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Fall Prevention

The events in which the person comes on the surface of the ground unintentionally are termed as falls (Bok et al. 2015). These events can cause severe injuries in the patient and, in extreme cases, can cause the death of the person. In has been reported that in the United States every year, around 500,000 individuals fall while 150,000 people get severe injuries due to falls. The prevalence of falls is very high in older people than adults and children; moreover, women are at a significant risk of falling than men (Gale, Cooper & Sayer, 2016).

About 30 % of the falls observed in older people result in moderate or severe injuries. Some of the common injuries due to falls include hip fracture, head injuries, and trauma. It is also observed that falls can cause a fear of falling, which impacts the mental health of the person. Fall prevention or reduced number of falls is used as an indicator of the prevalence of falls. Higher the number of reduced falls, better is the fall preventive strategy and lesser is the prevalence of falls. The measurement of fall prevention can be done by evaluating the number of people who fall unintentionally and by the severity of the damages caused by these falls. Some of the methods of measuring fall risks are functional assessment, Romberg test, 6-minute walking test, dynamic GAIT test, Berg Balance Scale test, and balance evaluation system test (Ghahramani, 2016).

Summary of Literature

As per (Coad et al. 2018), falls are one of the major problems in residential aged care where around half of the population of older people falls every year. This can lead to severe injuries that eventually reduce patient outcomes. Falls have various risk factors associated with them, such as injuries, trauma, hospitalization, and disabilities. All these risk factors degrade the quality of life of older people and especially the one living in residential aged care settings. This is because the older people living in aged care homes do not have any family member or friend to look after them properly. They just have registered nurses and other healthcare professionals that only provide optimal care to them. As a result, falls lead to the development of depressive symptoms in older people and reduces their self-efficacy (Pin & Spini, 2016). Thus, fall preventions are essential to improve the quality of life of older people.

As per Berjk et al. (2017), one of the important assessment of fall-prevention is health-related quality of life (HRQOL) as falling leads to poor HRQOL. Effective fall prevention interventions can be measured by a high HRQOL of older people. The fall incidence can also be used to measure the quality of care provided to the patients of residential aged home. High fall incidence indicates inadequate fall prevention interventions, while a low fall incidence represents the use of effective fall prevention techniques. The assessment of fall incidence can also be used to analyze the quality of care provided to older patients at residential age cares. For example, high fall incidences support the fact that poor care is not given to older people due to which the number of falls is high. However, a low fall incidence represents that older people are provided with good quality care. These are some of the ways of measuring fall prevention in residential aged care.

Assessment of fall risks is essential for determining the efficiency of fall prevention interventions (Slade, 2017). Fall prevention interventions are important to reduce falls and to improve patient care. These interventions should include patient education on fall prevention, modification of the residential settings to decrease the rate of falls and clinical training for the healthcare professions to provide better care to the patients who are at higher risk of falls. The reduction in the risk factors of falls can increase the rate of fall prevention. Moreover, another way of measuring the effectiveness of fall prevention in reducing fall prevalence is to collect the information about falls recorded per day or month in residential age cares. The age cares that have more number of falls in a day or a month have poor fall prevention interventions while the age care homes that record less number of older people falling in a day or a month have better and effective fall prevention interventions.

As per Ghahramami (2016), various clinical assessments can be used to monitor the fall rate of a person. For example, the functional assessment test is used to monitor the duration for which a person can maintain balance. It can be used to monitor gait and body's balance for a short period. Romberg test is also used to measure the fall rate of a person, and in this test, the patient has to stand with both feet joined and opened eyes for 10 seconds. All these tests can also be used to monitor the success rate of fall prevention. The patients at higher risk of falls are given fall preventive interventions, and in case these interventions are successful, then the patient's performance in the fall assessment tests will improve. However, in case the patient's performance in these tests does not improve, then this indicates that the patient is still at risk of falls. The fall assessment tests should be used in residential age cares to analyze the effectiveness of fall prevention interventions and patient's quality of life.

