Fall Reduction Project: An Evaluation of the Implementation Process Chapter 3: Implementation

In Brief

Blank hospital had a significant increase in falls in the inpatient acute care setting. For this reason, the need for an immutable and comprehensive fall strategy was identified at the hospital following an evaluation of the various costs (both financial and ethical) associated with falls deemed preventable. Towards this end, a fall prevention project was undertaken. I was responsive for overseeing the fall prevention project implementation.

1. Description of Steps

· Pre-implementation phase

· Implementation phase

· Sustainment phase

1.1. Pre-implementation Phase

The pre-implementation phase took a total of 2 months. In essence, pre-implementation phase was meant to prepare the entire facility for the actual phase of implementation. Towards this end, various steps were undertaken. These will be highlighted below.

1.1.1. Identification of Improvement Opportunities

This was founded on the collected fall data. There was an observed increase in the number of falls in the inpatient units. In essence Blank Hospital did not have in place a well-defined fall prevention strategy. There were a number of issues that were identified as contributing significantly to falls. These could be grouped as patient factors and contextual, situational, as well as environmental factors. Patient factors were inclusive of medications impeding orientation, perceptual impairments, orthopedic concerns, muscle weaknesses, and age. On the other hand, contextual, situational, as well as environmental factors were largely inclusive of physical obstacles that further enhance the risk of falls, poor furniture or bed positioning, slow response times to patient alerts, and poor monitoring of patients. In that regard, therefore, a multidisciplinary, multifaceted intervention approach was proposed with the identified areas of concern being leadership and management, human resources, quality assurance processes, communication, physical design, and policy drafting.

1.1.2. Prioritization of Improvement Opportunities

Here, the most critical improvement opportunities were identified. This was particularly important given that an attempt to tackle all the identified issues at the same time was likely to be overwhelming and therefore prone to failure. For this reason, only a few interventions were identified as being worthy of immediate attention. The identified areas of concern that were taken into consideration on this front were inclusive of

· Leadership and management

· Human resources

The implementation team met twice a week for a period of 1 month to fine-tune prioritizing opportunities.

1.1.3. Action Plan Refinement

Following the identification and the prioritization of opportunities for improvement, the action plan was further refined. The following items were assessed:

· Sensitize management on the need for change

· Identify and address the gaps in staff competency and education

Further, it should also be mentioned that in addition to the two items identified above, the roles and responsibilities of key unit persons were identified and those accountable for implementation monitoring recognized. The specific metrics to be utilized in the assessment of changes in performance were also identified. Effort sustenance mechanisms were also addressed.

1.2. Implementation Phase

The implementation phase took a total of 5 months. In basic terms, this phase was largely focused on the implementation of the two interventions that had been fine-tuned in the action plan.

1.2.1. Sensitize Management on the Need for Change

The relevance of obtaining management support in the implementation of change cannot be overstated. It is important to note that in some instances, the same management/leadership that champions for improved performance in some cases derails change efforts in what appears to be a curious irony. Essentially, this happens through failure on the part of management to advance the necessary support to the change initiatives. It is for this reason that the fall prevention project recognized the relevance of management in this endeavor. The roles of the management in this undertaking have been defined below.

· Commitment of resources: it should be noted that I was fully aware of the fact that for this project to succeed, adequate resources had to be committed. Some of the resources that were needed in this endeavor were inclusive of the more tangible resources like new items and products, and the intangible resources such as education and training time,...

The commitment of the said resources was a managerial function. In this case, the management committed sufficient resources at every stage of the fall prevention project.
· Formulation of a steering committee: there was need to develop a link between the management and I. In addition to fast tracking the recommendations made, the steering committee would help in the facilitation as well as proper coordination of the identified courses of action. In this case, the steering committee met every two weeks to hear or deliberate upon the recommendations made.

· It was also recognized that the management would be of great relevance in the management of resistance to change. The fall prevention project called for the adjustment of various procedures and the adoption of new ways of doing things. There were no guarantees that all the key stakeholders would be appreciative of the courses of action adopted.

In seeking to gain the full support of management, I engaged in the following undertakings:

· Demonstration of the necessity of the fall prevention project: in this endeavor, I made use of statistics demonstrating that, amongst other things, falls in the inpatient acute care setting had increased by more than 30% over a two-year period.

· Preparation of the budget and demonstration of the long-term financial implications of preventing patient falls: suggestions were made on how the fall prevention project would be funded. In this case, a suggestion was made to the effect that the reduction in costs associated with patient falls would in the long-term help offset the costs incurred in the implementation of measures to curb patient falls. It is important to note that at present, patient falls that result in injury do not receive any reimbursement from Medicaid/Medicate. Other insurance companies are embracing a similar stance. Essentially, if a fall resulted in the patient extending his stay in the facility, Blank Hospital took a loss for the elongated stay.

· Issuance of regular updates: the management was kept fully aware of all the key factors relating to the project. This was done so as to ensure that the management was fully aware of the fact that it was part and parcel of the fall prevention project.

· Fitting into managerial goals: Blank Hospital already had in place other objectives competing for the same resources that the fall prevention project was after for successful implementation. For this reason, I had to indicate how the fall prevention project would complement some of the other key hospital goals and objectives. More specifically, the fall prevention project was tied to the hospital’s objective of providing a safe and therapeutic environment that supports patient treatment and continued wellbeing.

1.2.2. Identify and Address the Gaps in Staff Competency and Education

Measurement of nurses’ knowledge as well as capabilities in fall prevention revealed the need for training. In this case, it was found that for training to be effective, it had to be integrated with the prevailing work routines. The full implementation of fall precautions called for the training and retraining of all hospital staff that interacted closely with patients. I felt that the only way for the fall prevention measures to be embedded deeply into the culture of Blake Hospital was via effective and comprehensive employee training on fall prevention. Towards this end, training focused on the following three areas:

· Fall risk assessment

· Adherence to the fall prevention strategies/approaches

· Identification of the steps to take in case a fall occurs

1.2.2.1. Fall Risk Assessment

· Medication fall risk assessment: pharmacists were introduced into the Medication fall Risk Score with an intention of ensuring that are capable of assessing hospital patients’ medication-related risk factors for falls. In seeking to determine if a patient is at risk for falls so that care can be planned as appropriate, the tool was utilized alongside a nursing risk scale and a clinical assessment.

· Fall risk factors identification: staff nurses were introduced to the Morse Fall Scale for Identifying Fall Risk Factors. This is an important tool for the identification of hospitalized patients’ risk factors for falls. It is important to note that in seeking to predict future falls, the total scores gathered in this case can be utilized. Staff nurses were instructed on how to plan care using the risk factors identified using the scale – with the said planning meant to address…