NURS FPX 8030 Assessment 5 Creation of Policy or Procedure

Name

Capella university

NURS-FPX 8030 Evidence-Based Practice Process for the Nursing Doctoral Learner

Prof. Name

Date

Standard Patient Fall Prevention Bundle Policy to Avoid Patient Falls at Henry Ford Hospital

Purpose: 

A comprehensive inpatient fall prevention plan to mitigate falling events, particularly among elderly patients, is being employed to overcome the patient safety challenge of patient falls in a hospital setting. Patient falls are a significant cause of concern because they increase medical expenses, lengthen hospitalizations, and exacerbate patients’ health conditions. About 700,000 to 1 million inpatient falls occur annually (Xia et al., 2022). The fall incidence ranges from 1 to 9, and injury falls 2.0 per 1000 patient days in acute care settings. Falling events in acute settings result in injuries and raise mortality and length of stay (Heikkilä et al., 2024).

The internal evidence of Henry Ford Hospital (HFH) anticipated that 20% of elderly patients face fall incidents and serious injuries (HFH, 2024). Medical personnel neglect to regularly examine risk factors or follow fall prevention standards. Despite the association between inadequate preventive measures and a boost in fall rates among patients during hospitalization. A formal policy is required to ensure that all departments, particularly acute care settings, adhere to standardized and efficient fall prevention strategies considering this practice gap.

NURS FPX 8030 Assessment 5 Creation of Policy or Procedure

A review of recent compliance audits and fall prevention reports revealed that staff did not adhere to current fall prevention methods and performed inconsistent risk assessments, demonstrating a lack of understanding or training. Furthermore, it has been noticed that patients are not sufficiently informed of falling dangers and hospital environmental hazards, highlighting the need for this policy. Research supports the importance of a comprehensive fall prevention bundle in lowering inpatient fall rates. For example, Bargmann and Brundrett (2020) discovered that introducing a fall prevention bundle intervention reduced the 55 % fall rate and boosted personnel adherence with interventions to 89% in hospitals.

The evidence was obtained using observational studies, data analysis on fall prevention, and a complete literature review by adhering to inclusion and exclusion criteria. The PICO(T) question apprising this policy is “In an acute care unit, would a standard patient fall prevention bundle, in comparison to current prevention practices, lower fall incidences in elderly adults within 12 weeks?” To improve patient safety outcomes, it is critical to act and implement this plan to reduce the fall prevention practice gap. Transparent, evidence-based fall prevention procedures must be used to reduce inpatient falls and improve the standard of care offered to patients. This will standardize processes and ensure that staff constantly adhere to the best procedures (Johnson et al., 2020).

Population Affected by the Policy:

The intervention’s target demographic at HFH in Detroit, Michigan, includes all elderly patients in acute care settings. This policy specifically targets the needs of the elderly patients receiving care in these settings and excludes children and adult patients. 

Definitions: 

• Inpatient Fall: It is defined as an incident when a patient loses equilibrium and unintentionally comes to rest on the ground. In this case, an unexpected fall of patients in the hospital setting can cause injuries (Strini et al., 2021).
• • Acute Care Setting: This setting involves the emergency and intensive care units of the hospital, where patients receive prompt and short-term care for any severe injury or life-threatening disease. In this context, patients need fall prevention intervention.

• Intervention: It refers to actions taken to modify people’s understanding and actions through the application of guidelines, education, and practices. It describes approaches for preventing falls among patients (Bargmann & Brundrett, 2020).
• Fall Prevention Bundle: This refers to adapted guidelines and methods for identifying people in danger of falling and providing preventive measures to minimize fall risk and fall-related injuries. It includes numerous activities such as training personnel and patients, altering the hospital environment, evaluating fall risks, and employing supportive tools (Bargmann & Brundrett, 2020).
• • Observational Studies: The method of research entails systematically recording and analyzing activities or outcomes without changing variables. In this context, medical staff should be observed to evaluate fall prevention practices (Weston et al., 2021).
  • PICO(T) Question: An approach for developing clinical study questions. PICO(T) refers to Population, Intervention, Comparison, Outcome, and Time, which assists in concentrating the research on specific areas of medical care or patient safety issues (Hosseini et al., 2023)

• Risk Assessment: It is the method of identifying, assessing, and prioritizing risks linked to potential dangers. In this context, it refers to the analysis of patients during their hospital stay to assess their possibility of falls based on several factors, such as medical condition and mobility (Shao et al., 2023).

• Assistive Devices: These are equipment designed to help a person accomplish a specific task. In this context, assistive devices include wheelchairs, safety bars, and walkers for elderly patients to prevent falls (Goher & Fadlallah, 2020).
• Environmental Modifications: It involves reorganizing, renovating, or adapting an existing place or structure to make it more accessible and safe for individuals. This sort of modification can include equipment installation and adjustments. In this context, it includes building zero-step entryways, short halls, and motion-sensor lighting in a hospital setting to reduce falls (Campani et al., 2021).

