Fall Prevention Protocol

Fall Prevention Protocol

Falls among patients occur in most healthcare facilities. The majority of patients that find themselves victims of these falls hurt themselves, leading to long-lasting and serious harm, increased hospital bills, and prolonged stay in the facility. The aging population tends to raise rates and incidents of falls since factors such as age are uncontrollable. Healthcare facilities and healthcare professionals, such as nurses, can utilize several techniques to minimize the rate of falls in hospitals and enhance the patient’s safety, satisfaction, and outcome (El-Khoury, Cassou, Charles, & Dargent-Molina, 2013). In this paper, the focus is on evaluating fall prevention policy and its application by nurses in their practice. The paper also involves reviewing, evaluating, and examining nursing practice with the aim of identifying some of the possible ways of improving patient safety, satisfaction and outcomes while also preventing the increase in associated high hospital bills, as well as delivering effective and safe patient care.

Nursing Practice Policy

The fall prevention protocol and invention policy includes detailed guidelines useful in the identification of at-risk patients through a provision of assessment tools and the procedures that need implementation in recognizing an at-risk patient. The policy also contains an outline of how to handle on-going risk assessments, proposing a care plan for at-risk patients, providing a framework on maintaining the status of the patients, and preventing them from becoming at-risk patients. The policy recommends a protocol that nurses should follow when responding to any situation involving a fall.

Nursing Practice

The current nursing practices are all outlined in the policy, and it stipulates that all nurses must engage in assessing the condition of all the at-risk patients by utilizing standardized criteria. The policy further outlines how nurses should begin the fall prevention protocol in case of any of such events. Morse Scale is the most used and standardized tool employed in evaluating risks among patients. Nurses use the Morse Scale in gauging and scoring six various categories, and the patient’s level of at-risk is determined by a total score.

In case the Morse Score is equal or greater than 45, then the risk of falls is high and thus the nurses should initiate the fall bundle. The fall bundle involves patient education, safety position belt, use of chair and bed alarms, assistive mobility devices, door signs, yellow bracelets, and yellow fitted nonslip socks. Patients should be trained on the use of light call whenever they need assistance while walking, heading to the bathroom, and sitting on a chair, as well as other needs (Vlaeyen et al., 2019). Nurses have the responsibility of assessing every patient at the beginning of their shift when assuming care or maintaining an assessment that is already in progress. The nurses should also conduct re-assessment regularly and make adjustments on the type of care to provide.

Why Change is Necessary

Falls that happen in healthcare facilities can be of serious consequences in terms of harming the patients. These injuries tend to prolong hospital stays and increase the bills. There is a significant rise in the number of days that patients stay in the hospital when they get injuries from falls. In the healthcare facility setting, many factors can lead to patient falls in hospitals. Mental and physiological changes, physical mobility, and age are some of the factors that tend to enhance falls in healthcare facilities.

The Joint Commission’s analysis of 400 reported falls established significant contributing factors associated with the nursing practice. The elements were poor communication, skills mix, inadequate assessment, failure to conform to safety practices and procedures, low staffing levels, and ineffective supervision and staff orientation. Thus, the current nursing practice cannot be effective if there is no sufficient nursing staff with the right skills mix to attend to the patients. Patients fall in healthcare facilities due to many reasons, and most of them can be avoided. Nurses should understand issues that can lead to falls, such as mental and physical changes, frailty, and age. In preventing falls, nurses should focus more on preventable falls as they can be avoided with the right steps.

Key Stakeholders

All healthcare facilities have well-defined structures that involve different significant stakeholders. The key stakeholders in these centers can help with the identification of potential problems among the patients, as well as in the formulation of the health plan to resolve health-related issues and improve patient safety and outcome. Identification, investigation, examination, and analysis of the root of the problems is important in enhancing patient outcomes (Guirguis-Blake et al., 2018). These stakeholders should be involved in gathering and reviewing the collected evidence and statistics funded on their national standards. Identifying areas that can be of high risk, as well as determining factors that may lead to falls among patients, is necessary for nursing practice. The key stakeholders, as far as fall prevention is concerned, include clinical partners, physical therapists, nurse educators, nursing managers, and physicians.

Role of Stakeholders

Every stakeholder has a role to play in preventing falls in healthcare facilities. In this case, each stakeholder is important in ensuring reduced fall rates in health care. The main function of physicians entails providing a medical plan for the established care, helping to identify patients who are a risk, and working with the interdisciplinary teams in offering the best patient care (Morello et al., 2019). The nurse managers have the responsibility of representing nurses, encouraging, and enhancing the patients’ interests and needs by guiding and leading nurses, as well as other healthcare staff.

A nurse educator also has a crucial role in the interdisciplinary team by serving as the provider of clinical expertise and helping in the implementation and provision of education on matters of evidence-based practices. Physical therapists are involved in assisting the patients in regaining mobility, determining the capacity and strength of patients’ mobility, and identifying the ambulatory devices that patients might need. The clinical partners have the role of supporting the patients to reach the bathrooms, assisting them in and out of their beds, and encouraging them to walk outside their wards.

