Management

This week you should be developing the evaluation plan for your quality improvement proposal. Discuss the method you propose to monitor the quality of the plan, what the timeline for reevaluation should be and how you will apply the nursing leadership/theory to your plan. Below is the topic that needs the QI evaluation Falls are the most common cause of injury and or death particularly in the elderly population; however, anyone is prone to fall and can sustain injury from it. According to,( Dykes, P. C. et al. 2018) an estimate of about 3% of hospitalized patient fall and 25% of those patients that fall sustain different ranges of injury which could be from minor cuts or bruises or a critical injury of fractures or subdural hemorrhage. The injuries caused by falls can create a lengthy stay in the hospital which can also lead to one problem or the other that may include death. Resnick, B( 2015) also added that the impact of fall in the healthcare system affect the quality of life of the patient and it also causes a financial burden for the patients, their family, and the healthcare system. The center for disease control (CDC) mentioned that falls and injury is an alarming concern to public health creating the cost of care for patients that fall and sustain any form of injury is about 34billion dollars per year. PICOT question Population- Patient in the acute care setting Intervention- prevention of fall and revision of fall risk tools with the addition of medication evaluation. Comparison- MORSE fall risk tool, past and present fall rate and medication assessment Outcome – Decrease in the number of falls Time – During admission in acute care Question; In Acute care setting what evidence-based interventions can decrease falls. In the acute care setting, the patient is prone to falling for one reason or the other which could be from comorbidities such as disease proses, blindness, immobility, medication and unfamiliar space. The nurses play a significant role in fall prevention plan for all the patient by assessing a patient upon admission, and the assessment tools identify the needs of each patient however other comorbidities can deter this which could be non-compliant patient. Furthermore many patients’ fall because they don’t believe that they are at risk for fall because they were independent at home and they don’t see themselves as someone that needs to follow the fall prevention process. Dykes et, al. (2018) emphasized that it is imperative to involve patient and family to complete the fall risk assessment this enlighten them on their risk factors; also by involving patient in their plan on fall prevention broadens the chance of following the plan and accepting the idea. Cangany et al. (2015) also stated that patient that falls while in the hospital is a serious threat to patient safety. The evidence-based approach in this article is to determine if the patient signs, improved education on current fall policies with the use of fall contract and fall prevention could decrease the total number of fall. The goal is to reduce the number of falls by 50% within a year per National Database for Nursing Quality Indicators (NDNQI) benchmarks. After the implementation of the fall intervention, it appears that the total number of fall decrease drastically to about 50% and the fall rate is below the NDNQI benchmark. More assistance is needed for nurses to prioritize fall intervention based on patient-specific need and identify what will affect each patient effectively. Bóriková, I., Tomagová, M., Žiaková, K., & Miertová, M. (2018) aim Is to determine the correlation between pharmacotherapy and high fall risk by using the MORSE fall scale to identify significant fall risk factor which include history of falls, iv therapy, presence of more than one medical diagnosis, recent pain medication, use of ambulatory aid and patients mental status are determinants of this risk. This was initiated by using a quantitative cross-sectional descriptive study. Even though pharmacotherapy plays a useful role on the patient, it is imperative that the medical team pays close attention to the patient at risk for fall .due to the fact that assessment of pharmacotherapy was only done during patient admission in this study. This research was unable to provide the number of falls that occurred during the time of study which is a sign of limitation. According to Resnick, B. (2015) who stated that more research is needed to validate an inpatient self-assessment to this would help the patient understand and be open to the risk factors that will allow the patient to be accepting and participate in their plan of care. Also, nurses must develop an adequate relationship with the patient and their family that would focus on how to maintain the patient sense of freedom Furthermore, to prevent fall in acute care is essential even though it may show its signs of difficulties due to patient compliance. To perform an impactful patient-centered care, it is imperative to understand this risk from the patient perspective and create a strategy that will correlate with the patient at risk. Also, fall risk and prevention plans would provide insight that can be used for future prevention strategy. Finally, it is essential to review and assess fall risk and medication assessment. Best practice for decreasing fall is continuous reassessment for fall risk and development of increasing collaboration and communication between all medical staffs by doing this will lower the cost related to injuries sustained during fall success of this would improve patient care. References Bóriková, I., Tomagová, M., Žiaková, K., & Miertová, M. (2018). Pharmacotherapy as a Fall Risk Factor. Central European Journal of Nursing & Midwifery, 9(2), 832–839. https://doi-org.ezproxy.umuc.edu/10.15452/CEJNM.2018.09.0012 Cangany, M., Back, D., Hamilton-Kelly, T., Altman, M., & Lacey, S. (2015). Bedside nurses leading the way for falls prevention: an evidence-based approach. Critical Care Nurse, 35(2), 82–84. https://doi-org.ezproxy.umuc.edu/10.4037/ccn2015414 Dykes, P. C., Adelman, J., Adkison, L., Bogaisky, M., Carroll, D. L., Carter, E., … Yu, S. P. (2018). Preventing falls in hospitalized patients: Engage patients and families in a three-step prevention process to reduce the risk of falls. American Nurse Today, 13(9), 8–13. Retrieved from http://ezproxy.umuc.edu/login?url=http://search.ebscohost.com.ezproxy.umuc.edu/login.aspx?direct=true&db=ccm&AN=131761851&site=eds-live&scope=site Resnick, B. (2015). Learning from our history: prevention of falls in acute care. Geriatric Nursing (New York, N.Y.), 36(5), 339–340.Retrieved from https://doi-org.ezproxy.umuc.edu/10.1016/j.gerinurse.2015.08.002