Policy Statement:

Addressing patient safety issues to enhance patient outcomes and mitigate falling events among older patients, the HFH has committed to implementing a comprehensive fall avoidance bundle program in its hospital setting, particularly in acute care units, over the next 12 weeks. This plan strives to ensure that medical professionals adhere to the guidelines and procedures for preventing patient falls (Schoberer et al., 2022).

The HFH is committed to creating a more secure patient setting by implementing and adhering to evidence-based fall prevention strategies. The goal is to lower patient fall rates and related problems by 45%. This will enhance the standard of care while lowering the likelihood of patient falls and associated consequences. The HFH exhibits its dedication to avoiding inpatient falls while offering quality patient care by undertaking this initiative.

Procedure:

The plan for an inpatient fall prevention program spans 12 weeks. It comprises numerous approaches, such as staff and patient education, complete risk assessment, implementing environmental modification, and utilizing assistive devices. In the first phase, during the first three weeks, educational sessions for patients and key stakeholders such as nurses and physicians will be conducted. It educates patients about the dangers of falling and the repercussions that can result, as well as how to use supportive equipment and self-care procedures.

Furthermore, training prepares medical staff for comprehensive risk assessment utilizing fall threat evaluation tools like the Morse Fall Scale (MFS) while offering knowledge of fall prevention guidelines and procedures. It will discuss the need for risk assessment for fall prevention and also the evaluation schedule when a patient is admitted to the hospital (Ji et al., 2023). The training will be provided through both online platforms and in-person workshops. Educational and financial resources are essential for staff training. To ensure that staff understand and can effectively perform the risk evaluation practice, pre- and post-training evaluations, and surveys will verify compliance.

NURS FPX 8030 Assessment 5 Creation of Policy or Procedure

In the second phase, stakeholders will undertake a complete risk assessment in four to six weeks to identify the risk variables that contribute to increased fall rates and fall-related injuries. Recognizing the hospital’s capabilities, the risk assessment will be conducted using MFS and real-time data provided by the Electronic Health Record (EHR) integrated Fall Risk Management Information System (FRMIS) based on constant tracking and feedback (Wang et al., 2024). Medical personnel are mandated to adhere to the risk assessment protocols on a regular basis, both upon patient admission and afterward. Frequent risk evaluations help to reduce fall rates by continually assessing threatening elements such as patient medical conditions, environmental risks, and mobility issues and offer insight into areas for improvement (Altuhaifa et al., 2023).

In the third phase, in seven to nine weeks, environmental modification will be implemented through the collaboration of hospital administrators and leadership. Environmental modifications include implementing Zero-step entry points, non-slippery floors, short halls, and motion-sensor lighting in corridors and washrooms in hospital settings (Campani et al., 2021).  In the fourth phase, which is 10 to 12 weeks, assistive devices will be provided to elderly patients who face mobility difficulties or are disabled. Assistive devices include hearing devices, walkers, wheelchairs, and medication dispensers.

Moreover, grab bars must be implemented in corridors and washrooms to offer support to elderly patients (Goher & Fadlallah, 2020). Furthermore, commencing in the first week, continuous monitoring of fall prevention guidelines and intervention compliance will be conducted utilizing an EHR-linked FRMIS and observational methods. Designated fall prevention officials will conduct audits to document adherence and fall rates and monitor fall prevention measures. The fall prevention and patient safety committee will prepare and assess the report regularly. They will receive feedback that shows their abilities and areas of advancement (Albasha et al., 2023).

NURS FPX 8030 Assessment 5 Creation of Policy or Procedure

Lastly, medical staff will be invited to contribute their opinions and suggestions for improving fall prevention practices. Questionnaires and regular personnel meetings will be employed to collect input. The fall prevention and patient safety committee will review assessment and feedback data twice a month to identify trends and implement any necessary intervention changes (Albasha et al., 2023). Based on recognized gaps and emerging best practices, regular training will be organized to develop staff knowledge in fall prevention. The accessibility of assistive equipment and other supplies must be continued (Goher and Fadlallah, 2020). The maintenance staff will ensure that the hospital environment is safe and that crucial supplies, such as proper lighting and non-slippery or dry floors, are in satisfactory condition. These quality improvement endeavors aim to strengthen fall prevention at the HFH to reduce inpatient falls among senior patients and improve patient safety and outcomes.

