Part 3: Formulate possible evidence-based practices and an action plan that could work towards achieving improvement outcomes.

Provide insight into the diagnostic processes (e.g., root cause analysis) used to determine the primary causes of the problem. Consider both qualitative (cause-effect diagram, barrier analysis), and quantitative (theory testing or drill down analysis) methods.

Analyze the cost-effectiveness of your initiative and how your initiative mitigates risk and improves health care outcomes.

Countless interventions have been used for fall prevention amongst the elderly population. These include risk-assessment and management programs, I.e. Designed to screen those who are most at risk and to design interventions that will reduce their risk of falling; exercise programs slanted dot enhancing flexibility, endurance, and strength; education programs (including one-to -one counseling on methods to prevent falls); environmental modification in homes or institutions (and amongst environment engineers in the outside environment such as parks streets and so forth); medication; and nutritional or hormonal supplementation. .

In a 20001 exhaustive review of 62 studies and trails and incidents related to falls amongst an elderly population (65 +), Gillespie and colleagues concluded that the most effective interventions are those that target already known fallers, rather than being general in their approach. Individual tailored packages may be no less effective than 'packages delivered INS group format, and duration or intensity of management is also not shown to have significant results.

Exercise is effective, particularly that focusing on endurance, balance, and strength. Of all the exercises types, they found brisk walking to have the least impact. Ebrahim (1997) for instance reported that al his women in his brisk walking study group had had a limb fracture within the last two years, and progressive resistance exercise also consequents in more falls. Environment modification (aimed to reduce falls form occurring on the home premises by modifying elements) appears to be somewhat successful, but only when used in synthesis with other strategies.

There was no evidence that cognitive / behavioral interventions alone reduced falls, and incomplete evidence discovered that gradual reduction of medication reduced falls. In a more specific sense, vitamin D supplements do show some promise for reducing falls, but more studies have to be conducted to corroborate the effect.

In a met analysis study conducted by Chang et al. (2004), researchers scrutinized the following five factors -- multifactorial falls risk assessment (I.e. individuals who had a history of falling and were most likely, therefore to fall), management program addend to individuals who displayed increased risk of falling (addressing these risks; such a program often included drugs), exercise, environmental modification, and education. The researchers discovered that the interventions most effective in preventing falls were exercise and falls risk assessment and management program. Education (aimed to instructing seniors how to mitigate their tendency to fall and conducted via pamphlets or posters at community centers to more intensive one-to-one counseling) was found to have negligible effects, as too was environment modification (where the immediate housing environment was engineered so as to prevent falls form occurring, more especially and to exemplify to monitor lighting, sliding carpets etc. And to remedy situation). For falls reduce the risk of falling of people who fell at least once and curtail the monthly rate of falling. Corroborating previous research that measured types of exercise (including endurance, tai chi, resistance, platform balance, and flexibly) it was found that no difference what the type of excise, exercise as a whole, particularly that that includes aerobic endurance, walking, cycling, gait-related practices, and other endurance related themes - was effective in reducing falls. Balance, gait, and strength were the recommended areas of focus. An integrated approach combining all three was ideal.

An international analysis of falls found that proportion of falls had risen in recent years (Brown, 2012). Why this is so, and indeed if this is so, is an interesting question in its own way. It may be that the incidence of higher increase f elderly and of people living longer lives may consequent in the larger record of falls. Either way, Chang et al. (2004) emphasize that understanding incidents that can induce and are related to falls is crucial in order for nurses to prevent falls form occurring and to deal with their patients in a mascot effective way. One of the ways in which this can be done is by recognizing individuals who are more immune to falling and by designing the institutional / hospital environment in such a manner so that it more readily discourages falls.

Chang et...

(2004) recommend adopting a two-pronged approach to fall intervention where a multifactorial falls risk assessment would be used in combination with a management program that would largely revolve around exercises. Both, too, would be targeting a selected population who has a history of falls, although the exercise programs could be generalized to anyone. Level of supervision and intensity are needed.
Implementation of such a program would help elder adults retain two of their most valuable resources -- independence and functionality -- as well as (amongst other factors) reducing burden of care on caregivers and reducing related national cost.

In a similar manner, Gillespie et al. (2001) recommended a program of muscle strengthening and balance retiring, as well as a 15-week Tai Chi group intervention program. Unlike Chang and colleagues, they thought home modification could be helpful; that psychotropic medication should be reduced; that a multifactorial risk assessment and management program should be implemented in connection with both individuals and in institution, and that this should be targeted towards individuals with a history of falling; and that cardiac pacing should be inserted in fallers with a history of cardio inhibitory carotid sinus hypersensitivity. Interestingly enough, individual exercise seemed more effective than exercise delivered within a group environment; national supplement was questionable; as was pharmacological therapy, home modification delivered alone; hormone replacement therapy; and correction of visual deficiency. Brisk walking in women over 65 should be discouraged.

A program could be put in place that would integrate each of these approaches mentioned above; the program would feature a combination of exercise, diet, instructional, and environmental components.

The program would also feature incorporation of some novel findings that have recently appeared and are debated in medical literature, namely whether or not Vitamin D reduces falls. There is no conclusive evidence on the subject although researchers have unanimously agreed that providing the Vitamin can only help and currently does not hurt. We will, therefore, incorporate Vitamin D in our agenda and keep a regular log monitoring whether or not admission of the drug reduces falls.

Brahe's germinal study on the subject investigated 2 questions: firstly whether or not Vitamin D was helpful in reducing falls. Secondly, if so which level of Vitamin D would be helpful in preventing falls. The study framework was a double blind, control design group. With participants being randomly selected and divided between 5 groups. The research design was done in as objective a way as possible. One single environment -- the Hebrew Rehabilitation Center for Aged (HRCA) - was chosen. 187 participants were carefully selected from within this population. Even though this was a convenience sample, the participants themselves were randomly divided between the 5 groups (one control and 4 Vitamin D treatment oriented). The whole occurred over a 5-month span. Baseline measurements of Vitamin D (and other patient characteristics) were taken at the outset as well as during the session period. A database of the amount of falls that the hospital had experienced (the facility incident tracking database) was assessed. Nurses gave participants daily the Vitamin D / placebo. Blood serum was taken. An objective outsider matched the serum results with the ratio of falling. Compliance was also recorded by blister pack counts after the completion of the study.

The researchers measured their current quantity of falls to the amount of falls that had occurred in the hospital's past amongst their participants. The other measurement was the blood serum of Vitamin D This seems reliable to me.

Baseline measurements of Vitamin D (and other patient characteristics) were taken at the outset as well as during the session period. A database of the amount of falls that the hospital had experienced (the facility incident tracking database) was assessed. Nurses gave participants daily the Vitamin D / placebo. Blood serum was taken. An objective outsider matched the serum results with the ratio of falling. Compliance was also recorded by blister pack counts after the completion of the study Analysis of variance (ANOVA) was used for continuous variables and chi-square tests were used for categorical variables. Poisson regression (to correct for over dispersion and used as model count) was used to compare the amount of falls of each of the groups to that of placebo group. Each of the analyses was adjusted for age and vitamin use. Because not all were taking the vitamin D and some may have been taking it outside of the study, a secondary statistical analysis was conducted investigating study pill + vitamin, again using ANOVA, chi-square and cox.

The researchers concluded that Nursing home residents in the highest Vitamin D group (800…