- QUESTION
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Prevention of Falls in the Elderly in a Community Clinic Setting
| Subject | Nursing | Pages | 25 | Style | APA |
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Answer
Prevention of Falls in the Elderly in a Community Clinic Setting
Contents
Introduction and Background. 3
Problem Identification and Description Using PICOT Format 4
Population/Patient Problem.. 4
Falls among the Elderly: Literature Review.. 7
Project Aims, Values, and Desired Outcomes. 11
Falls among the Elderly: A Theoretical Framework. 14
Proposed Evidence-Based Change Project Plan. 17
Actual Outcomes/Evaluation. 21
For most elderly persons, falls as well as associated injuries and mortality form a crucial area of concern. Every year, according to Shubert et al. (2013), it is estimated that 30 percent of adults who are 65 years and older experience falls in the clinical settings. Such falls are not only costly in terms of treatment of the resultant injuries, but also affect the quality of life of the elderly (Goldsack et al., 2015). The problem of falls is projected to increase by 2020. In specific, it is expected that by 2020, a total cost of $54 billion will be spent each year on medical costs associated with falls (Shubert et al., 2013). Effective management of fall risks among the elderly is a complex process which requires the involvement of various groups of healthcare professionals. The aim of the groups is to perform screening for early detection of fall risks, prescribe tailored interventions, and ensure decreased fall rates. One of the strategies that can be used in the prevention of falls in clinical settings is hourly rounding.
The use of hourly rounding in the prevention of falls in the elderly in clinical settings has been found to be an effective strategy (Goldsack et al., 2015) In specific, the method ensures that the elderly patients are regularly checked hence prevents instances of falls without detection (Dyck et al., 2013). This project assessed the effectiveness of hourly rounding compared to bedside reporting in the prevention of falls in clinical settings. The significance of the project is that it provided concrete information as to the most effective strategy which can be used to ensure a reduced number of falls in clinical settings. Although some facilities have deployed hourly rounding, others have favored bedside reporting. As such, a need arose to research on the two strategies to evaluate the most effective one.
Problem Identification and Description Using PICOT Format
The population that drove the project/change is the elderly. In specific, the project focused on individuals (both men and women) aged 65 years and above. The reason for the selection of this population is because people in this age bracket are susceptible to falls. In specific, because of their decreased mobility as well as the lack of muscle strength to move, such a population is vulnerable to falls (Shubert et al, 2013). The patient problem is that of falls. The choice of this patient problem was informed by the worrying trends of falls as well as injury-associated costs in terms of medications and the quality of life for the elderly.
Intervention
The proposed intervention for the prevention of the falls among the elderly in the clinical settings is hourly rounding. Notably, hourly rounding refers to a healthcare process whereby in every hour, nursing staff members or their assistants enter the room of a patient in the quest to assess the needs of the patient (Goldsack et al., 2015). The choice of this intervention was based on the availability of evidence which demonstrates that it has successfully been applied in various organizations. Additionally, the ability of the strategy to ensure an assessment of the needs of the patients in close intervals made it be chosen as the intervention.
The intervention of hourly rounding was compared with bedside reporting. In specific, bedside reporting refers to a nurse leaving reports for the next nurse in shift about the patient’s needs and condition (Goldsack et al., 2015). The goal of bedside reporting is to ensure that a safe handoff of care is ensured between nurses (Ofori-Atta, Binienda, & Chalupka, 2015). The comparison of hourly rounding with bedside reporting was meant to assess which of the two is the most effective in reducing falls, especially for the elderly in the clinical settings.
Various outcomes were expected after the implementation of hourly rounding in the prevention of falls for the elderly. One of the outcomes is that the rates of falls would decrease in clinical settings. Additionally, after hourly rounding, it was expected that there was an increased level of comfort and decrease in the level of pain for the patients. Moreover, the levels of satisfaction were expected to increase. Finally, it was expected that the quality of life for the elderly in the clinical settings would increase after the implementation of the project.
Time refers to the period in which the outcomes are expected to be observed after the implementation of the intervention. In this case, the time that the outcomes are expected to be assessed is 1 year. The choice of 1 year was based on the fact that there is a need to observe and establish any changes brought about by the project after some time. A year would ensure that the two interventions were well evaluated and hence, the most effective established.
