Free Falls Prevention In An Inpatient Rehabilitation Unit For Patients Over 60 Years Old Research Paper Example

Abstract

Falls among the elderly people is a problem that is faced by health workers and care givers worldwide. This is a situation that affects not only the elderly patient but also the patient’s family member and health institutions. Evaluating the occurrence of falls by the Association of Rehabilitation Nurses (ARN) indicate that over forty percent of old people experience a fall every day worldwide, with the situation being more prevalent among those over sixty years of age. This is a similar case that is experienced in the rehabilitation unit where I work with the facility recording at least four cases of falls every week. This project therefore, aims at finding an effective strategy that could be used in mitigating this issue in the rehabilitation unit. The project involves the evaluation of the current strategies and measures that are used and come up with a new strategy that could be used in mitigating the issue. Several issues involving how the strategy will be implemented and evaluation process is also provided as well as the resources required to implement the strategy.

Introduction

Falls and falls related incidences and trauma is one of the most complicated issues that is facing the elderly especially those in the rehabilitation units and nursing homes. Over thirty percent of old people aged over sixty years are reported to fall daily either at home among other places, with the rates being higher in medical care units and nursing homes. The issue is further alleviated by the lack of concrete strategies and measures to identify and manage the occurrence of falls as well as lack of information on the possible causes of falls to the elderly patients. This is a problem that health workers in the rehabilitation unit have faced for a while and due to lack of an effective falls assessment tool, the cases of falls had risen tremendously, with the new patients over sixty years having a higher chance of falling during the first week of their admission. This calls for a need to analyze the cases of falls as a way of coming up with an action based plan that will assist the nurses and other staff in the rehabilitation units to mitigate issue while improving the wellbeing of the patient as discussed in this project. The main global objective of this project is to design Falls Assessment Tool that will be used to identify and prevent fall related risks. The implementation process of this project is guided by the QSEN competency of quality improvement.

Frame of the problem

Fall related incidents are more prevalent among the elderly patients admitted in the rehabilitation unit, especially those aged sixty ears and above. Falls are prevalent during the first days after the admission into the rehabilitation centers (Tinetti, 2003). This is whereby such incidences are associated with anxiety and the abrupt change of the patient’s living environment (Cannard, 2011). Other factors such as medications, environmental factors, drop attacks, visual disturbance, neurological disturbances or loss of consciousness among other health factors are likely to increase the occurrence of falls if not carefully evaluated and controlled.
The number of falls recorded among the elderly has increased over a period of time, particularly as a result of existence of other illnesses that weakens the posture of the elderly people. According to the US center for Disease Control and Prevention, approximately a third of the elderly people aged over sixty years fall each year with an elderly person being treated in the emergency room while a person dies every twenty nine minutes in the US, all resulting from falls particularly in rehabilitation centers.

Successful and unsuccessful strategies

The complexity of this issue called for the implementation of various strategies that encourages the use of interdisciplinary approach that involves the inclusion of various staff members at the rehabilitation unit to collectively come up with a solution of reducing the number of falls recorded within the unit. Some of the successful strategies include forming the safety committee with the aim of collecting and evaluation of information concerning the scope of the problems. The committee met on weekly basis to discuss the issue as well as provide insights that could be applied in reducing the number of falls within the unit. Implementation of some of the suggestions such as installing proper lighting, placing carpets and proper drying of floors, and evaluating the patients’ medical and falls related history led to the reduction rate of falls. The success was further enhanced by working with the mentor who is the unit supervisor, to identify information gaps and briefing on the current falls prevention strategies.
Involvement of interdisciplinary staff in implementing falls prevention strategies particularly those related to environmental conditions was however slow as some of the involved parties had to be involved constantly on what to do.

