The safety problem I selected that impact on health delivery is fall. Fall event, particularly in the elderly population in acute care setting can have the major issue as well as the care providers. Patients who sustain fall are at higher risk of developing worsening injuries such as traumatic brain injury (TBI), hematoma, abrasions, hemorrhage, and fractures. (Faes et al., 2010). This directly contradicted of the first aim for improvement which is safe “do not harm” (Wakefield, 2008). According to Institute of Medicine. “The healthcare environment should be safe for every patient all the time. The standard of safety implies that organizational should not have different, lower standards of care on nights and weekends or during times of organizational change” (Institute of Medicine, 2001). Patients and their families should be included in plan of care, the risk and treatment.
However, up to half of older adults over 65 experience a fall every year. They are associated with high morbidity and mortality and are responsible for higher than 20 billion dollars a year in healthcare costs in the United States, (CDC). Fall injury rates are higher in individual with poor health than for those with excellent health (Institute of Medicine, 2001). The fragile patients seem to have the inability to identify the causes of their falls especially if they are altered. If the patient had history of falls, the have higher risk of again. Lessening a patient’s fear of future falls can increase his or her ability to involve in physical activity and therefore produce a behavioral modification that will lead to continuing decrease fall-risk (Mahler, 2011).
Impact of the falls
Unfortunately, older adults feel that falls are the result of an accident when in most cases the cause is preventable. A patient who falls is likely to feel lack confidence and despairing, become depressed and experience a loss of quality of life and physical functioning as a result. Moreover, decreased self-confidence and physical functioning. Patients who fell are likely to fall again. Falls in older adults is huge problem on the health care system. A patient who fall are less likely to take part in beneficial activities like exercising or socializing because of a fear of getting hurt again and the humiliation. Active falls prevention activities and targeting these high-risk groups should be a priority. Falls that happen in acute care setting can increased length of stay and use of health resources. Involving the physical therapy program has the potential for lowering falls risk and enhance mobility.
Proposed Practice Changes
Fall and injury prevention continues to be a considerable challenge across the care field. Elderly population with fall risk factors are not the only ones who are susceptible to falling in health care facilities. Any patient of any age can be at risk for a fall due to a medical condition, medications, surgery, procedures, or diagnostic testing that can leave them debilitated or altered.
During admission, it is imperative to assess the patient for fall risk and initiate proper interventions and reassess risk regularly. Appropriate fall screening is necessary. Research shows that proper evaluations are the key to preventing falls (Tzeng, 2008). Developing tools for the emergency department to communicate a patient’s risk factors for falls to the admitting department and activate fall risk wristband. Improving handoff tools between department and shifts changes.
The Purposeful Hourly rounding will support the provision of proactive care such as the need for assistance to the bathroom and to ensure that all possessions is within reach.
Hourly rounding helps to meet the patients` needs on time and helps to assess any change in patient status. EBP shows that hourly rounds can reduce the rate of recurrence of patients’ call light use, increase their satisfaction with nursing care, and decrease fall (Mitchell et al., 2014). Communicate any changes in condition and behaviors during the report. Ensure that high fall risk is moved closer to nursing station so that nurses hear the bed alarm. Providing fall prevention training for professional disciplines Education of clinical and nonclinical staff. •Having unit champions reinforce discussions about mobility as part of the care plan for each patient, at interdisciplinary rounds.
Mitchell, M. D., Lavenberg, J. G., Trotta, R., ; Umscheid, C. A. (2014). Hourly Rounding to
Improve Nursing Responsiveness: A Systematic Review. The Journal of Nursing Administration, 44(9), 462–472. http://doi.org/10.1097/NNA.0000000000000101
Institute of Medicine of the National Academies. (2001). crossing the quality chasm: The
IOM Health Care Quality Initiative. Retrieved fromhttp://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2001/Crossin g-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf
Tzeng, H. M., Yi Yin, C. (2008). Nurses’ Solutions to Prevent Inpatient Falls in
Hospital Patient room. Nursing Economics, 26(3), 179-87.
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