For elderly patients (P) in a community clinical setting, is the use of hourly rounding (I) compared to bedside reporting (C) result in decreased rates of falls (O) over a one-year period (T)?
Prevention of falls among the elderly in a community setting using hourly rounding is an important topic which should be researched and implemented. Firstly, falls among the elderly is the leading cause of their death. By researching and implementing a prevention strategy, the lives of the old will be saved as well as several trauma and injuries that are caused after falling. According to the study conducted by Ofori-Atta, Binienda, and Chalupka (2015), every single year accidental falls happen in approximately one-third of people aged more than 65 years, with about 10% of the falls causing in serious injuries. Falls then lead to reduced independence, high level of anxiety, and poor quality of life.
Secondly, the associated health care cost is a burden to every country and healthcare as a whole. For instance, in the United States, approximately 2.6 million individuals aged above 65 years suffer from falls, which require medical attention. According to the records, about $ 19 billion is needed to care of their medical needs. On the other hand, in the UK, about 650,000 individuals above 60 years suffer from falls, which require about $ 1.4 billion to manage. It is in this context that if prevented or reduced, countries such as the United States, Australia, and other states can use the money spent in managing falls on other projects. Therefore, when researched and properly implemented, hourly rounding is an effective preventive measure which can be used to prevent falls among the elderly ones. It will save a lot of money spent in treating and managing the victims of falls. It will also ensure that the old people have a good quality of life.
Falls among the Elderly: Literature Review
The elderly population has been of concern in clinical practice following the number of falls that occur among the elderly while they are in the hospitals and primarily even outside the medical facilities and in their homes. The health of the elderly is one that is given priority due to their susceptibility to infection and other related consequences. In essence, the elderly have been victims of a number of accidents that would otherwise have been prevented and still influenced by a number of factors within their environment. Factors such as medication that is administered to the elderly may render some subconscious of their environment and any unauthorized movement may result in the elderly patients falling. In other cases, the texture of the ground is slippery and without due knowledge the elderly patients end up falling and in the process suffers more injuries. In this regard, there have been studies conducted on the impact of falls among the elderly alongside the causes and prevention measures that can be used and some that have been implemented for purposes of improving and reducing the rates of falls that occur unnoticeably among the elderly in the medical facilities.
The causes of falls among the elderly, the injuries experienced and the management of falls among the elderly is the primary focus of Abraham and Ciminio-Fiallos (2017) in their study on falls among the elderly. Based on the findings of their research, falls are the leading mechanism of injuries among the elderly. These falls have both mild and adverse impacts on the elderly in terms of injuries whereby, while some situations may result in minor bruises, other cases will be the source of fractures and intracranial injuries. The study further revealed that between 2006 and 2010, traumatic brain injury deaths that the elderly population faced was as a result of falls. While majority of the falls are preventable and can be managed, many of the elderly patients fail to let their physicians know about their falls thus creating a gap in their treatment in the event that the fall resulted in an underlying issue. The study further stipulates that in some cases, unavoidable factors such as age and a history of falls contribute significantly to the occurrence of falls among the elderly. In this directive, the authors blame lack of initiatives that are aimed to protect the wellbeing of the elderly patients to be factors that further contribute the problem.
Medical conditions such as hypertension, diabetes and impaired hearing have also been perceived to be additional contributors to the increased risk of falls among the elderly. This is based on a study conducted by James et al (2014) from the perspective of Jamaican elderly population. Primarily, while the study looks into the wider scope of falls among the elderly to include situations outside the medical facilities, the authors point out that medical conditions and the medication administered to the elderly increase the risk of falls as much of their cognitive and balance abilities become impaired from the use of strong medication and also due to their health conditions. The lack of awareness on the impact and risk of falls among the elderly as projected in the study reveals how little is known about the severity of the impact of falls among the elderly and thus, the lack of preventive measures and even necessary infrastructure such as rails to help in ensuring that the elderly have sufficient points of support to prevent the falls. In essence, the authors propose the necessity of conducting health education and promotion activities to advance more awareness on the risks and management of falls among the elderly.
