NUR-590 Fall Precautions Implementation Plan Paper

Expected Outcomes

The proposed project seeks to address the issue of hospital falls among elderly patients of 65 years and above in an hospital setting. This is in line with the American and British Geriatrics Societies practice guidelines that require health practitioners to develop innovative strategies for addressing the issue (The American Geriatrics Society, 2011).

The project seeks to establish an individualised fall prevention plan for older patients that can be quickly and efficiently implemented within the nominated hospital to increase quality and safety of care. This will be achieved by enhancing the clinician’s knowledge about fall prevention, especially on fall risk assessment, risk communication availability of fall prevention resources.

The second intended outcome of the STEADI project will be reduced fall cases by enhancing fall prevention screening among adults of age 65 and older. This will be a chieved through an initial screening program using the Timed Up and Go (TUG) screening tool. Lastly, STEADI project expects reduced fall rates because of a comprehensive fall medical assessment that relies on the Timed Up and Go (TUG) screening tool to develop an individualised comprehensive fall prevention plan for each patient.

Data Collection Tools

Assessing the STEADI project will require data collection tools that engage the various stakeholders to identify the project’s impact. Furthermore, the project will require data collection tools that can effectively utilise the limited resources to yield comprehensive feedback (de Oca et al., 2021). In this regard, Shaw et al. (2021) proposed questionnaires as an appropriate data collection tool that allows for a continual data collection through stakeholder engagement.

The questionnaires will be appropriate for evaluating all the three intended interventions namely training, screening and medical assessment. For training, questionnaires will yield data on the clinical staffs and supervisors’ knowledge of patient fall as a clinical issue, both before and after the training to gauge the progress. For screening and medical assessment, questionnaires will be useful in gauging the clinicians’ and patients’ use of the Timed Up and Go (TUG) screening tool, and the effectiveness of the various fall prevention plans such as occupational therapy and vitamin D supplements and physical therapy. Lastly, the questionnaire swill be useful in gauging the overall effectiveness the program as seen by the change team, especially by gathering their opinion on the overall effectiveness of the adopted change implementation strategy.

Statistical Tests

Descriptive statistics will be the most appropriate statistical tools for evaluating the proposed project. Thomas et al. (2019) defined descriptive statistics as a statistical summary of quantitative data that describes the features of a set of collected data to develop quantifiable conclusions about the phenomenon under investigation.

Because the project will rely on questionnaires as the main tool of data collection, descriptive statistics such as mean median and mode will be helpful to gage different aspects of the project. for example, the project team would use descriptive statistics to understand the average number of falls before and after STEADI implementation. Similarly, mean scores would be used to quantify the clinicians’ and supervisors’ knowledge of patient fall risk assessment before and after the training.

More importantly, mean will be used as the best measure of central tendency to gauge the project’s effectiveness through Likert-type questionnaire items. Through descriptive statistics, similar questionnaire questions will be combined into a single composite variable or score and analysed as interval data (Lohman et al., 2017). The scale might also be described through standard deviations.

Strategies that will be taken if outcomes do not provide positive or expected results

During the implementation process, the change team might experience certain challenges with various aspects of the project such as the TUG screening tool that may prevent the achievement of positive results. For instance, Nguyen et al. (2021) observed that the TUG may not be acceptable to all users, or it might not fit well with the hospital’s clinical workflow due to space and time constraints. In this case, the project will select other fall risk screening tools such as the 30-second chair stand test. Also, some screening strategies such as routine checks for orthostatic blood pressure may cause unacceptable delays within the clinical system and therefore, they will be limited to patients who report certain symptoms such as balance difficulties, dizziness, or undetermined causes of gait.

The plans to maintain, extend, revise, and discontinue a proposed solution after implementation

Sustaining the STEADI project will require a continuous performance monitoring of each clinician and practice site. Furthermore, the project will benefit from sharing the performance results among the supervisors and clinicians in various departments because this will ensure a sustained interest from all the stakeholders. In case there are incidences of staff turnover or decreasing screening levels, the project team will need to implement refresher training sessions.

References

Lohman, M. C., Crow, R. S., DiMilia, P. R., Nicklett, E. J., Bruce, M. L., & Batsis, J. A. (2017). Operationalisation and validation of the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) fall risk algorithm in a nationally representative sample. Journal of Epidemiology and Community Health, 71(12), 1191-1197. http://dx.doi.org/10.1136/jech-2017-209769
de Oca, M. K. M., Reid, H., Spinosa, D., Watson, C., & McNally, L. (2021). Perioperative risk stratification using the timed up and go test. Gynecologic Oncology, 162, S234. https://doi.org/10.1016/S0090-8258(21)01096-9
Shaw, L., Kiegaldie, D., & Morris, M. (2021). Educating health professionals to implement evidence-based fall screening in hospitals. Nurse Education Today, 101, 104874. https://doi.org/10.1016/j.nedt.2021.104874
Thomas, E., Battaglia, G., Patti, A., Brusa, J., Leonardi, V., Palma, A., & Bellafiore, M. (2019). Physical activity programs for balance and fall prevention in elderly. Medicine, 98(27), e16218. https://doi.org/10.1097/md.0000000000016218
The American Geriatrics Society. (2011). AGS/BGS Clinical Practice Guideline: prevention of falls in older persons. Accessed 14^th November from http://www.alabmed.com/uploadfile/2014/0504/20140504033204923.pdf. www.americangeriatrics.org/education/prevention_of_falls.shtml