¶ … Reduce Patient Falls in a Hospital Environment Method of Obtaining Necessary Approval(s)

Description of Current Problem

Explanation of Proposed Solution

Implementing Change

Resources Required for Implementation

Risk and quality management is a fundamental and important aspect to many health care organizations and patient lives are often at stake. This is especially true in nursing facilities or hospitals that house elderly patients because of the level of direct patient interactions that occur on a daily basis and the specific needs of this population. There are many potential risks that can emerge from this population. Three common risks were identified from a literature review based on evidence-based practices. One common risk deals medication error and making sure patients receive the right dosage of the correct medication at the right time. Another risk that is becoming increasingly common is the risk of the spread of infection and in severe cases infections that are resistant to common antibiotics. However, this analysis chose to focus on patient falls in a hospital setting, with a focus on elderly patients, because not only is there a large body of research devoted to this topic, but patient falls is an excellent opportunity to institute the best practices that are derived from evidence-based research to reduce the likelihood of a common and preventable healthcare risk. This analysis will frame the opportunity to reduce the occurrences of patient falls, followed by a literature review of the research, and then propose a plan to implement a fall reduction strategy at a local healthcare institution.

Method of Obtaining Necessary Approval(s)

To obtain the necessary approvals from the healthcare institution, the first step will to consider the data and the rate of occurrences of patient falls at that institution. If there is data available, the rate of patient falls may be calculated. If the organization does not track the number of patient falls, then a recommendation to monitor this specific type of risk may be made along with the implementation plan. Having a baseline rate will allow for the measurement of the effectiveness of the practices to be implemented and will also assist in securing support from the organization's leadership and fellow staff.

Description of Current Problem

Falls are the leading cause of hospital related injuries in the United States. In the organization chosen, there is not a formal strategy for preventing patient falls. Based on an informal analysis with the staff, many of the nurses are aware of the issue but there is not a dedicated procedure in place to reduce the likelihood of patient falls. To implement a formal policy, the issue should be looked a comprehensively from a range of different factors. Evidence-based practices should be compiled that focus on fall related incidents. Given the importance and the common challenge this risk represents, there is a large body of evidence available to guide the implementation.

Explanation of Proposed Solution

Instituting a formal fall prevention strategy is an important aspect to risk management. Furthermore, fall prevention is an important aspect to patient safety that can be facilitated by staff, patients, and their families to mitigate potentially harmful outcomes. Implementing a formal fall prevention strategy can not only improve the quality of care provided, but it can also reduce the organization's legal liabilities relative to fall related accidents.

Rationale for the Proposed Solution

There are a number of different risk and risk mitigation strategies that are available in any healthcare setting. Focusing and patient falls is one of the more fundamental intervention strategies that is available and has a number of direct as well as indirect benefits (reducing stress and improving patient satisfaction among others). There have been a number of studies conducted on the topic which makes mitigation strategies stand the likelihood of being more effective and the implementation strategy can be based on solid evidence-based studies. Furthermore, patients injured in a fall incur increased hospital costs due to additional treatment and longer lengths of treatment.

Review of Literature

There are many different factors that can influence a patient fall. There are specific risk factors that this type of risk that included factors such as environmental hazards, adaptive equipment maintenance, psychotropic drug use, physical therapy or exercise, staff education, post fall problem solving, and hip protectors (Colon-Emeric, et al., 2006). Each of these factors should be included in the intervention strategy.

There are also many studies that show that fall related intervention strategy implementations have proven successful in mitigating the likelihood of patient falls. For example, one study in Germany was able to implement a fall reduction intervention in an environment...

The study took place in the geriatric clinic of an academic teaching hospital in the northwest corner of Hamburg, Germany (250,000 inhabitants in this area), serving approximately 2,300 inpatients annually (a predominantly urban population) and accounting for 22% of geriatric inhospital patients in Hamburg. One third of the patients are referred from the hospital's emergency room or admission ward (integrated geriatric service) and the remaining patients are directly referred by general practitioners and internists (35%); come from other hospital departments, including intensive care and stroke units; or are referred from other hospitals in and around Hamburg for acute care and early rehabilitation (Renteln-Kruse, Krause, & Georgr, 2007). In this environment, before the intervention was introduced, 893 falls were recorded and after the intervention was implemented, only 468 falls were recorded thus giving evidence-based support for the effectiveness of fall reduction interventions.
Implementation Logistics

Implementing a fall reduction intervention can be logistically complex, but still entirely feasible. The first step will include to identify and recruit a qualified project manager to oversee the intervention. The intervention can be managed effectively using a project format. Collecting the baseline data will also be a key consideration. This will allow the organization to have a point of reference that will allow them to judge the effectiveness of the intervention. Much of the intervention itself will involve creating appropriate metrics and training the staff to follow the best practices that were identified in the literature regarding effective strategies for reducing patient falls. However, after the project is implementing, another critical component will be monitoring the compliance with the intervention strategy and taking corrective action when necessary. Any future falls can also be analyzed to attempt to understand what was responsible for the occurrence and the results can be shared and processes improved.

Initiating Change

There will need to be a dedicated project team recruited to implement the organizational change initiative. This team will ultimately be overseen by the project manager that is selected for the project. A skilled project manager can institute a process improvement implementation strategy with a greater likelihood of success than someone that does not have project management skills. It is also important that the project team consists of a cross functional group that can ensure that different organizational functions are represented in the project. This team can look at a process redesign

The team can chose to use a wide variety of management tools for the implementation. Once the design is completed, the transformational aspect of the project begins. It is at this point that a leader must motivate the staff to accept the changes and collect feedback if there are issues in which the design is working properly. For example, if an employee is simply overwhelmed, not due to neglect or incompetence, then the workload must be reassessed and the design augmented. Furthermore, it is rarely the case that a design moves to implementation without any complications. One simple and effective model was identified to be the PDCA cycle. PDCA is an acronym for Plan, Do, Check and Act. The PDCA cycle is a way of continuously checking progress in each step of the process.

Implementing Change

The implementation will begin with training the staff relative to the new processes and best practices determined by the cross-functional project team. The training will have to cover the related topics to the project including the justification for the project, the scope of the project, the changes in processes and procedures, and information about the best practices that were identified and chosen to be part of the intervention. This information will allow the nursing staff to have a comprehensive knowledge of the reasons the change is being instituted. There should also be mechanisms built into the project to collect feedback at each stage of the project's development as this can identify valuable insights. Each department should chose a project champion that can implement tactical changes in their department and be department leaders for their team.

Resources Required for Implementation

This project will require several organizational resources. The project manager will be one of the most fundamental resources required as this will likely require a full-time position. The other members of the cross-functional project team will also have to have their primary organizational responsibilities temporarily reduced so that they have sufficient time to dedicate to the project. The entire staff will also have to make time available for training sessions. The project team should also collect data about the current level of information that the staff possess before the training sessions so…