Matters regarding the use of multiple medications and their effect on the stability and cognitive awareness of the elderly is deeply discussed by Maher, Hanlon and Hajjar (2014). Polypharmacy is defined as the use of multiple medications than is necessary. This is a clinical practice that is commonly extended towards the elderly as in most cases it is difficult to diagnose the specific condition that the elderly individuals are suffering from. This is such that, in most cases, the symptoms and signs that are displayed by the elderly can easily be confused with the effects of old age. Hence, prior to the determination of the actual condition to be treated, the elderly are usually dowsed in multiple medications. This practice consequently affects their ability to support themselves following the various side effects of the medications that they take. Primarily, from the negative consequences that arise from polypharmacy, the study suggests interventions that can reduce the risks and necessity of multiple medications being administered to the elderly. In essence, in working towards reducing polypharmacy, the elderly have the opportunity to reduce the rate of falls as experienced.
The position on the use of various medication and underlying health factors are supported by Alshammari et al (2018) in their study looking into the falls among the elderly and the relation these falls have to health factors and environmental factors with focus in Riyadh. The study takes on a cross-sectional analytical study and involved a total of 357 participants to the study. Subject to the approach duly used in the study, the outcomes revealed that underlying health factors and a history of falls contributed significantly to increased risks of falls among the elderly. However, the environment also played a significant role thus supporting other research that postulate that the environment is a factor that enhances the occurrence of falls among the elderly.
Pfortmueller et al. (2014) also look into the environmental factors with strong emphasis on how these contribute to falls among the elderly population. The environment, based on the study, is an area that enhances the occurrence of falls among the elderly leading to serious injuries and frequent hospitalization of the elderly. According to the study, the lack of consideration of the elderly population only serves to advance the negative consequences of falls on the wellbeing and health of the elderly. Further, Pfortmueller et al. (2014) acknowledge that the interventions and measures that have been put in place do not necessarily apply to all elderly persons as some of the interventions such as the substitution of diets with vitamin D would only be suitable for elderly patients with vitamin D deficiency and cannot be applicable to the elderly with hearing impairment that has affected their balance. There is a gap in the studies surrounding falls among the elderly with regard to establishing wholesome measures that accommodate different circumstances that influence falls among the elderly.
In essence, subject to the various studies that have been conducted over the decades, falls among the elderly remain e among the leading sources of healthcare expenditure among the elderly (Gelbard et al., 2014). This is even after decades of research on falls among the elderly. The outcomes in the modern society remain highly identical to past outcomes thus revealing a significant gap in the studies and in the implementation of better measures to assist in the elimination of the high risks of falls among the elderly population. As such, there have been little measures that have been implemented and considered in alleviating the situation and the measures have remained to be insufficient to curb the situation. The elderly’s needs in essence with reference to protecting them from the risk of falls have been overlooked and there is a growing need to develop and establish better measures and interventions that will secure the safety of the elderly in different environments and avoid the risks of falls.
Scholarly work surrounding falls among the elderly reflect the magnitude of the problem at hand and the importance of change in the approach of handling the situation. The elderly experience significant injuries and even death threatening injuries from the falls that they experience. It is thus imperative that better interventions are put in place to ensure that the risk of falls are reduced significantly. Better monitoring of the movement and health of the elderly will also suffice to maximize on protecting the wellbeing of the elderly and protect them from grievous injuries that may contribute to their suffering and even sudden deaths.
Project Aims, Values, and Desired Outcomes
The aim of the project was to reduce the rate of falls among the elderly in the community setting. This is primarily because the proposed changes involved having the movement of the elderly monitored better and further ensuring that the environments that the elderly are exposed to are accommodating to their situations. Practically, elderly patients who visit the clinic are usually accompanied with their caregivers or at other times they show up alone. The increased risks that the elderly are exposed thus makes it necessary to have the community educated on the implications of leaving the elderly unattended to and without sufficient care. Based on this, the project aimed at educating the community on better ways to ensure that the rate of falls are reduced. An educated community strengthens the practice of monitoring the movement of the elderly and also ensur that the environment is designed in a manner that is fit for the movement of the elderly (Abraham & Cimino-Fiallos, 2017). Additionally, educating the community even as they visit the clinic on the effects of se of the medication administered to the elderly is aimed at advancing knowledge to caregivers and ensure that they take into consideration frequent monitoring of the elderly patients.
