Health Management. Falls Risk Assessment Report

Introduction

The incident of falls is said to be a major public health challenge for various countries with an ageing population (Huang et al., 2003). At about 30% of people aged over 65 years and 50% aged over 80 years will fall in a particular year. In addition to the morbidity and mortality linked with the injuries they cause, falls are a major reason for emergency attendance at the hospital, hospital bed utilization and transfer to nursing home care. Falls can have a great negative result on the performance and quality of life of older persons (DeRekeneire et al., 2003).

There are often multiple causes for falling in one patient. Consequently, most attempts have addressed various assessment and intercession. Multifactorial assessment has been viewed to lessen the risk of falling with a risk ratio of about 0.82 in a meta- analysis conducted through a study. However, with the limitation of mobility training, it is still vague on which parts of the multifactorial assessment are efficient and how huge the effect on fall risk is for an every single intervention (Hitcho et al., 2004; Shaw et al., 2003).

One of the probable single intercessions is withdrawal or the discontinuation of fall- risk increasing drugs. Though there are no strong data about the efficiency of this single intercession, a lot of links between falls and drugs have been reported (Buckwalter et al., 2003).

Specifically, psychotropic drugs such as antipsychotics, antidepressants, and sedatives, and cardiovascular drugs such as diuretics, type IA antiarrhythmics and digoxin are taken as risk factors. With the people’s basic knowledge, one study has pointed out to the effect of the suspension of a fall- risk increasing drug. In 1999, a randomized controlled attempt was published which illustrated that the discontinuation of a subgroup of probable FRID or fall- risk increasing drugs such as antidepressants and sedatives can minimize the risk of falling.

There are studies that did not include other probable FRID and it did not even centre the target geriatric patients with the previous cases of falls (Hazzard et al., 2003), but somewhat healthy and fit community- dwelling older people. Thus, a performance of a prospective cohort study was made in a population of geriatric outpatients where in an empirical investigation on whether the suspension of FRID has something to do with the decrease in fall risk.

A study cited by Cameron (2005) concluded that the withdrawal of FRID was efficient as a single intercession in order to minimize the incident of falls. It was shown that the suspension of FRID is safe and probable in a geriatric outpatient setting (Cameron, 2005). The impact of fall incidence was huge for the suspension of cardiovascular drugs (Cameron, 2005). Generally, FRID suspension as a single intercession is more likely to decrease the incidence of fall during a short term follow up in a weak faction of geriatric outpatients (Hazzard et al., 2003)). The findings endorse the guideline advice that suspension of FRID should be part of the multifactorial intercession for patients possessing with falls (Cameron, 2005).

The use of FRID is just an example of an assessment which relates to the fall risk. Drugs are vital for the determination of such cases and needs proper approach, however, other issues will be scoped such as other contributing factors why falls happen (Jester et al., 2005).

Generally, this paper points out to the result of knowledge of advanced leadership and management. Designing an innovation in healthcare which may be a new strategy for the related key players will be the benefit of this paper. An evidence- based data will be presented in order to overtly define the need for a change and its comparison with the recent practices (Braun, 2003). A business plan will be proposed and a strategy for evaluating such proposal will be shown together with a contingency plan on how to disseminate the innovation.

Discussion

Evidence of the need for a proper medication

Injuries resulting from falls portray an essential public health concern for all ages, but specifically for older people (Buckwalter et al., 2003). Falls consider for a substantial proportion of injury -related morbidity and mortality among older people. Undoubtedly, falls also illustrates the very significant injury- related reason for hospital admissions for all ages and are a strong predictor for placement in a nursing home (Myers and Nikoletti, 2003).

The determination of amendable risk factors for falls could lead to the improvement of preventive strategies that may increase quality of life (Lesher, 2005), reduce premature mortality and lower health care costs such as the profound understanding of drugs used for the patients and how it is associated with the incidents, and other contributing factors which should be highlighted for the incident of falls (Cameron, 2005).

The contributing factors for falls may be separated into two most important categories which are; those factors that are specific to the individual or intrinsic and those factors that have something to do the environment or extrinsic (Kelly & Dowling, 2004). Primarily, Intrinsic factors would comprise of age-related changes such as impairment in hearing, vision, musculo-skeletal functioning, mobility, and physical activity. Intrinsic risk factors also take account of health status-related factors such as the existence of a range of chronic and acute illnesses such as diabetes, cognitive discrepancies (Pynoos et al., 2005), Parkinson’s disease and the like.

Extrinsic factors comprise of the physical environment, the activity in which a person is normally does, such as bathroom-related activities, transferring, dressing, and footwear. The medication profile of an elderly person could be taken as either an intrinsic factor or an extrinsic factor (Bergland & Wyller, 2004). This is because of a possessing a specification for an individual that is why an intrinsic factor is attributed to it while the extrinsic factor accounts for the medication profile which is theoretically modified by the medical professional in able to lessen the level of an elderly person’s risk of falling (Buckwalter et al., 2003).