Evidence Critique Table

Full APA citation for at least five sources

Evidence Strength (1-7) and Evidence Hierarchy

1. El-Khoury, F., Cassou, B., Charles, M. A., & Dargent-Molina, P. (2013). The effect of fall prevention exercise programs on fall induced injuries in community-dwelling older adults: Systematic review and meta-analysis of randomized controlled trials. BMJ, 347, f6234.

1 and Meta-analysis

2. Vlaeyen, E., Poels, J., Leysens, G., Stas, J., Meurrens, J., Laenen, A., … & Milisen, K. (2019). Prediction of fall prevention behavior of staff within nursing homes: A multicenter cross-sectional survey. In CARE4, Date: 2019/02/04-2019/02/06, Location: Leuven.

4 and Cross-sectional

3. Hudson, S. A. (2020). Systematic literature review on fall prevention in an acute care hospital setting.

1 and Systematic review

4. Guirguis-Blake, J. M., Michael, Y. L., Perdue, L. A., Coppola, E. L., Beil, T. L., & Thompson, J. H. (2018). Interventions to prevent falls in community-dwelling older adults: A systematic review for the US preventive services Taskforce.

6 and Single qualitative review

5. Morello, R. T., Soh, S. E., Behm, K., Egan, A., Ayton, D., Hill, K., … & Redfern, J. (2019). Multifactorial falls prevention programs for older adults presenting to the emergency department with a fall: Systematic review and meta-analysis. Injury Prevention, 25(6), 557-564.

1 and Systematic review

Evidence Summary

The chances of serious injuries from inpatient falls are high, which leads to an increased stay in the facilities and higher hospital bills. The identified fall prevention strategies have been utilized in various healthcare centers as policies. From these policies, there have been decreased inpatient fall rates. However, despite these efforts, cases of inpatient falls are still reported in the healthcare facilities. The stakeholders have a role in maintaining and preserving the safety of all the patients when in their facilities, especially by ensuring that preventable falls are avoided at all costs (Jang et al., 2016). The number of falls can also be reduced by engaging in appropriate interdisciplinary approaches and early invention measures. The strategies of interdisciplinary fall prevention help in minimizing fall rates among patients. Increased adherence and compliance with the established guidelines tend to have a greater impact on reducing the nursing staff to lessen the number of falls reported in their facilities.

Compliance can be enhanced by providing health information and education, as well as maintaining staff commitment and increasing its availability to attend to patients’ needs (Hudson, 2020). The prevention of falls requires assessing the patients’ physical and mental status regularly. Spending more time with patients makes it easy to understand what can cause falls among them and what to do to prevent the occurrence of such accidents.

The multifaceted nature of fall prevention strategies means that they require full involvement, cooperation, and participation of interdisciplinary teams. Most of the fall prevention approaches include regular assessments, frequent rounding, visual checks, bed alarms, and patient education. Systematic, methodological, timely, and accurate execution of protocols and policies is the only way of ensuring their effectiveness. Thorough implementation of multiple tactics is necessary for preventing falls since no single technique can fully avert falls.

Recommended Best Practices

Studies have established that the only way of reducing fall rates is through the implementation of a multidisciplinary and multifaceted approach. Regular assessment of patients is also necessary for preventing falls. Healthcare facilities should utilize the Morse Scale to help them in identifying at-risk patients. Besides, on-going assessments are vital since the patients’ mental and physiological status can change at any time. Early interventions, patient education established walk, and bathroom times are all essential for minimizing falls.

Practice Change Model

Several factors drive change in healthcare facilities: pharmaceutical and medical advancements, new requirements for evidence-based practices, elements for enhancing patient satisfaction and safety, low number of staff, and healthcare costs. No matter the reason for the change, achieving the desired goal could be challenging. Kottler’s eight change phases model would make it easier to implement the needed changes because of its simplicity (Pollack & Pollack, 2015). Such transformations help in improving service delivery in health facilities.

Model Justification

The process of implementing the desired changes in an organization is never easy and can be stressful and daunting in some cases. However, a failure to have these changes may also be tricky and unsatisfying for an organization. Long-term changes are only possible if all the stakeholders want the amendments. The model explains that the initial stage should be to get the support of all the stakeholders. The model also has measures to tackle instances of resistance to change.

Model to Guide Implementation

The model recommends that the professionals involved in the change process must identify an existing problem before working together to find a lasting solution through the right strategies. The next step is establishing a task force to spearhead the desired changes. The techniques adopted should enhance patient outcomes and safety while also maintaining a safe environment to reduce the chances of falls.

Barriers to Implementation

Like any other case of change implementation, there will be barriers. Nurses might lack the necessary skills to implement the changes. Besides, the leadership style can be a problem or the nurses may resist the changes. The lack of motivation among the staff can also make the process more challenging. External barriers to change may be a lack of skills mix, inadequate resources, or communication problems.

Ethical Implications

Ethical obligations are necessary when making any change in an organization. Leaders should think of the obligations involved before implementing the changes. If the strategy includes the use of a seat or bed belt, then the belt should be warranted by making it available and suitable for use. The belt should also be used among the patients who need it the most, such as those with mental problems and are likely to slide from their chairs or beds.