Typically, the overall aim of the project was to initiate change that will not only have the community educated on better care giving towards the elderly but also ensuring that the environment outside the medical facility such as the homes where the elderly stay are designed in a manner that can accommodate the needs of the elderly and reduce the risk of falls (Gelbard et al., 2018). This is inclusive of having less slippery grounds, ensuring that there are sufficient support bars around the environment to provide support and observing the movement of the elderly. The implementation of these changes are thus bound to achieve the objectives of advancing the safety of the elderly.
The health of the elderly was at the forefront in the execution of the project. This is such that the basis of the project was to add value to the health of the elderly and thus improve the rates of falls among the elderly as well as possibly reduce the same to levels that are minimal and/or caused by unavailable circumstances. Practically, by advancing the changes and implementing the changes such as placing support beams and ensuring that the environment is characterized with surfaces with better grip the elderly are bound to benefit following the reduction in the risk that may otherwise affect their health adversely (Alshammari et al., 2018). In addition to this, cases of the elderly frequently visiting the clinic in search of services and medications to facilitate for pains associated with falls and medical check up services to enable them identify areas that they are hurt.
Cases of injuries and fatalities from falls will also be positively impacted as the changes will be sufficient to ensure that the well-being of the elderly is duly prioritized and thus eliminating these cases. Practically, the project ensures that patient care services are accorded even outside the medical facility. Further, educating the caregivers on the proper care to advance to the elderly and the significance of monitoring the elderly patients’ movement to take note of any falls occurred or injuries incurred (Gelbard et al., 2018). In essence, this project adds value to the observation of the movement of the elderly and further advances patient safety and care towards a population that is prone and susceptible to grievous injuries and even possible fatal falls.
It is projected that a large portion of the incomes of the elderly are usually spent on medical treatment and associated care after cases of falls. As such, falls have been found to be among the top factors that primarily affect the well-being and health of the elderly. In the implementation of this project, the anticipated outcomes included a reduction in costs spent on healthcare by the elderly in relation to falls. Secondly, it was anticipated that with the observance of the projected changes, the elderly population will make fewer visits to the clinic over matters relating to falls. This will thus provide more opportunities to look into other matters that may be affecting their health. Thirdly, educating the caregivers and the community on the risk factors surrounding falls among the elderly was expected to increase awareness and in turn promote better Healthcare practices among the caregivers and the consideration of implementing better strategies to protect and enhance the safety of the elderly population. In this directive, not only will the elderly benefit by receiving proper care, but also have their well-being prioritized beyond the medical setting.
The elderly population is affected by various factors especially in terms of their health. Ensuring that the risk factors associated with falls are eliminated serves to ensure that the well-being and safety of the elderly is assured. The implementation of the changes not only secures the safety of the elderly, but also enables the community to take better care of the elderly population and spread awareness on the implications that falls have on the health and lives of the elderly. The project’s aims, values and desired outcome thus were all tailored to improving the communal awareness and knowledge of falls among the elderly and the importance of patient safety.
Falls among the Elderly: A Theoretical Framework
Instituting changes to improve the quality of services and the delivery of services requires that proper consideration of the factors in place is addressed. In this regard, the area of focus is reducing the rates of falls among the elderly within the community based on a community clinic setting. Based on the fact that the clinic does not necessarily admit patients, it is imperative that in the implementation of the changes, the external environment in which the elderly population who are the main focus of the program for change is duly considered. In this directive, it becomes clear in what perspective the changes in terms of reducing the rate of falls among the elderly may be duly implemented. Practically, the theoretical framework is based on variables that are primary to the results and consequences that affect the elderly. These variables are inclusive of medication offered to the elderly patients, their health conditions, the environment and the supervision of the elderly. Based on a formal hypothesis approach, it is therefore possible to explain the nature of the changes (Kaplan et al., 2010). This will further provide the predictions in terms of the outcomes that are anticipated with the implementation of the provided changes in the community. The Florence Nightingale Environment theory will be applied in this project as it best fits with the intended environmental changes to be implemented with regard to the modifications needed to reduce the rate of falls among the elderly. The Environment theory looks into ensuring that the health of the involved parties is prioritized based on the safety of the environment that they are in.