References:

Albasha, N., Ahern, L., O’Mahony, L., McCullagh, R., Cornally, N., McHugh, S., & Timmons, S. (2023). Implementation strategies to support fall prevention interventions in long-term care facilities for older persons: a systematic review. BioMed Central Geriatrics, 23(1), 47. https://doi.org/10.1186/s12877-023-03738-z

Altuhaifa, F., Al Tuhaifa, D., Al Ribh, E., & Al Rebh, E. (2023). Identifying and defining entities associated with fall risk factors events found in fall risk assessment tools. Computer Methods and Programs in Biomedicine Update, 3, 100105. https://doi.org/10.1016/j.cmpbup.2023.100105

Bargmann, A. L., & Brundrett, S. M. (2020). Implementation of a multicomponent fall prevention program: Contracting with patients for fall safety. Military Medicine, 185(Supplement_2), 28-34. https://doi.org/10.1093/milmed/usz411

Campani, D., Caristia, S., Amariglio, A., Piscone, S., Ferrara, L. I., Barisone, M., & IPEST Working Group. (2021). Home and environmental hazards modification for fall prevention among the elderly. Public Health Nursing, 38(3), 493. https://doi.org/10.1111%2Fphn.12852

NURS FPX 8030 Assessment 5 Creation of Policy or Procedure

Goher, K. M., & Fadlallah, S. O. (2020). Assistive devices for elderly mobility and rehabilitation: Review and reflection. Assistive Technology for the Elderly, 305-341. https://doi.org/10.1016/B978-0-12-818546-9.00016-6

Heikkilä, A., Lehtonen, L., & Junttila, K. (2024). Consequences of inpatient falls in acute care: A retrospective register study. Journal of Patient Safety, 20(5), 340-344. https://doi.org/10.1097/PTS.0000000000001230

HFH. (2024). After a fall. Henryford.com. https://www.henryford.com/services/senior/after-a-fall

Hosseini, M.-S., Jahanshahlou, F., Akbarzadeh, M. A., Zarei, M., & Gharamaleki, Y. V. (2023). Formulating research questions for evidence-based studies. Journal of Medicine Surgery and Public Health, 100046–100046. https://doi.org/10.1016/j.glmedi.2023.100046

Ji, S., Jung, H.-W., Kim, J., Kwon, Y., Seo, Y., Choi, S., Oh, H. J., Baek, J. Y., Jang, I.-Y., & Lee, E. (2023). Comparative study of the accuracy of at-point clinical frailty scale and Morse fall scale in identifying high-risk fall patients among hospitalized adults. Annals of Geriatric Medicine and Research, 27(2), 99–105. https://doi.org/10.4235/agmr.23.0057

Johnson, K., Scholar, H., Stinson, K., None NEA-BC, M.A.-L. Sherry Razo, & None NEA-BC. (2020). Patient fall risk and prevention strategies among acute care hospitals. Applied Nursing Research, 51, 151188–151188. https://doi.org/10.1016/j.apnr.2019.151188

Schoberer, D., Breimaier, H. E., Zuschnegg, J., Findling, T., Schaffer, S., & Archan, T. (2022). Fall prevention in hospitals and nursing homes: Clinical practice guideline. Worldviews on Evidence-Based Nursing, 19(2), 86–93. https://doi.org/10.1111/wvn.12571

Shao, L., Shi, Y., Xie, X. Y., Wang, Z., Wang, Z. A., & Zhang, J. E. (2023). Incidence and risk factors of falls among older people in nursing homes: Systematic review and meta-analysis. Journal of the American Medical Directors Association, 24(11), 1708-1717. https://doi.org/10.1016/j.jamda.2023.06.002

NURS FPX 8030 Assessment 5 Creation of Policy or Procedure

Strini, V., Schiavolin, R., & Prendin, A. (2021). Fall risk assessment scales: A systematic literature review. Nursing Reports, 11(2), 430–443. https://doi.org/10.3390/nursrep11020041

Wang, Y., Jiang, M., He, M., & Du, M. (2024). Design and implementation of an inpatient fall risk management information system. Journal of Medical Internet Research Medical Informatics, 12, e46501–e46501. https://doi.org/10.2196/46501

Weston, L. E., Krein, S. L., & Harrod, M. (2021). Using observation to better understand the healthcare context. Qualitative Research in Medicine & Healthcare, 5(3), 9821. https://doi.org/10.4081%2Fqrmh.2021.9821

Xia, L., Zheng, Y., Lin, Z., Chen, P., Mei, K., Zhao, J., Liu, Y., Song, B., Gao, H., Sun, C., Yang, H., Wang, Y., Song, K., Yang, Y., Luan, X., Wen, X., Yin, X., Fu, A., Cai, Y., & Xie, L. (2022). Gap between risk factors and prevention strategies? A nationwide survey of fall prevention among medical and surgical patients. Journal of Advanced Nursing, 78(8), 2472–2481. https://doi.org/10.1111/jan.15177