Practice Problem
The proposed intervention aims to address the problem of falls and adverse health outcomes, such as injuries, in older adults. Currently, 1 in 5 falls in this population causes broken bones (CDC, 2020). Three hundred thousand elderly people have to stay in the hospital due to a fracture after a fall, the most common of which is a hip fracture (CDC, 2020).
Falls among the elderly carry significant risks of traumatic brain injury (CDC, 2020). Quality improvement (QI) tools include risk assessment of falls, the introduction of balance and coordination exercises such as the Enhance Fitness program, the CAPABLE intervention to prevent falls at home, and the FallsTalk approach to raise awareness. The resources required to successfully implement the intervention are additional equipment, staff training, and time for home visits to patients.
Evidence-Based Practice Plan
The QI plan includes implementing programs for the elderly: Enhance Fitness, CAPABLE, FallsTalk, and fall risk assessment tools. The first step towards implementation will be introducing a fall risk assessment tool based on an individual assessment of the number of falls. This will help to subsequently evaluate the effectiveness of the proposed program.
The next step will be to promote and popularize the Enhanced Fitness and CAPABLE programs. Enhance Fitness addresses the four elements of fall risk prevention: improving the cardiovascular system, balance, strength training, and stretching (FitzGerald, 2022). It is proposed that this program be introduced in the community and that people at risk be invited to be visited by nurses and doctors three times a week (The National Council on Aging, 2021).
The CAPABLE program is conducted in the home environment and includes visits from doctors and nurses to ensure the correct implementation of recommendations and equipment at home for the patient’s needs (FitzGerald, 2022). FallsTalk is also an effective program for seniors with balance issues (The National Council on Aging, 2021). It focuses on interviewing and raising awareness about preventing subsequent falls.
The programs described are effective because they allow the necessary changes to be made at the patient’s home, which is an integral part of success. These interventions may be used when patients are discharged home with an elevated risk status for falls (Ibrahim et al., 2021). At each stage of the program, an important strategy should be to educate patients about minimizing the risk of falls by removing unsafe objects (Heng et al., 2020).
Home visits are also part of a successful plan to educate older people and help make their homes safe (Ong et al., 2021). The nurse can advise on the availability of assistive devices that may be needed, such as canes, walkers, or shower chairs. When working with patients in a hospital environment, mats should be used to minimize the negative effects of falls.
Resources
The described QI plan implies a significant use of additional resources to reduce the risk of falls and prevent their negative consequences. First, additional training for medical staff will be required. Nurses and doctors should be aware of the side effects of drug therapy that can increase the risk of falls (Morin et al., 2019). Staff also need to be trained in strategies for raising awareness among older patients (Heng et al., 2020). Healthcare professionals also need to be able to assess the risks of falls based on imaging and medical history. Additional education supplies include flyers, testing aids, and extra time to organize lectures.
Another valuable resource is the time health workers take to make home visits. Nurses and physicians should be able to visit older patients regularly for briefing and reassessment of risks and the patient’s condition (Ibrahim et al., 2021). In the hospital and nursing home setting, staff should have time to implement exercises to improve coordination and balance.
Within the framework of the QI plan, significant costs for new equipment are not required. However, funds will be spent on providing patients with the necessary things: ramps for the house, walking sticks, exercise equipment, and wheelchairs (Singh, 2020). In addition, it is necessary to check whether hospitals and nursing homes have rugs, mats, and equipment for coordination and balance exercises (WHO, 2021).
Each resource is equally valuable to the successful implementation of the plan. Education of healthcare workers will reduce the number of falls by increasing patient awareness. Time for home visits will help prevent the risk of traumatic falls. Equipment for patients and hospitals is needed to perform exercises to improve balance and coordination, which will also have a tangible effect.
Summary
Falls and injuries among the elderly are serious practical problems that need to be addressed. Reducing the risk of falls and preventing injury requires implementing exercise programs, raising awareness, and equipping patients’ homes to improve safety. Implementing a QI plan requires equipment costs, additional staff training, and time to complete home visits. While resource-intensive, change is needed to improve the lives of older patients and ease the burden on the healthcare system.
References
Centers for Disease Control and Prevention (CDC). (2020). Keep on your feet. Older Adults Falls. Web.
FitzGerald, P. (2022). Evidence-based programs for fall prevention. American Bone Health. Web.
Heng, H., Jazayeri, D., Shaw, L., Kiegaldie, D., Hill, A. M., & Morris, M. E. (2020). Hospital falls prevention with patient education: A scoping review. BMC Geriatrics, 20(1), 1-12. Web.
Ibrahim, K., Cox, N. J., Stevenson, J. M., Lim, S., Fraser, S. D., & Roberts, H. C. (2021). A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatrics, 21(1), 1-16. Web.
Morin, L., Calderon Larrañaga, A., Welmer, A. K., Rizzuto, D., Wastesson, J. W., & Johnell, K. (2019). Polypharmacy and injurious falls in older adults: a nationwide nested case-control study. Clinical Epidemiology, 11(1), 483-493. Web.
Ong, M. F., Soh, K. L., Saimon, R., Wai, M. W., Mortell, M., & Soh, K. G. (2021). Fall prevention education to reduce fall risk among community‐dwelling older persons: A systematic review. Journal of Nursing Management, 29(8), 2674-2688. Web.
Singh, H. (2020). Understanding the complexity of falls and fall prevention for wheelchair users with spinal cord injury across the continuum of care. University of Toronto.
The National Council on Aging. (2021). Evidence-based falls prevention programs. Web.
World Health Organization (WHO). (2021). Strategies for preventing and managing falls across the life-course. Web.