First, the community clinic is often handling cases of falls among the elderly and, therefore, the clinicians have to constantly administer medications that are associated with relieving pain to the extent of treating injuries. In this regard, in understanding the connection between the medications and the impact that they have in increasing falls among the elderly, it becomes possible to gauge which medications should be substituted with less strong ones. The medication often has the impact of impairing the stability of the elderly either because of the fact that they cause drowsiness or based on the reaction they have with the body (Schouten et al., 2008). In this perspective, in changing the intensity of medications given to the elderly, it is possible that the stability of the elderly population will not be as adversely affected. In addition, ensuring that the clinicians do not administer an array of medications that are bound to react adversely with the elderly is equally bound to reduce falls that are as a result of medications taken. The effectiveness of the outcome will be measured by comparing the number of cases of falls among the elderly submitted at the clinic before and after the implementation of the project and analyzing how many are as a result of the medications administered to the elderly patients.
Secondly, the environment plays a critical factor in the rate of falls. Many of the elderly patients visiting the community clinic have to endure using the same environment that increases the risk of falling. Therefore, ensuring that better infrastructure is in place will suffice to significantly reduce falls that occur following slippery and unstable environments. It is anticipated that with a change in the infrastructure and ensuring that there are enough support beams, the elderly would have reduced risks in terms of falls (Schouten et al., 2008). Practically, subject to the provisions of the environment theory, changes in the environment are bound to improve the health and well-being of the elderly population from suffering from falls.
Thirdly, the health of the elderly population is often difficult and confusing in regard to making diagnoses. The effects of old age often interfere with medical conditions that would render clinicians to brush off even a serious matter. In this regard, thorough diagnosis of an elderly patient’s condition would be beneficial in establishing the cause of the condition suffered and further reducing the potential of the patient being susceptible to falls. The consideration of all factors from old age through to health conditions that may be underlying serve to improve the situation entirely.
Finally, the supervision accorded to the elderly population is important that the aides are available and monitor the elderly at all times. This is the clinical microsystem approach that will be duly used. This is such that, the caregivers will work directly with the families and the patients in advancing quality care and attention to the patients (Gelbard et al., 2018). Practically, it has been shown in studies that the elderly may fall and not report on the same. This is why the aides are necessary to facilitate for round the clock supervision of the elderly. The execution of proper supervision is thus expected to reduce the rate at which the elderly fall without it being recorded and overall reduce the falls. Ideally, in the implementation of these changes, it is postulated that the rate of falls among the elderly is bound to reduce significantly across the different platforms to the benefit of the elderly population and also reducing the cases handled in the clinic relating to falls. This will be measured as well through the number of cases reported in the various homes of the elderly relating to falls before and after the implementation of the project
Plan-Do-Study-Act
The implementation of the changes of the project relating to falls among the elderly in essence will observe four distinct stages (Taylor et al., 2014). The first is the planning stage in which the primary issue is identified within the community clinic and how the issue related to the population sample which involves the elderly population. This identification process will also take into account the clinic’s records on falls. The second is the do stage which involves engaging in a pilot test of the changes to be implemented such as educating the supervisors, putting in place support beams and even prescribing medication that do not react adversely with each other. The third stage is the study phase. In this step, the outcomes of the pilot test are compared with the anticipated results to determine whether the plan is effective. After analysis of the outcomes, the changes may be effected in the event that the outcomes are positive or changes to the plan are considered if the outcomes reveal some downsides.
Proposed Evidence-Based Change Project Plan
The community clinic is the primary area of the project at hand. Ideally, it is the section that constantly deals with the cases of the elderly reporting falls and in need of the changes to be effected for the benefit of the patients. Primarily, the community clinic is designed in a manner that the environment surrounding it projects a situation in which the necessary changes should be effected for purposes of reducing the rate of falls (Forsberg, & Malmborg, 2003). The environment in this regard is equipped with materials that do not necessarily advance the safety of the elderly. Practically, the environment is comprised of structures and infrastructure that is rather tedious for the elderly to use thus increasing the risks of falls. Based on the assessment of the environment, he impact of the changes is bound to be beneficial to the target population and therefore, proving the efficiency of the changes.