As per WHO (2018), fall prevention measures must be comprehensive, supportive towards a safe environment and should remove the causes of falls. The role of fall prevention strategies and measures is to reduce the number of falls every year. Falls are preventable by using the techniques of fall preventions, such as improving balance and gait. The movement of the body through limbs is termed as gait. Consulting a doctor is a very important step of fall prevention as the dizziness and joint pain can lead to falls. Physical activities and regular exercises are also important for fall prevention as they improve body balance. Most of the older people suffering from obesity are at higher risk of falls due to their heavyweight. Physical fitness is important for older people to reduce weight and maintain their body balance.

Older people should be recommended to wear properly fitting shoes that have nonskid soles. Wearing heels and floppy slippers increase the risk of falls, and this is the reason that older people having the risk of falling must not wear these type of shoes. This can improve their movement while walking and can be used for preventing falls. Another method of fall prevention is to remove all hazardous substances to keep older people safe. This helps to prevent severe injuries that can be fatal in many cases. For example, all the substances with sharp ends must not be present in the residential old cares. The health care professionals working in the old age homes can provide assistive devices such as handrails near staircases, and supportive walking sticks to the older people that can support their movement while walking (Mayo Clinic, 2019). All these methods are effective in preventing falls and improving the quality of life. These decrease the chances of severe injuries during falling and also provide self-efficacy to older people by removing their fear of falling.

PDSA Quality Cycles

As per Christoff (2018), the PDSA cycle is a four-step cycle used to improve the quality of any process. These four steps are Plan, Do, Study, and Act. The clinical problems can be solved by using this cycle. The following three PDSA cycles can be used to test the components of care related to fall prevention:

PDSA Cycle 1

Plan: Residential age care X conducted a meeting to discuss its low fall prevention rate as compared to the other residential age care homes in the area. During the meeting, it was observed that the professional experts and registered nurses were not following the correct protocol of fall risk assessment due to which they were not able to determine the patients who were at high risk of falls and the ones who needed more fall prevention interventions.

Do: The higher authorities of residential age care X conducted a meeting on 15 January 2020 between 1 pm to 3 pm, and this meeting aimed to implement the above plan. All the health professionals and registered nurses were included in the meeting, and they were taught about the protocols of fall risk assessment.

Study: During the meeting, it was observed that most of the health professionals and registered nurses were unaware of the importance of fall risk assessments, and they were not following the correct protocols of fall risk assessment. This was the reason that they were unable to find the patients who were at higher risk of falls.

Action: The authorities of residential age care X made it compulsory for all health care professionals to maintain a detailed document on fall risk assessment of every patient. Moreover, regular remainders were given to the healthcare professionals and registered nurses to follow the protocols of fall risk assessment properly. This was conducted for one month.

PDSA Cycle 2

Plan: A second meeting was conducted by authorities of residential age care X to discuss the fall prevention interventions that can be provided to all the older patients who were at high risk of falls.

Do: A meeting was conducted on 12 February 2020 to discuss the techniques that can be used for increasing the fall prevention rate of residential age care. Suggestions were taken from every health professionals, registered nurses, and some of the older patients who were at high risk of falls.

Study: During the meeting, it was observed that some of the common and useful fall health interventions that can be adopted by residential age care X were building handrails, removing the sharp materials from the aged care, providing hand sticks to the older people and giving them properly fitting shoes.

Action: Within one week, handrails were built on both side of the staircase, new shoes were given to all the older people, supportive hand sticks were provided to all the older people who were at high risk of fall and all the sharp materials were removed out from the age care home.

PDSA Cycle 3

Plan: The authorities of age care X organized a meeting to discuss the documentation of reduced falls after the implementation of the above two plans.

Do: A meeting was conducted on 20 March 2020 in which the above plan was implemented. A team of five members (2 health professionals and 3 registered nurses) was formed, and the role of this team was to evaluate the effect in the fall prevention rate after the implementation of the above two plans.

Study: During the meeting, it was observed that the health professionals and registered nurses were not aware of the accurate documentation methods for fall prevention.

Action: A conference was held on 24 March 2020, and in this conference, health professionals and registered nurses were taught about the documentation methods that can be used for evaluating fall, fall risk, and reduced falls. After this, the team that was formed to evaluate fall prevention rate started analyzing the impact of PSDA Plan 1 and 2 on the fall prevention rate.