Stakeholders and resources

The major stakeholders in this case are the patients who are likely to incur physical and psychological damage from the fall. The family patient is also exposed to the fear of safety for their patient while at the rehabilitation centre and as such, most families end up cancelling the admission of the patient in case of a fall (ARN). Lastly, prevalence fall has a direct impact to the establishment as the incidences ruins the reputation of the establishment as careless towards its patients (Connard, 2011). In addition, it affects the establishment’s compliance with the requirements of the quality assurance.
Resources that are essential for the implementation of this plan involve money required to train the safety team and to buy necessary materials to repair the current environmental hazards that may be the cause of falls. Conducting patients’ survey and counseling especially the patients suffering from post-fall trauma will take some time to achieve positive results. Human resources which involve the collaboration of staff members is also an essential resource that will determine the success of this strategy.
Second solution to the problem
The implementation plan heavily focused on safety assessment and implementation plan that aims at reducing falls through modification of physical environment and assessment of the patients’ physical health in mitigating fall related cases. The second strategy involves evaluation of the patients’ medical related issues that could be the cause of prevalent falls.
Implementation plan
The implementation of the risks assessment plan is set to begin with remodeling the areas identified as high risk areas. These include toilets and bathrooms, sleeping area and hallways. According to the data collected on the previous falls related reports within the facility and by the ARN, most elderly patients are likely to fall in these areas, especially during their first week of admission. The plan to be used in this case involves remodeling the flooring and constant drying and removal of any element that may cause the patient to fall. Personal assistance by a nurse is also necessary for the first time patients and those patients found to have a likely hood of falling, based on the analysis of the medical history of each patient.
As a way of improving physical stability of the elderly patients, daily physical exercises and therapies is also an essential strategy. This will involve using a motivation strategy whereby the patients are encouraged to participate in physical activities not only to prepare them in case of a fall but also to keep them healthy and strong. This should however be implemented with caution in regard to physical abilities of patients and age. This should be coupled with counseling those who may have experienced a fall before with the help of the mentor. Successful implementation will involve drawing a responsibility chart, where every safety committee member is given certain responsibilities which he/she should report on their progress in every weekly safety meeting.
Evaluation plan
The effectiveness of the falls prevention strategy will be evaluated through daily interaction with the patients and monitoring their behavior, particularly the newly admitted patients and those suffering from post-fall anxiety. This will help in determining how the patients are coping with the new environment and the extent of the fear of falling. The success of the strategy will also be recording and analyzing the progress of falls related cases within the establishment as proposed by Pierce (2005). Since the implementation of some of the strategies proposed by the safety team which include improvement of the physical environment, the number of falls cases recorded per week has reduced from four to one case. This means that the measures applied are effective to some extent.
The overall evaluation of the ICP has proven that the plan will yield positive results if all the involved stakeholders are actively involved in implementing it. While working with my mentor, I have been able to identify various gaps that needs closer attention and also monitored the effectiveness of the safety staff and the rest of the workers in the rehabilitation unit in ensuring that the strategy is working successively.
Conclusion
Management of falls related problems among the elderly patients is a complex issue that has proved to be problematic among the health workers. Successful implementation of falls mitigation strategies calls for a careful planning and implementation of various measures through an interdisciplinary approach, as the problem can only be achieved through engaging works from various departments to work collaboratively in implementing the strategies.
With the aim of achieving the global and personal falls assessment tools and strategies, this project has shown a positive progress and with the application of the proposed strategies, the rate of falls is likely to reduce within the unit and also in other residential places and homes. Working with the mentor has also helped to understand the concept of patient involvement in looking for the suitable solution to dealing with falls since the issue has a direct impact to the patients. In order to come up with long term solution to this issue, additional research is necessary especially in the field of polypharmacy in order to identify the impacts of medications to the increased chances of falls among the elderly patients.
References
Association of Rehabilitation Nurses- http://www.rehabnurse.org/about/content/About-ARN-index.html.
QSEN Institute. http://qsen.org/competencies/quality-improvement-resources-2/.
Tinetti, M.E. (2003). “Preventing falls in elderly persons”. New England Journal of Medicine, Vol. 348 (1), 42-49.
Cannard, G. (2011). Fall Prevention for Older People: A Survival Guide. NY: Paragon Publishing.
Lord, S. et al. (2007). Falls in Older People: Risk Factors and Strategies for Prevention. Cambridge: Cambridge University Press.
Pierce, L. (2005). “Rehabilitation Nurses Working as Collaborative Research Teams”. Rehabilitation Nursing Vol. 30(4). Retrieved from http://www.rehabnurse.org/pdf/RNC_244.pdf