Patient’s Fall Proposed Evidence-based Change – Project Plan

Answer

Patient’s Fall Proposed Evidence-based Change – Project Plan

            This proposed change project plan aims to reduce the risk of patient falls in a geriatric care setting. Patient falls are a major healthcare issue, which can challenge patient safety. Falls may result into higher costs of care, prolonged hospital stays, injuries, and even death. It is estimated that fall-associated injuries could be linked to about $15000 increased costs of healthcare per fall. The total cost of fall-associated injuries in the United States could reach about $58.27 billion by end of 2020. The increased costs of  patient falls is important to understand environmental and situational root causes analysis of patient falls so as to develop effective and appropriate interventions (Najafpour et al., 2018).  This project plan proposal includes identification of environmental/situational risk factors, development of a work breakdown structure, budget, and tool for assessing outcome measures.

Environmental Assessment

Risk Factors

            Patient factors are the primary risk factors for falls. In a geriatric setting, advanced age is the major risk factor for falls. Elderly people (aged over 65 years) experience a greater risk of falls compared to the younger population. Fall risk is increases in people aged more than 65 years who have chronic conditions such as Parkinson’s disease and dementia (Slade et al., 2017). The increase in the number of the aged people in the population has also resulted to increase in the number of reported patient falls (King et al., 2016). Advanced aged is also associated with functional decline, especially cognitive and/or motor deficits, which also increases the risk of falls (Vonnes & Wolf, 2017). Other relevant patient factors include visual impairment, delirium, urinary incontinence, cognitive impairment, multi-morbidity, and gait instability (Slade et al., 2017).

            Environmental factors that may contribute to patient falls include slippery floors, loose cables on the floor, and loose rugs. Stairs, uneven ground, and clutter may also increase the risk of falls (Physiopedia, 2020). Situational or environmental factors such as fall locations and patient ambulation can also contribute to the risk of inpatient falls. In inpatient geriatric setting, healthcare staff should identify vulnerable patients so as to develop comprehensive interventions to help reduce extrinsic, intrinsic, and environmental risk factors (Zhao & Kim, 2015). Patient toileting activities, locations such as hallways, patient rooms and bathrooms, and unassisted transfers are also known risk factors for falls (Zhao & Kim, 2015). Dark corridors and poor lighting is another risk factor for falls. In addition, wet toilet floors, lack of wall-side rails in corridors, and clutter, loose cables and equipment on walk ways are major risk factors for patient falls (Najafpour et al., 2018).

            A multidisciplinary team should ensure that there is proper lighting, maintenance of dry floors including toilet floors, and that the pathways are always clear. Besides, wall-side railing should be installed to provide support to patients who are walking in the corridors. Patients should also be provided with safe footwear and adequate number of walking aids. Other strategies include improvement of the patient-centered care plan, which may include effective pain management, management of hypoxia, management of delirium, and toilet scheduling (Najafpour et al., 2018).

Work Breakdown Structure and Budget

Table 1: Work Breakdown Structure and Budget

Measurement Tool

Table 2: Outcome Measures

            Outcome measurement tool in this project will include comparison of falls and injuries in the current year from the previous year. Please refer to table 2 above. Upon implementation of the intervention measures in Table 1, outcome measures will be recorded to be used later to determine the effectiveness of the intervention measures. Outcome measures will determine the effectiveness of the project or if there is need for modifications or improvement. Outcome measures of interest that can be measurable and quantifiable include rate of patient falls, rate of fall associated injuries, additional bed stays, patient satisfaction scores, additional costs of care (either indirect or direct), and number of fall associated deaths.