Evaluation of Quality Improvement Program on Fall Prevention

According to Carlucci (208), a number of programs have been implemented to improve the fall prevention rates of older people. These programs aim to reduce the number of falls that can provide better and improved care to older people. The success rate of quality improvement programs on fall prevention can be evaluated by the change in the number of falls reordered after the implementation of these programs. The reduced number of falls after the implementation of quality improvement programs represent a high fall prevention rate and improve patient care. However, in case the number of falls after the successful implementation of these programs does not decrease, then it represents that the program is not appropriate for fall prevention. Moreover, this program is not useful in improving the quality of care provided to the patient.

For example, the plans mentioned in PDSA 1, 2, and 3 can be called successful only when the fall prevention rate of older people staying in residential age care X increases. The increased fall prevention rate reflects that the number of falls recorded after applying these three PDSA cycles has decreased. This also indicates that the quality care provided to the older people of residential age care has improved due to the implementation of these three PDSA cycles. The increased fall prevention rate also represents that the health professionals and registered nurses of residential aged care X have started providing better care and more attention to the people who are at higher risk of falls and this will eventually improve patient's quality of life. Another method of emulation of fall prevention programs is to determine the improvement in the gait movement, balance, and confidence of older people who are at high risk of falling. The improvement in daily activities can also be checked to evaluate the effects of fall prevention programs (Carlucci et al. 2018).

References

Bjerk, M., Brovold, T., Skelton, A. D. & Bergland, A. (2017). A falls prevention program to improve quality of life, physical function and falls efficacy in older people receiving home help services: study protocol for a randomised controlled trial. BMC Health Services Research, 17(1), n.d. doi: 10.1186/s12913-017-2516-5

Bok, A., Pierce, L.L. Gies, C. & Steiner, V. (2015). Meanings of falls and prevention of falls according to rehabilitation nurses: A qualitative descriptive study. Rehabilitation Nursing, 41(1), 45-53. doi: https://doi.org/10.1002/rnj.221

Carlucci, C., Karddachi, J., Bradley, M. S., Prager, J. Wyka, K. & Jayasinghe, N. (2018). Evaluation of a Community-Based Program That Integrates Joyful Movement Into Fall Prevention for Older Adults. Gerontology and Geriatric Medicine, 4(8), n.d. doi: 10.1177/2333721418776789

Christoff, P. (2018). Running PDSA cycles. Current Problems in Pediatric and Adolescent Health Care, 48(8), 198-201. doi: https://doi.org/10.1016/j.cppeds.2018.08.006

Coad, F. J., Beer, E. C., Bulsara, C., Blackburn, C., Chivers, P. & Hill, M. A. (2018). Evaluating the impact of a falls prevention community of practice in a residential aged care setting: a realist approach. BMC Health Services Research, 18(21), n.d. doi: https://doi.org/10.1186/s12913-017-2790-2

Gale, R. C., Cooper, C. & Sayer, A. A. (2016). Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing. Age and Ageing, 45(6), 789-794. doi: 10.1093/ageing/afw129

Ghahramami, M. (2016). Fall risk assessment in older people. IJES, 5(11), n.d. doi: 10.9790/1813-05110114

Mayo Clinic. (2019). Fall prevention: Simple tips to prevent falls. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/healthy-aging/in-depth/fall-prevention/art-20047358

Pin, S. & Spini, D. (2016). Impact of falling on social participation and social support trajectories in a middle-aged and elderly European sample. SSM Population Health, 2(n.d.), 382-389. doi: 10.1016/j.ssmph.2016.05.004

Slade, C. S., Carey, L. D., Hill, M. A. & Morris, E. M. (2017). Effects of falls prevention interventions on falls outcomes for hospitalized adults: protocol for a systematic review with meta-analysis. BMJ Open, 17(11), n.d. doi: 10.1136/bmjopen-2017-017864 World Health Organization (WHO). Falls. Retrieved from https://www.who.int/news-room/fact-sheets/detail/falls

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