Drug use and risk of falls

However, the issue about the use of drugs highlighted in some areas and is presented through studies (Cameron, 2005). Evidence showed by one of the studies examined, an incident report was finished for every fall that was carefully observed and suspected in a specific institution. A fall was said to be as any incident where in the residents come to rest on the floor, ground or any other hard surface which may involve slipping or found lying on the floor (Hendrich et al., 2003).

Some medical charts were reviewed to obtain the necessary data such as the diagnostic information. Moreover, the records for medication come from the order sheets of the doctors. The drugs that prescribed are implicitly written with the use of a tailored Anatomic Chemical Therapeutic (ATC) coding system. The system is described as a hierarchal arrangement which segments the drugs into 14 significant groups and four diverse levels of subgroups (Brucher et al., 2007).

The code was initially developed by the World Health Organization and modified to present a unique code for every chemical entity. In addition to the drug code, dates for the beginning and end of the use of drugs were also seen. Alterations in the status of drugs also involved changes in strength or its dosage. Hence, a new start of a drug could be either a different one from those which is taken before or perhaps it is just a matter of changing the dose of the same drug.

Evidence that the change planned meets the need for proper medication

Basically, the health status of those individuals depicts in terms of the four various treatment programs to which they could be appointed where in the responsibilities are based on their health status and on the availability of space. One particular program should be set for the individuals with an average loss in physical autonomy that may as well be moderately cognitively impaired. Another suggestion points out to the admission of the individuals with a more harsh physical autonomy loss who may also be moderately cognitively impaired (Trader, 2003).

Analyzation that the innovation or change for the proper medication of the patients should then consider the grounds for the drugs used and the environmental factors which relatively contributes to the development of such cases (CMMS, 2005). Evidences that a change for an innovation meet the expectations of the individuals who may likely to be prone with these instances and a contingency plan should also be imposed with the inclusion of the factors such as the organization, and the individual’s perceptions.

Change Strategy in relation to best practice

Considering the facts that was empirically stated should have a strong and direct strategy for the change in proper medication. The necessary actions should be taken as the overall framework comprise of the change in the management of staffs or attendants whom will give those services to the patients such as providing the proper dosage of drugs and the keen observation for every individual with its environmental factors (Isham & Kraemer, 2003). Implementation of a successful risk management strategy will apparently give a decrease to the incident of falls and thus give the patient a better and safer life taking into consideration their respective conditions (Manno et al., 2006).

Individually, the level of responsibility perceives when a specific patient has been recognized with a particular condition. In this case, the patient should be treated properly and be provided with proper medications such as the right dosage of drugs and the effects of the certain drugs to the patient which may slightly result to be the foundation of having a risk of falling (Cameron, 2005). Another one is the proper care which sets out to the consideration of giving attention in every activity that the patient will do (Keys, 2004).

Strategies can be enumerated with the following in general; the implementation of a new procedure in giving the drugs, this has something to do with the specifications of appropriate dosage and time of intake and the aftermath observations of the carers, the addition of staffs around the premise where in patients will be carefully watched to avoid any actions which may trigger the accident and the assignment of personal nurses for each patient to ensure that the person responsible for the patient is widely attuned with the condition of the patient (AMDA, 2003). These are significant for accomplishing the desired changes for an innovation and the proper management in healthcare systems.

In one study, the number of participants who had fallen was low among participants living alone and independently, which may be because of gender- related issues and fully functioning without obvious health problems. Similarly, Simpson et al (2004) suggested that loneliness was not related to falls or recurrent falls.

Proposals

The business plan primarily suggests the development of the actions in which the changes should be applied to. The tasks should be carried out in terms of a general approach which will be pointed to the management and handling of the systems concerned with the implementation of such changes and improvements. Responsibilities may be given to the organization and individual senses.

Priorities are speculated in the operational management with regard to the assignment of staffs and carers in specific areas around the institutions such as the stairs, windows, and other high areas in order to achieve the proper medication processes of the risk fall assessment (Hunag et al., 2003). However, costs will be added and taken account for the additional employees that will be hired in order to implement the proposal and of course with the recognition of responsible employees are restricted to. A responsible employee is described to be properly trained and skilled regarding the tasks given to him or her and relates substantially with the principles and guidelines of the institution (Keys, 2004).

Furthermore, this business plan specifically caters to the improvement of staffs and depicts better employment relations in order to achieve a well- managed staff that will take charge in minimizing the risks of falling. This is a long term institutional change though but this should be taken as an immediate response for a change in the proceedings of such institutions. Dissemination of this plan includes the implementation throughout small units at first and apparently be applied to large hospitals or vice versa depending on the affirmative results of the plan. Evaluation of the plan should take account of a contingency plan that should be developed for the realization of various risks involve in the management of the field.

As what should be anticipated, a successful risk of falls management will be achieved through the given premises. Specifically, dissemination includes the promotion of hiring more staffs in certain areas such as adding more nurses for each patient or perhaps for each room to provide more attention with the patient’s needs. This would largely be efficient in giving proper care and thus, avoid the risk of falls (Pynoos et al., 2005).