Practically, the environment requires that the infrastructure in place is rectified in a manner that advances proper stability for the elderly population. This is such that, other than having slippery floors, more concrete and stable grounds may be used that would reduce the risk of falls. In addition, setting up support beams that are strategically placed will suffice to ensure that the elderly population is capable of having sufficient support and stability even as they move around. The records in place in the community clinic reveal a high rate of falls which must be addressed accordingly. In essence, the project in place is thus executable as the environment in question can be redesigned and restructured in a manner that will ensure that it is suitable for the elderly population (Jonsson, 2000). Further, the environmental assessment takes into account the homes of the elderly to ensure that the matters are addressed conclusively in the community.
Primarily, the execution of the project took place in five distinct stages that were strategically placed to ensure that the process in question is fully executed. The project was completed in a period of seven weeks which was sufficient to ensure that the project is duly completed. In this regard, the project was handled on a weekly basis in which, the tasks were handled one after the other is completed. It ensured that the stages were completed accordingly and the tasks were well implemented. The stages involved are; researching on the problem which is falls among the elderly. The second stage involved the establishment of the project design which in essence determined the approach that was used in terms of executing the project. The third stage involved the development of the project which encompassed the environment assessment and determination of the areas that were impacted with the changes to be made in the community clinic and surrounding environment. The fourth stage involved implementation of the project. This stage primarily took the longest time as it involved the actual execution of the project’s changes. Finally, the evaluation of the changes was the final stage of the process which was conducted after the changes had been in place for a period of two weeks. The evaluation was done specifically for purposes of establishing the efficacy of the changes in achieving the intended objective of reducing the rate of falls among the elderly in the community.
The budget for the project will ideally cover the expenses that are anticipated to be covered in the achievement of the changes. The budget therefore will serve as an estimate presentation of how much the entire project will cost. Ideally, the estimates are used as approximations on the higher side so as to ensure that a shortage is not experienced during the course of the project. Practically, the budget also takes into account the acquisition of the various materials and supplies that will be used in the infrastructural changes as well as the equipment needed by the elderly population visiting the community clinic. Further, all external and internal staff who will be involved in the project also have their costs covered. In essence, the budgetary costs of the project have been considered conclusively even as funds have been set aside for any miscellaneous activities that may emerge in the process inclusive of risk assessment. Practically, the budget is designed to ensure that the personnel, supplies and equipment are accounted for and the project is successful in terms of the implementation process.
The implementation of the project and the execution of the changes in the environment for purposes of reducing the risk of falls among the elderly is particularly not the end. It is important that the projects efficacy is evaluated to establish if it has been successful or whether there are areas that require to be revised and therefore better measures implemented to ensure the efficacy of the project in its entirety (Kusek & Rist, 2004). The evaluation method in this regard that was the indicator evaluation approach. Ideally, this method of evaluation takes into account the various indicators as selected in the process to determine whether the project is efficient or requires changes. The indicators in this regard to be used are the SMART indicators that project the specific, measurable, achievable, relevant and time-bound indicators associated with the implementation of the project. In essence, by using the SMART indicators, it is possible to carefully and thoroughly look into the sustainability of the project in the long term.
The SMART indicators are techniques and tools that are effective in analyzing the significance and relevance of the project implemented. Further, through this evaluation method, various factors are taken into consideration in the determination of the effectiveness of the project. Primarily, through the SMART indicators, it is possible to save on costs in terms of the project being relevant in ensuring that the elderly make fewer visits to the community clinic as a result of falls thus spending less of their finances catering to costs associated with treatment and medication for injuries and pain sustained from falls. In addition, the implementation of the projects proves to be specifically consistent with the achievement of the objective of reducing falls among the elderly and in turn resulting in patient satisfaction as well as positive quality clinical outcomes (Von, 2002). Based on the relevance of the project, injury prevention and risk reduction are assured to the satisfaction of both the patients and the community clinic. Practically, through the evaluation of the indicators, it is evident that the project would significantly achieve its mandate; a factor that can be verified through the figures and records of individuals reporting to the community clinic for treatment for injuries emanating from falls.
