Nursing strategies to address falls
Introduction
Medical personnel are well positioned to meet the needs of the communities they serve through clinical inquiry that allows them to bridge the gap between clinical practice, scientific information and research result. In fact, today’s medical personnel are capable of integrating information from different sources and across disciplines, through cultivating the spirit of inquiry, translation and dissemination of evidence-based knowledge to bring about changes to medical practice (Lundy & Janes, 2016). That is the case with fall incidence in which case evidence is presented to show that falls are a problem within an inpatient rehab unit, along with proposing solutions to the current problem based on evidence from medical research results. In this respect, the purpose of the present paper is to discuss the need for change in a medical facility, and proposing viable solutions based on collected evidence.
Discussion
Incidence of falls in the inpatient rehab unit
A review of the variation between actual fall incidence and targeted incidence as presented in the nurse-sensitive quality indicator shows that the inpatient rehab unit has been getting better at achieving its targeted falls figures. In this case, the unit initially had problems achieving the desired fall incidence reporting the worst variation figures in the first quarter of 2006 at 21.44. Over time, the facility improved its capacity to achieve the targeted figures with the best variation results reported in the first quarter of 2010 at -6.05 (see Figure 1). Based on the changing variation figures, there is a need to develop protocols for handling patients to ensure that fall incidence are effectively reduced.
Figure 1. Variation between actual falls and targeted incidence reported over time
A review of the falls data in terms of staffing levels shows that there is some correlation between them. In this case, there is a negative correlation between percentage BSN and total falls such that increasing the percentage BSN reduces the number of falls with the inverse being equally true. On the other hand, increasing the percentage of certificate nurses increases the number of falls (see Table 1 and Figure 2). It can be explained that BSN are more knowledgeable and proficient than certificate nurses thereby making them better prepared to reduce fall incidence.
Table 1. Correlation between mean falls figures, percentage BSN and percentage certification
| TOTFALLS | %BSN | % CERT | |
| TOTFALLS | 1 | ||
| %BSN | -0.28555 | 1 | |
| % CERT | 0.123284 | 0.586249 | 1 |
Figure 2. Mean falls figures compared to mean percentage BSN and percentage certification
Understanding the problem from a nursing perspective
The identified problem is the incidence of falls in the unit. The intention is to identify nursing practice approaches to eliminate these incidence. Natan, Heyman and Israel (2016) mention this problem by conceding that there are specific factors responsible for the occurrence of falls among patients, particularly those in a rehabilitation facility. Of importance is the fact that the patients at high risk of falls in these facilities are have unique characteristics that can be used to identify and target them for greater nursing intervention so as to reduce the possibility of falling. Based on this awareness, it is logical to suggest that nursing personnel working in rehabilitation units can refine their operating procedures to ensure that risks and incidences of falls are eliminated (Weber & Kelley, 2013).
Nursing interventions to eliminate risks and incidences of falls in a rehabilitation unit
Three nursing strategies have been identified to address the presented problem. The first strategy entails increasing nursing supervision on patients at highest risk of falls based on demographics. This requires that more knowledgeable and proficient nurses be employed since they are better prepared to reduce fall incidence. This would entail reviewing the falls data to determine if it has demographic implication to include gender, age, ethnicity, and the particular condition. If possible, designate these patients for fall precaution, key in the same information in their charts, and use restrains where necessary. For instance, Natan, Heyman and Israel (2016) report that the fall risk for elderly persons in rehabilitee units is 14%. The study further adds that males with normal BMI, suffering from cardiovascular ailments, transferred from internal medicine, and very active during rehabilitation are more likely to experience falls (Natan, Heyman & Israel, 2016). Hunt (2016) similarly mentions that patients at high risk of falls should be identified using screening tools with the intention of targeting them for focused care to reduce fall incidence. This means that nursing personnel should closely supervise the patient demographics identified as being at highest risk of falls in rehabilitation units, and target them for closer supervision.
