Strategy for Reducing Falls in Nursing Homes

Fall Prevention Project

The target audience for this fall prevention plan consists of RNs and LPNs who work at nursing home facilities, or otherwise work with the elderly. There is a strong body of evidence that shows that fall-related injuries to the elderly are associated with negative health outcomes that go beyond the immediate injury. The elderly are more at risk of falling than other patients are, and nursing homes are not always properly equipped, designed to prevent falls. Further, the staff at nursing homes do not always have the best possible training with respect to fall prevention. Nursing homes experience 1.5 falls per bed per year, and there are a number of precipitating causes (Rubenstein, Josephson & Robbins, 1994).

The main causes of falls in nursing homes are gait and balance disorders, weakness, dizziness, environmental hazards, confusion, visual impairment and postural hypotension (Rubenstein, Josephson & Robbins, 1994). Most of these are medical in nature. However, environmental hazards are one of the major risk factors, and it is best practice to understand what these are and ensure that the nursing home is as free from environmental hazards, such as things that people can trip over, as possible. Knowing that many of the other causal factors for falls are medical-related, nursing home staff need to ensure that they understand what they can do to help patients to prevent falls.

One intervention that has been shown effective in some situations is strengthening exercises, as weakness is something that to an extent can be prevented. Stronger seniors are less likely to fall. But more effective is that the staff need to have means by which they can recognize and identify high-risk seniors. The people who are at most risk of falling are the ones who need the most attention from staff at nursing homes, to ensure that they are not moving without help, when they should have help. Not only do falls occur at nursing homes, but often falls precipitate admission to nursing homes, as they result in the injuries that reduce a person's ability to take care of him/herself (Tinetti & Williams, 1997).

The facility at which the project is to be implemented is a skilled nursing facility. A skilled nursing facility is the highest-level of care provided to the elderly. This is a facility where the patients live, usually in a room, and they receive round the clock care. Often, they are unable to care for themselves, or at the very least require assistance to do so. Residents of skilled nursing facilities are often the very old, the frail or potentially those with some form of mental illness; in other words they are the highest risk seniors for falls and injuries due to falls (Zimmer, Watson & Treat, 1984).

The project will be completed at a medium-sized skilled nursing facility where the target audience is employed. The project is important to nursing because of the challenges that falls present to the health of seniors. A fall can mark a downward health progression. Seniors who are frail may suffer broken bones or hips as the result of a fall. When this occurs, they lose mobility. This affects their quality of life, and in many cases precipitates a decline in their physical and mental health. The residents of skilled nursing facilities are more likely to be seniors in the highest-risk categories, and therefore there is a strong need to improve fall prevention strategies at such facilities. Nurses are the front line in fall prevention, since they spend more time with the patients, and are generally closer to the patients physically at the facility. Nurses therefore are uniquely positioned to implement fall prevention strategies at nursing homes. This is why the project is important to nursing, because nurses are going to be the ones who implement the project, and both patients and nurses will benefit from a reduction in falls at the nursing homes.

To accomplish this project, the first step is to gain the approval of senior management. Ultimately, senior management will need to assess the project, and will need to make determinations about its viability. More importantly, senior management support is needed to ensure buy-in from the nurses, and to ensure that sufficient resources are dedicated to this project to bring about its successful completion.

Once senior management support is acquired, the next step is to ensure that the resources are available. Where this means training, a training program needs to be developed, and personnel identified who can deliver the training. Where this means changes to the physical layout of the facility -- such as moving furniture, or installed handrails -- then this must be implemented. Plans should be made and approved that illustrate what is required at this stage.

The nursing staff, and other staff, will be trained on the project. Each person needs to hear what the project is, why it is being implemented, and what their role in the project will be.. Ultimately, this is how buy-in can be achieved, if everybody understands what they are contributing and why their contribution is important. The nursing leaders are an important part of this process.

Finally, there needs to be a plan to assess the plan post-implementation. This is an important step, to determine what the plan accomplished. The outcomes should be evaluated in the sense of preventing falls. An assessment will need to be conducted with respect to what changes to the plan might improve its effectiveness in the future.

There are a number of potential obstacles to the plan. While the medical case for fall prevention is clear, changes to policies are often met with resistance. Change management experts note that resistance to change is common for all changes. To overcome natural, inertia-related change resistance requires a few different things. First, the organization needs to get buy-in from the leaders of the organization. If people at lower levels see that the leaders are not committed to change, they are unlikely to be committed either. Furthermore, the change needs to be communicated effectively. Workers are more likely to commit to a change program where they understand why the change is needed, what problems the change solves, and by having a vision for what the project will bring to the facility (Palmer, 2004).