Project proposal concepts and framework

Hospital Falls

Fall Prevention

Falls are the leading cause of hospital related injuries in the United States. There are many surprising factors that affect patients in regards to hospital falls; they involve patients of all ages and over a range of different scenarios. As a result the fall incident rate has been the target of the academic world and professionals alike as inpatient falls are serious patient safety and quality issues. Fall prevention is an important aspect to patient safety and effective communication among staff, patients, and their families is required to mitigate potential risks. This project will outline an effective strategy for outlining an intervention that implements a proactive fall prevention program. Patients injured in a fall incur increased hospital costs due to additional treatment and longer lengths of stay (Pearson, Coburn, 2011). According to the IOM, (Institute of Medicine) creating safe, effective, patient-centric, timely, efficient, and equitable care has become the structure for the national patient safety movement, built upon clinically excellent care (Joint Commission National Patient Safety Goal, 2014).

Goal Statement

This project will consist of interventions that include education and process improvements that are aimed at reducing the level of patient fall rates. The goal of the project will be to identify and implement successful intervention strategies that can be used in an effective manner to reduce the amount of patient falls that occur at the hospital.

Project Objectives

This project will implement a pilot program with a purpose to reduce the number of patient falls and preserve patient safety in a pilot program at the hospital. This project will consist of interventions that include education and process improvements that are aimed at reducing the level of patient fall rates on a departmental level with one department serving in the role of the pilot study. The goal of the project will be to identify and implement successful intervention strategies that can be used in an effective manner to reduce the amount of patient falls that occur at the hospital. The project will be successful if there is data collected after the pilot that suggest an improvement in the fall rate.

Methodology

Historical data will be collected from hospital records to produce a baseline fall rate at the hospital. Then a literature review will be conducted to identify some of the most effective fall prevention strategies that have been implemented in other facilities. The best practices used in these strategies will be customized to fit the department that was chosen to participate in the pilot program. After the intervention has been conducted in this department, data will then again be collected and a statistical analysis will be compared the baseline data.

Literature Review

Quite little is known about the extent to which fall prevention interventions can be successfully implemented in an acute care facility. Systematic reviews and meta-analyses of falls rely on randomized controlled trials, which are challenging to perform. Evidenced-based literature on falls and fall prevention focuses more on community settings rather than hospitals (Rand, 2003). The research literature review used to assist in finding the best evidence-based process would be to use the (PICO) method, the acronym for Population, Intervention, Comparison and Outcomes. The PICO perspective the project will hopefully produce outcomes that are successful in the pilot program.

Fall-related injuries can be some of the most common, disabling, and expensive health conditions encountered by adults, especially older adults. (Schwendimann, Buhler, De Geest, & Millsen, 2008) The research has identified many specific risk factors including environmental hazards, adaptive equipment maintenance, psychotropic drug use, physical therapy or exercise, staff education, post fall problem solving, and hip protectors (Colon-Emeric, et al., 2006). However, implementing an intervention strategy to address the environmental conditions and the human conditions that can work to mitigate the risks associated with patient falls.

There have been many attempts to implement an evidence based approach to reduce the instances of falls that have shown to be successful in certain areas. For example, an evidence-based nursing guideline had been locally developed in 1993 to reduce fall incidence rates, creating a thirty percent reduction in the fall rate post-implementation (Semin-Goossens, van der Helm, & Bossuyt, 2003). However, the literature has produced many studies that have shown conflicting outcomes of interventions. Yet, in the studies that found positive outcomes, interventions have indicated that a fall-risk assessment on admission and reassessment after a fall additional supervision and assistance with the patients' transfer and use of the toilet, provision of an information leaflet, individual patient and caregiver counseling, encouragement of appropriate use of eyeglasses, hearing aids, footwear, and mobility devices, and staff education (Von Rentein-Kruse & Krause, 2007).

One study that indicated what could be considered a positive outcome used thirty six participating community nursing homes also well as data from over three hundred nonparticipating nursing homes for a control measure in a data set to describe the changes in process of care before and after an evidence-based fall reduction quality improvement collaborative in nursing facilities (Colon-Emeric, et al., 2006). The researchers in this study found that even though many of the risk factors associated with falls were significantly reduced that the actual outcome of the post intervention fall rates were not significantly different than the control group. Therefore, these is some question of whether or not the pilot program will be successful using the intervention program identified.