The second strategy is to engage the patients and their family members during the process of admission by informing them about the need for a collaborative effort to prevent fall incidence. In this case, it is accepted that treatment side effects and deconditioning in the rehabilitation unit cause fall to occur since patients are tempted to overestimate their functional status and abilities, resulting in them taking unnecessary risks and falling. For that matter, it is projected that since nurses can only attend to the patients periodically, then integrating the patients and their family members into the care planning process would inform them of the risk of fall, make them aware of how to avoid the risks, and actively implement fall avoidance strategies even when the nurse is not around (Vonnes & Wolf, 2017).
The final strategy entails screening patients for falls and orienting them to the rehabilitation environment. This includes screening mobility and stability skills such as sitting down, walking, and standing. This strategy determines the patients’ functional abilities to facilitate planning for ways in which nurses can ensure safety and improve problem areas. Additionally, nursing personnel should review medication to determine whether they increase the risk of medication and discuss with other members of the care team on whether the patient has an absolute need for the medication (Bulechek et al., 2013).
Conclusion
One must accept that nurses are well positioned to meet the medical needs of their patients through close interactions and professional knowledge. In addition, one must acknowledge that the variation for fall incidence reported in the inpatient rehab unit is a problem since it shows that there is a disconnect between actual and target fall figures. To address this concern from the nurses’ perspective, three strategies have been proposed. The first strategy is to increase nursing supervision on patients at highest risk of falls to include designating them for fall precaution and keying in the same information. The second strategy is to apply a collaborative effort that entails engage the patients and their family members during the process of admission. The final strategy is to screen patients for falls and orienting them to the rehabilitation environment. Overall, it is anticipated that applying the three mentioned strategies will reduce the incidence of falls within the inpatient rehab unit.
References
Bulechek, G., Butcher, H., Dochterman, J. & Wagner, C. (2013). Nursing interventions classification. St. Louis, MO: Elsevier/Mosby.
Hunt, K., (2016). Keeping our frail and elderly patients out of hospital. Practice Nurses, 46(2), 16-20.
Lundy, K. S. & Janes, S. (eds) (2016). Community health nursing: caring for the public’s health (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Natan, M., Heyman, N. & Israel, J. (2016). Identifying risk factors for elder falls in geriatric rehabilitation in Israel. Rehabilitation Nursing, 41, 54–59.
Vonnes C, Wolf D. (2017). Fall risk and prevention agreement: engaging patients and families with a partnership for patient safety. BMJ Open Quality, 6(2), e000038. doi: 10.1136/bmjoq-2017-000038. Retrieved from https://bmjopenquality.bmj.com/content/6/2/e000038
Weber, J. R. & Kelley, J. H. (2013). Health assessment in nursing. Philadelphia, PA: Lippincott Williams & Wilkins.
First look at the dashboard I have submitted with the assignment as an attachment. We are going to use the dashboard indicator and focus on falls. Look at how many falls there was each quarter. There is a mean for each quarter as a variance look and analyze the data. Compare the fall rate with the mean and variance (variance means did they meat their golf?) IF they didn't meat their goals look at the other QIs like staffing levels or Rounding, or %BSN and see if there is a correlation between the two. Were falls due to low staff? If they had enough staff, state that, but try to correlate why the falls rates are high or low with another indicator on the dashboard. Maybe they have fallen all because the patients were not educated about using the call light, or poor nurse rounding (which is also oon the dashboard) Falls is the QI that we are comparing and contrasting and trying to correlate other QIs to Falls. Are falls high or low depending on what the dashboard says. Maybe first quarter they were high and staffing was on point, but second quarter they were lower but staffing was the same you can correlate that no matter if they had x staff or x staff second quarter was lower. This is just an example as I have not looked and studied the dashboard just trying to give you an example. Based on what you correlate come up with a care plan for that patent. The care plan should be evidence-based ways to make sure they do not fall that the nurse can implement to make them not fall so the fall QI gets better. 1.SELECT One Quality Indicator that needs improvement. Thoroughly review the statistical data provided in the Dashboard and develop a nursing action plan based on best practices. To prepare Review the Week Assignment Rubric • Review the Week 4 Resources that pertain to the NDNQI and use of dashboards Choose a Nurse-Sensitive Quality Indicator that needs improvement based on the data presented in the Dashboard. Include information on why this area was chosen. • Develop a nursing plan that outlines suggestions on how to improve performance in the chosen area. Provide at least three best practices from evidenced-based literature to support your nursing plan.