Evaluation should account for the feedback of the patients as how it will be depicted on the decreased rate of patients from falling. Costs will more likely be adjunct into the operational costs and will be needing funds for the salaries of the staffs such as considering the compensation rate of a health care provider in a specific institution, technologies such as new equipments for altering the dangerous sites inside the institution.

This may include changing the stairs into elevators to avoid the risk of falling whenever they have to go to other areas of the institutions. Convenience and safety of the patients should be the first one to consider and management of fall’s risk should be the main objective of the plan. This plan will be made known to the significant people involve such as the staffs, health care professionals, patients and other concerned people in the area through the implementation of new policies and putting into actions these plans. Thus, a leader should then organize an event to launch the plan with the members and cooperate with each other to better visualize the outcomes of the proposal.

Transitional arrangements such as the alteration of drugs or its dosage will more likely depict the careful observations and proper handling of the carers for each patient. In addition to, each individual responsible for this area should be an expert for the field that needs appropriate screening and possesses profound interest for full cooperation (Trader, 2003).

In analysing the risks involved for the strategy should be referred to the guidelines imposed by the Risk Management Guideline that was developed by the governments of Australia and New Zealand (Australia/New Zealand risk management, 2004). Accordingly, risk management is “the culture, processes and structures that are directed towards the effective management of potential opportunities and adverse effects.” (Australia/New Zealand risk management, 2004).

The management of risk somehow should take other conditions attributed to the patient or some diseases that should be given attention such as the following diseases: hypertension, myocardial infarction, diabetes mellitus, angina pectoris, heart failure, atrial fibrillation, heart rhythm disorders other than atrial fibrillation, stroke, transient ischaemic attack, arthritis, Parkinson’s disease and parkinsonism, chronic obstructive pulmonary disease, delirium, depression, epilepsy, eye disorders, anxiety disorders, sleeping disorders, history of hip fracture, history of nonhip fracture, thyroid disorder, malignancy, Menière’s disease, urinary incontinence, other diseases and total number of comorbid diagnoses. Thus, risks of the plan arise when other conditions of the patients integrates with the dosages and apparently affects the risk of falls for of a patient (Spath, 2003).

A long term end result for older people may be depicted from the fall injuries which may comprise of various physical injuries and the worst case is death. Various attempts are made previously and it needs to be sustained through developing a contingency plan that will act as a backup for the application of changes in proper medications. Such plan involves the continuous action after the implementation process and a suggestion to be acted on different locations not only in a certain premise. The cooperation of different hospitals or institution should also be sought after the outcome of the changes has prevailed.

Conclusion

The most normal approach to the reduction of fall in many institutions use a system or programme of comprehensive interferences that generally involves the patient assessment; risk identification; medication review; eliminating environmental factors such as simple phenomenon like slippery floor, obstacles, and the like; educating patients regarding personal risk of falling; providing physical assistance to high-risk patients most especially to the activities such as mobilization and self care; and increasing staff awareness of patient risk to falls (Ozcan et al., 2005).

One of the major strategies of a fall prevention programmes is the detection of patients at risk of falling. This is most commonly performed with the aid of a fall-risk assessment tool (Myers & Nikoletti 2003).

The fear of falling is said to a predictor which triggers the actual scenario of falling in real- life events. Even though no physical injury is at hand, recurrent falls can have a serious psychological crash which may include the fear of falling that may consequently result to self-imposed restrictions in an activity and reduced autonomy (Coughlin, 2005).

In the same way, in one of the studies conducted, the fear of falling prevailed that it was radically superior in patients who had fallen in the previous year and hence it largely points out to the recurrence of such case. A recommendation that no fall should ever be underestimated and that the fall should be used as an opportunity to identify risk factors in order to alter behaviour. In addition to, Epidemiological studies of falls in older people who usually gets the case have indicated that falls are a multicausal phenomenon with multifaceted dealings between intrinsic factors and extrinsic factors mentioned earlier (Keim, 2003).

Generally, the extent of the changes in risk of falls in the use of proper medication as found makes a cohort conclusion regarding the assessment of the ideas imposed. The increase in risk of falls normally exists within at least the first few days after the transformation in prescription which makes this at risk to an efficient monitoring and should allow for deterrence. It is confirmed in other areas or population that it may also be shown to be broad as to other populations (Stevens, 2005).

One would look forward to that this would be broad to other weak elderly in situations such as the study population in the recent studies like the institutions for the chronically ill people (Tinetti, 2004). It is somehow probable that the outcome can be shown to be in totality to the elderly in poor health in a specific community as well. However, predictors of falls in older people who live autonomously prevails to be have significant health problems which may contribute to the risks of fall (Hendrich et al., 2003).

The assessment for falls risks suggests that there may be a considerable interactive end product of a lot of fundamental factors that need to be taken. Further assessment of new techniques to measure the risk of falling for active elderly people is then require to help put off falls and other fall-related injuries. Thus, an excellent management proposal is necessary to change the things which will improve the previous ways of approaching this specific issue.

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