Answer

Capstone Project Change Proposal: Falls among the Elderly

Background

As individuals age, they become very susceptible to a variety of health condition and diseases. However, the burden of ill health among individuals can be reduced by preventing the risk factors that cause such disease or health conditions. One of the health conditions that affect majority of old adults in American is falls.  According to the study conducted by Moncada and Mire (2017), people above the age of 65 have higher risk of falling as one in three older individuals who are living in the community fall at least once in a year and the number increases as they grow older. Falls, basically cause long term problems that include loss of independence, disabilities, and even death. While there are several preventive measures that have been put in place to prevent falls among people above 65 years, the incidence rate is still increasing, a factor that indicates that an operative strategy has not been put into action. This paper, therefore, proposes a change that should be applied in order to prevent falls among the old.

Problem Statement

The incidence of falls among people above 65 years old is worrying, causing significant burden not only to the individuals, but also to the hospitals and communities as well.  The consequences of falls among the elderly make it one of the critical health concerns in society. In terms of health, falls reduce the quality of life as one is subjected to pain and fracture depending on the intensity of the fall. To some individuals, falls cause total disability which makes such people to depend on other individuals for support such as movements. According to Luk, Chan, and Chan (2015), some falls cause minor injuries such as abrasions, bruising, sprains and strains, as well as lacerations, but still cause significant discomfort and pain. However, it is also important to note that falls can cause major injuries such as head injuries and fractures than can lead to death. Financially, elderly fall has been a burden to health institutions and the country as a whole.  In particular, the cost of fall among the elderly in the United States was approximately $ 50 Billion in the year 2017. This amount represents 6% of all Medicare expenditures and 8% of all Medicaid expenditures (Isaranuwatchai et al., 2017). Therefore, elderly falls is one of the most expensive health issues that burden quality care delivery. Such kind of money can be channeled to other sectors of health in order to improve care delivery that leads to positive patent outcome. Based on the above effects of falls among the elderly, an effective preventive measure should be employed to reduce the incidence. The most effective way of preventing patient falls is the use multifactorial interventions instead of a single strategy.

Purpose of the Change Proposal

The purpose of the change proposal is to examine whether multifactorial interventions will reduce the rate of falls among the elderly compared to a single standard strategy. It is important to note that the common nursing interventions for preventing falls among the elderly patients include medication review, exercise, environmental modifications, behavioral therapy, dietary supplementations (especially vitamin D supplementation), and behavioral therapy. These interventions can be delivered alone or in a combination. However, it should be noted that multifactorial assessment and programs do not prevent the risk of falling, but help in reducing the rate of falling. In addition, multifactorial interventions help in reducing the risk of sustaining one or more recurrent falls within a specified period of time.

PICOT Question

In older adults aged 65 years and more (P), does multifactorial intervention (I) compared to patient standard fall prevention strategies (C), result in significant prevention of the number of patients falls that occurs within the healthcare setting (O) in a year (T)?

Literature Search Strategy

Several research has been done to establish the efficiency of multifactorial intervention approach in reducing falls of aged patients. Despite the wide literature employed in investigating multifactorial intervention, I opted for a database searching technique. This method focuses on getting information from articles, books, and published journals about the research topic. For instance, the search databases employed included, Google Scholar, NCBI, PubMed, and COCHRANE. These are essential medical databases that provide vast research materials about issues that are related to health of individuals and those that affect healthcare as a whole. Some of the search terms that were used are ‘multifactorial intervention,” “prevention of falls using multifactorial intervention, “and “comparison between multifactorial intervention and standard fall prevention strategies”. In order to get up to date articles, the databases were customized only to provide peer-reviewed articles that were published in the last five years.