It was expected that the community based clinics would effectively help reduce the falls of the elderly. However, it was discovered that prevention of falls require multifactorial and address on the physical, psychological, functional and educational components. The project failed to establish effective way of preventing falls. Prevention of falls requires “The active involvement of leadership and front-line staff in program design and as unit champions during the project run-in period is critical in meaningfully reducing inpatient fall rates and call bell use in an adult medical unit. Ensuring that the risk factors associated with falls are eliminated serves to ensure that a well-being and safety of the elderly is assured p. 102”. Although the project stressed on the importance of supervision of the elderly and need to create better infrastructure, it failed to outline how the community based clinics would collaborate with the leadership to ensure that safe infrastructure is built. The application of hourly rounding not only safeguards the well-being of the elderly, but also allows the society to take better care of the aged population and spread cognizance on the implications that falls have on the health and lives of the elderly. As result, there is need for collaboration between the Community clinic and the society. Further, the project established the importance of continuous medical check-ups. It established mechanisms through which the elderly would be supervised, their conditions examined and medication administered.
Here is the summary of the actual outcomes.
|
Actual outcome |
Rating |
Reasons |
|
Patient satisfaction |
Excellent. It increases patient satisfaction by 42% increase in patient satisfaction ratings |
Hourly rounding ensured that the elderly patients were regularly checked which gave them room to address their problems within a period of only one hour. A study conducted by Shubert et al. (2013) reveals that some of the dissatisfaction presented by most patient is inability to access professional not only regularly but at the correct time. In this, case hourly rounding will enable the patient especially the elderly ones not only to see nurses regularly but also to engage with different nurses such that if the patient is not going along with one of the nurses, he or she has the opportunity to engage with another nurse.
|
with
|
Clinical outcome |
Positive |
This is the end point of care, significant changes in the health condition of a patient, and changes in patient behavior caused medical practices and interventions. Due to regular visit of patient by the healthcare professional, there was likelihood that every bit of the patient progress was monitored and managed hence positive outcome. |
|
Patient outcome |
Positive |
Patient outcome is determined by the health services a patient gets. It is believed that regular access to care is one way of improving the patient outcome. Notably hourly rounding ensured that patients, especially the elderly found regular services from the nurse who frequently visited them. |
|
Patient safety |
Good |
When patients are regularly visited and their condition accessed, there is high likelihood that there is safety is guaranteed. It is in this context that hourly rounding ensured patient safety as patient issues were solved within appropriate time. Increased staff satisfaction is evident when hourly rounding protocols are successfully implemented. In 2008, the Studer Group conducted a study which demonstrated a positive change in nurses’ perceptions of hourly rounding. |
a
|
Cost |
Reduces 40% |
The problem of falls is projected to increase by 2020. In specific, it is expected that by 2020, a total cost of $54 billion will be spent each year on medical costs associated with falls (Shubert et al., 2013). With hourly rounding, this figure can be reduced to half saving a lot of money which can be used for other purposes. |
Summary and Conclusion
Although the project outlined various ways of reducing falls among the elderly, it did not meet its anticipated goals and objectives. As mentioned earlier, prevention of falls require the physical, psychological, functional and educational components. However, the project failed to outline how the community clinic would facilitate these components. Besides, the project concentrated on the diagnosis rather than preventive measures. The project should have identified the various medications that the community clinics would administer on the elderly to prevent their falls instead of concentrating on the treatment of the injured.
Nonetheless, the project examined the importance of building safe infrastructure. The community clinic alone cannot achieve this goal. Building of infrastructure calls for political, economic and social factors. To achieve this, the community clinic must develop proper mechanisms and approaches getting support of the political leadership to build safe infrastructure.
The problem of falls is projected to increase by 2020. In specific, it is expected that by 2020, a total cost of $54 billion will be spent each year on medical costs associated with falls (Shubert et al., 2013). Effective management of fall risks among the elderly is a complex process which requires the involvement of various groups of healthcare professionals. One of the evidenced based method of preventing falls is the use of hourly rounding. In that regard, a PICOT question was formed which was, for elderly patients (P) in a community clinical setting, is the use of hourly rounding (I) compared to bedside reporting (C) result in decreased rates of falls (O) over a one-year period (T)? As such, falls have been found to be among the top factors that primarily affect the well-being and health of the elderly.In the implementation of this project, the aims and the values of the projects were met which included a reduction of cost, patient satisfaction, positive patient outcome, positive clinical outcome, and patient safety.
Implications
Falls continuously expose the elderly to health risks. This project effectively takes care of one of the important steps in dealing with falls. Reporting is one way of creating awareness. Creating awareness may assist in developing effective prevention plan and cost effective primary care for the elderly.
