care or after their research, importance of two pillars of clinical governance could be identified and these are participation of stakeholders and clinical risk management. This is because to prevent fall among elderly people, it is important to provide them with details about the risk, the lethality of the risk and ways using which their fall episodes could be prevented (Dalton 2012). On the other hand, it is also important to improve or enhance the quality of the healthcare process and provides a coordinated approach to the educational or intervention related strategies which are to be implemented to prevent fall among elderly people before or after their discharge from the facility (Heyrani et al. 2012). Further, these two pillars emphasizes on equal participation of patients or elderly population with that of care professionals to determine that the risk of fall could be prevented among elderly people (Ravaghi et al. 2013).

Evidence that the issue / problem is worth solving:

As per the reports of World Health Organisation (2018), fall is the second primary reason for accidental or unintentional injury which leads to death among older population as the older generation suffers primarily due to the fatal effects of fall. Reports further determine that 37.3 million falls were reported all over the world which were severe and required immediate medical attention. As per the reports of Centers for Disease Control and Prevention (2018), fall is the primary reason for injury related death among elderly population and the rate increased from 31% to 61.6%. as per the Australian Statistics provided by the Australian Institute of Health and Welfare (2017), the year 2012-13 witnesses more than 98,000 fall related cases within which 26% was for elder population who experienced fall and more than 72% falls were recorded in healthcare facilities or patient residence.

With increased age the risk of fall also increases, as it has been seen that after the age of 60, functional abilities tend to decrease due to which people are unable to fulfil their activities of daily life and suffers from the risk of falling.  Further falls also decreases the abilities of people to perform physical exercises, their mobility and increases their dependency on others.

Key Stakeholders:

Key stakeholders involved in the planning, implementation, evaluation and determination of strategies related to fall prevention among elderly population is Australia are divided among two sections, primary and secondary stakeholders. Primary stakeholders are directly involved in the process such as governmental departments, healthcare professionals and patients, whereas secondary stakeholders involves non-governmental organisations, communities, occupational therapists and physiotherapists. The role of primary stakeholders to regulate the norms and upgrade them so that elderly people with severe risk of fall could be provided with educational or intervention related strategies so that episodes of fall could be prevented. Whereas, the role of secondary stakeholders is to provide support and accepting the interventions so that implementation of regulations related fall prevention could be properly implemented.

CPI Tool:

This project chooses and implements the Plan-Do-Study-Act or the PDSA model which aims to decrease the fall episodes in elderly patients in healthcare facilities of Australia within 6 months of period (Sutterfield and Daramola 2016). For This purpose, the PDSA model involves two important strategies such as improving communication within healthcare facilities and professionals so that the strategies and ideas could be transferred from one person to another. This CPI tool is an application based tool which helps to identify the problem and then determines and provides ideas and strategies using which the problems could be overcome (Gabrielian et al. 2013). One of the primary things which should be remembered while using PDSA a CPI tool should be completed within the relative pace and should encourage the momentum of the acceptance of the interventions (Farrar 2015). The primary reason, due to which PDSA is successful in implementing the change it requires, is its narrower focusing and quick implementation strategy which helps to develop the continuous improvement for work (Siracuse et al. 2012).

To prevent fall among elderly population of Australia before and after their hospital stay, it is important that they are aware of the fall related risks, the strategies of fall management and the severe implication of fall in their health so that fall could be prevented (Sutterfield and Daramola 2016). as the CG pillars chosen for the project focuses on the implication of involvement of stakeholders in the intervention and managing the risk of clinical risk of fall within the healthcare facility so that people with severe risk of fall could be provided with intervention to protect them of fall episodes (Klee et al. 2012).

Application of this tool could easily implement the interventions which can prevent fall in elderly people after their discharge. Implementation of healthcare education related intervention requires the healthcare professionals to plan, do action, study or evaluate the positive and negative aspects and then act as per the requirement of the patients for the fall prevention process (Klee et al. 2012). Due to this purpose, it helps to achieve a specific measurement and assesses the difference in a specific time so that the effectiveness of the intervention could be determined. As per Cameron et al. (2012), planning is an important part of the patient education and training session as without proper planning of the session patients are unable to understand the implication of the interventions. Therefore, this CPI tool will be implemented in the project for fall prevention among elderly population after their discharge (Sutterfield and Daramola 2016).

Summary of proposed interventions:

The interventions which will be used in case of fall prevention among elderly population could be divided in two sections, educational intervention and adaptive interventions (Inouye, Westendorp and Saczynski 2014). In case of educational intervention, elderly patients, who are at severe risk of fall, are provided with educational sessions and trainings so that all the risk related to fall or circumstances which can lead to fall could be shared with the patients (Gillespie et al. 2012). Further, the strategic intervention such as taking help of healthcare professionals, using the walker provided by the healthcare professionals for their mobility or taking their each step properly should be mentioned in the strategies so that each smaller and bigger risks could be avoided (Siracuse et al. 2012). On the other hand, they should be provided with physical exercise instructions such as cardio exercises, walking, jogging so that they can enhance their mobility and prevent fall related episodes (Gillespie et al. 2012).

These two intervention categories are completely related to the two Clinical Governance pillars which were chosen and connected with the fall prevention related strategies for elderly people after their discharge from healthcare facilities (Karlsson et al. 2013). As the healthcare professionals tried to include the patients in the care process, they were provided with educational interventions and provided with all the data regarding the process so that conflict related situation among healthcare professionals and others could be avoided and patients could be educated about the fall and its severity and importance of its prevention for their health and wellbeing (Gillespie et al. 2012).  Similarly, in this project, the healthcare professionals provided the patients with healthcare management so that the risks related to management process could be avoided. The risks involved severe fall injury among elderly population which increases with increased complexity of their health and wellbeing status (Krumholz 2012).

This is the clinical practice and integration tool which is used for the panning implementation and determination of the healthcare intervention related to fall prevention related intervention in their healthcare facility stay or after their discharge (Ambrose, Paul and Hausdorff 2013). All the professionals working in the healthcare facility has several responsibilities which will be fulfilled if the older patients are provided with educational intervention to prevent fall related injury (Karlsson et al. 2013).

Barriers to implementation and sustaining change:

The barriers which are associated to fall prevention related interventions for elderly population in Australia should be provided with several enablers as social, physical, healthcare related barriers are always present which decreases the effectiveness of the intervention and the educational and other interventions are not spread among the elderly population correctly. The primary barrier can be the inability of the healthcare professionals to understand the implication of fall prevention in elderly population. Majority of the geriatric department applies the fall prevention strategies but in this does not includes the patients in the healthcare preventive intervention study, planning evaluation and implementation due to which the intervention does not reach its success. The second barrier of this project was the patients and their ignorance towards these fall preventive strategies. They  were unable to understand the implication of the fall related risk and then understand the implication of it for their growth and development.

Evaluation of the project:

The entire project of fall prevention among healthcare facilities for elderly people who are discharged from the healthcare facilities. The project provides a detailed idea about the clinical governance and determined the pillars of clinical governance which is required to change or upgrade the healthcare facilities and the quality to healthcare. In this course, it also provided some of the interventions and hence the application of CPI tools in the incidence were inferred and the application of PDSA or the planning, doing, act, strategies and action were mentioned in the aspect. Further, the mention of several barriers mentioned in the project overcoming which could be avoided so that complete success for the intervention could be achieved.