Evaluation of the Literature

The search yielded several articles that provided different views about prevention of falls among the elderly. According to the study conducted by Moncada and Mire (2017), multifactorial intervention that include exercise, strength, gait training, management of medication, and vitamin D supplement effectively decrease falls in the hospitals, community and nursing home settings. On the same note, a study conducted by Luk, Chan, and Chan (2015) reveals that there may be several causes of falls in one person requiring a number of interventions at the same time, hence the standard strategies of preventing falls cannot achieve the needed patient outcome.  However, according to the study conducted by Luk, Chan, and Chan (2015), multifactorial intervention are effective but can be costly since it encompasses a variety of interventions that are done concurrently. Nonetheless, the study also reveals that the cost of multifactorial intervention depends on the care provider and the age of the patient. On the other hand, a peer reviewed article by Isaranuwatchai et al. (2017) asserts that multifactorial intervention is not effective since it involves different strategies that may not be completed by the patient owing to the fact that most of these patients are old hence some of the strategies of preventing falls such as exercise may be too hard to complete. In his study, the author argues that one effective strategy should be employed rather than several ones that put the life of the patient at more risk.  On the contrary, Fairhall et al. (2018) argue that falls have different causes, of which some may be as a result of lack exercise, or disease, hence require different strategies to prevent, a factor that calls for multifactorial intervention.

Applicable Change or Nursing Theory Utilized

The implementation of multifactorial intervention is based on the Iowa framework. This is a problem-solving approach. The change model is widely accepted and used in healthcare. The model helps in understanding EBP and designing change in healthcare (Lloyd, D’Errico, & Bristol, 2016). The framework occurs in stages that are associated with feedback cycles. The model stresses the need for a pilot study before conducting the actual research. A pilot study plays an essential role in collecting data, designing guidelines, selecting expected patients’ outcomes, implementation of data, process evaluation and modification of the guideline practice.  This model is essential in understanding the process of change implementation because it examines several factors such as time spent in the facility and nurse and patients’ satisfaction.

Implementation Plan

According to the Iowa change model, the first stage of the implementation process is the identification of the trigger. This trigger comes from an evaluation of the current practices. According to Lloyd, D’Errico, and Bristol (2016), the trigger is based on the number of escalating patients’ falls. In this regard, the priority of change entails using several preventive measures which reduces falls. The second step involves resource mobilization. Here, resources such as research material and funds to be used for documentation are collected.  The implementation process cannot be done without getting permission from the relevant institutions and without obeying the ethical codes.  The next stage of implementation involves educating the lead nurses and other stakeholders on the process and their roles. Here, nurses are also taught about different methods that can be used to prevent falls. Notably, the pilot study performs a critical role in examining any barriers and how they can be effectively eliminated.

The final measure differs depending on the objectives. Some specific data points like hourly rounding log measures factors such as time and the activities involved. They include toileting, patients’ pains, and positioning. According to Chu (2017), another factor that is measured is the patients’ needs since the needs are among the causes of falls. Further, other factors considered for improvement of fall data include rate of injury and number of falls. Goldsack et al. (2015) outlines that multifactorial interventions have been criticized since they are costly and require the attention of several nurses.  To assert this, nurse satisfaction must be evaluated and this is conducted in two control groups: one with multifactorial interventions and another without the multifactorial interventions.

Barriers to Change

Despite the effectiveness of EBP, several challenges were also identified. They include sustainability that is dependent on the availability of the nursing staff (Brown, 2016). The second challenged is staffing. Some inadequate competent employees are willing to implement the change.  Furthermore, the process requires skilled nurses with both professional and personal attributes. Some of the essential skills that are required and may be lacking include endurance and patience.  The third challenge is limited resources for funding and buying essentials such as placards, flyers, and materials for documentations. Another important issue is patient acuity. This may be hindered by nursing skills. Also, the organization must be willing to make some adjustments since most of the facilities and nurses are resistant to change due to its negative impacts (Potter et al., 2016). These challenges can be mitigated through proper planning, preparing the organization for change, selection of competent staff and training the nurses accordingly. Training is critical for enhancing nurses’ skills.