Recommendations
There should be close ties between the community clinic and the political leadership to facilitate the building of safe infrastructure, this will reduce number of falls caused by poor infrastructure. The community clinic should educate the community on the need of taking care of the elderly. The elderly are weak and exposed to high health risks. As a result, there is need to come need to sensitize families and the society to take care of the old. These may include, providing helpers who can guide them when they are moving from place to place.
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References
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Abraham, M. & Cimino-Fiallos, N. (2017). Falls in the elderly: Causes, injuries and management. MedScape (February 1, 2017) Retrieved from https://reference.medscape.com/features/slideshow/falls-in-the-elderly#page=5
Alshammari, S. A. et al. (2018). Falls among elderly and its relation with their health problems and surrounding environmental factors in Riyadh. Journal of family & community medicine, 25(1), 29-34.
Dyck, D., Thiele, T., Kebicz, R., Klassen, M., & Erenberg, C. (2013). Hourly rounding for falls prevention: a change initiative. Creative nursing, 19(3), 153-158.
Forsberg, A. & Malmborg, F. (2003). Tools for environmental assessment of the built environment. Building and environment, 39(2004): 223-238.
Gelbard, R. et al. (2018). Falls in the elderly: A modern look at an old problem. The American Journal of Surgery, 298(2): 24-253.
Gelbard, R., Inaba, K., Okoye, O. T., Morrell, M., Saadi, Z., Lam, L., ... & Demetriades, D. (2014). Falls in the elderly: a modern look at an old problem. The American Journal of Surgery, 208(2), 249-253
Goldsack, J., Bergey, M., Mascioli, S., & Cunningham, J. (2015). Hourly rounding and patient falls: what factors boost success? Nursing2018, 45(2), 25-30.
James, K. et al. (2014). Falls and Fall Prevention in the Elderly: Insights from Jamaica. Department of Community Health and Psychiatry Mona Ageing and Wellness Centre University of the West Indies Mona, Jamaica. https://www.who.int/ageing/projects/AMRO-Jamaica.pdf
Jonsson, A. (2000). Tools and methods for environmental assessment of building products- Methodological analysis of six selected approaches. Building and Environment 35: 223-238.
Kaplan H. et al. (2010). The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q, 88: 500–59.
Kusek, J. & Rist, R. (2004). Ten steps to a result-based monitoring and evaluation system: A handbook for development practitioners. World Bank
Maher, J., Hanlon, J. & Hajjar, E. (2014). Clinical consequences of polypharmacy in elderly. Expert Opinion on Drug Safety, 13(1): 57-65.
Ofori-Atta, J., Binienda, M., & Chalupka, S. (2015). Bedside shift report: Implications for patient safety and quality of care. Nursing2018, 45(8), 1-4.
Pfortmueller, C. et al. (2014). Fall-Related Emergency Department Admission: Fall Environment and Settings and Related Injury Patterns in 6357 Patients with Special Emphasis on the Elderly. Minerva Medica, 105(4): 275-281.
Schouten, L. M., Hulscher, M. E., van Everdingen, J. J., Huijsman, R., & Grol, R. P. (2008). Evidence for the impact of quality improvement collaboratives: systematic review. BMJ, 336:1491–4.
Shubert, T. E., Smith, M. L., Prizer, L. P., & Ory, M. G. (2013). Complexities of fall prevention in clinical settings: a commentary. The Gerontologist, 54(4), 550-558.
Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan–do–study–act method to improve quality in healthcare. BMJ Quality and Safety, 23:290-298
Von S. (2002). Health in sustainable development planning: The role of indicators. World Health Organization.
Appendices
Timeline
Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7
Research
Design
Development
Implementation
EvaluationBudget
Sample CATEGORY BUDGET AMOUNT ACTUAL AMOUNT DIFFERENCE
EXPENSES:
Project research $15000 $14000 $1000PERSONNEL:
Researchers $5500 $7500 $2000
Medical Staff $6500 $6500 $0
Field researchers $4500 $5500 $1000
Other staff $10000 $10000 $0SUPPLIES:
Movement equipment (wheelchairs, support crutches for the elderly) $25000 $25000 $0EQUIPMENT:
Construction materials (support beams, cement etc) $35000 $35000 $0MISCELLANEOUS: $15000 $17000 $2000
Total Investments and Expenses $116,500 $120,500 $6000