The Danger of Falls for the Elderly and Methods for Creating a Safe Space for Them
Fall prevention is a serious threat for the health and wellbeing of elderly patients. In this regard, elderly patients of the nursing home are at a particularly high risk because of their age and condition of their health. The current project focuses on the prevention of falls among elderly patients of Longhorn Village Nursing Home, where the risk of falls is quite high and the problem persists, in spite of efforts of the nursing staff and doctors. The proposed solution of the problem involves the extensive training of health care professionals, including nursing staff, along with the improvement of facilities and equipment to increase safety of patients and minimize the risk of falls.
- Literature review
Existing studies (Karlsson, Magnusson, von Schewelov, & Rosengren, 2013) reveal the devastating impact of falls on health and wellbeing of patients. Elderly patients may suffer serious complications after a fall to the extent that they may face the risk of disability that results in the consistent decline of their quality of living. The deterioration of health is caused by natural changes that occur to human body and fragility of bones increases in the course of time that results in higher risks of serious injuries for elderly patients.
At the moment, health care organizations may choose a variety of programs that help to improve the health care environment and decrease risks of falls among elderly patients. Researchers (Kannus, et al., 2005) argue that existing training programs can help elderly patients to decrease the risk of falls through regular exercises that enhance their balance and physical skills that help them to avoid falls. In addition, the training of the nursing staff may be needed to make them come prepare to decrease risks of falls among elderly patients and help patients, if they fall.
Therefore, the prevention of falls is the effective strategy not only in terms of the preservation of health of elderly patients but also in terms of cost-efficiency. Researchers (Hendriks, et al., 2008) argue that fall prevention programs can help to reduce health care costs substantially because elderly patients do not need long lasting and costly treatment after falls. Researchers (Hendriks, et al., 2008) insist that investments into fall prevention programs outweigh costs of treatment of falls among elderly patients.
- Gap analysis/needs assessment
Best Practice #1: A Matter of Balance is an 8-week structured group intervention that emphasizes practical strategies to reduce fear of falling and increase activity levels. Participants learn to view falls and fear of falling as controllable, set realistic goals to increase activity, change their environment to reduce fall risk factors, and exercise to increase strength and balance.
Best Practice #2: Bingocize® is a 10-week program that combines a bingo-like game with exercise and health education. The unique addition of bingo addresses many of the barriers to older adults’ participation because the game is fun, familiar, and done in a group setting. The program has been shown to increase older adults’ functional fitness, health knowledge, and social engagement in a variety of settings. The overall goals of the program are to help older adults improve and/or maintain mobility and independence, learn and use health information focused on falls reduction and other health-related behaviors, and socially engage with other older adults. A mobile app version is also available.
Best Practice #3: EnhanceFitness is low-cost, evidence-based group falls prevention and physical activity program developed specifically for older adults. The exercises have been packaged into a formal regimen focusing on four key areas important to the health and fitness of mature participants: low impact cardiovascular; dynamic/static balance work, strength training and stretching. Classes meet three times a week, an hour each session, providing social stimulation as well as physical benefits.
The major difference between the current practices and best practices that will be introduced in Longhorn Village Nursing Home is the lack of practical training of nurses to help them to conduct physical exercises that enhance balance of elderly patients and make them come prepared to avoid falls or minimize their risks. The new practice will include extensive training of the nursing staff to make them come prepared to help elderly patients to avoid falls as they will learn the key risk factors in the environment of elderly patients as well as the training of patients to help them to avoid falls.
- Project charter, scope, and objectives
Project Scope Description
The project focuses on the fall prevention among the elderly patient population in Longhorn Village Nursing Home. The scope of the project enrolls Longhorn Village Nursing Home and its patients. The project intends to improve the fall prevention program in the health care organization because elderly patients are at the higher risk of falls compared to younger people. This is why the project aims at the enhancement of the patient safety through the extensive training of nurses to increase their awareness of the risk of falls and help them to prevent falls among elderly patients through creating safe environment and training elderly patients to enhance their balance.
The project deliverables include the improvement of facilities of the Longhorn Village Nursing Home, such as the improvement of lighting of facilities, anti-slippery flooring, low steps and wider use of elevators, etc. The input of the organization is sufficient at the moment to enhance the quality of the fall prevention program in the elderly population. The health care organization has financial resources, material resources and human resources needed for the training of the nursing staff to reduce the risk of falls and improve facilities of the nursing home. Expected outputs of the project include the enhanced safety of the nursing home’s setting, where patients can feel comfortable and secure themselves from falls, and higher qualification of nurses trained to address the problem of falls.
Project Acceptance Criteria/Metrics Used to Determine Success
Project acceptance criteria that can help to determine the project success include the statistical data concerning falls before the introduction of changes to the fall prevention program in Longhorn Village Nursing Home and after the implementation of the program. The recent statistics for three years have to be measured and recorded before the introduction of changes to the fall prevention program. After the implementation of the program, fall statistics has to be measured to determine whether there are any positive changes concerning the patient safety. In a year after the implementation of the new program, the statistics of falls should be measured and compared to the statistics before the introduction of the change. If the quantity of falls has dropped, then the program is effective, but if the quantity of falls is still high or increased even more, than the project is not successful and needs either further changes or improvements or the health care organization should rather return back to the original program of fall prevention it has been trying to change. The measurement of the success of the program will include not only statistics but also tests of nurses to determine their knowledge and skills in terms of fall prevention. Tests will show whether nurses know how to prevent falls among elderly patients or not and what to do in case of falls.
The project exclusions may involve doctors because they focus on the treatment of patients, while nurses spend more time with elderly patients and are responsible for the safety of facilities for patients health, like clean and not slippery floors, good lighting, etc. Doctors focus on the treatment of patients only and are not involved in creating safe environment.
Project constraints include the limited time health care professionals have to develop and implement the program. Health care professionals have to develop and implement their program, while they are performing their regular job at Longhorn Village Nursing Home. This means that they will need extra time to develop improvements and implement them to make the fall prevention program of the health care organization better.
The major project assumptions include the expected improvement of the fall prevention program at Longhorn Village Nursing Home. The new program will reduce the risk of falls among elderly patients and create a safer health care setting for patients. As a result, the number of falls in Longhorn Village Nursing Home will reduce, while patients will be in the safer environment.
- Implementation plan
The implementation of the project of the prevention of falls among elderly patients aims at the creation of the safe environment and prevention of falls among elderly patients through the training of the nursing staff. The creation of the safe environment means that elderly patients stay in the environment, where they have the minimal risk of falls due to the proper lighting, good equipment, low steps, anti-slippery flooring, etc.
The training of nurses is also essential and involves two main goals. First, the training of nurses should develop basic skills that can help nurses to reduce the risk of falls. Often nurses are responsible for the maintenance of the safe environment, but the lack of training and awareness of the risk of falls among elderly patients, prevent nurses from the proper way of actions. The training course will help them to learn how to create the safe environment and minimize risks to elderly patients. Another goal of training nurses is the development of basic skills to provide first aid to elderly patients after falls. Nurses should be able to provide nurses with essential aid and secure them, if patients fall.
The implementation of the project includes several key steps. First, the clear identification of goals of the project is essential for understanding of the priorities of the project and its expected outcomes. Second, the preliminary evaluation of risks and threats associated with falls at Longhorn Village Nursing Home at the moment. The preliminary evaluation involves the analysis of the frequency and number of falls on the annual basis. The preliminary evaluation is necessary for the understanding of the scope of the problem and evaluation of the progress of the health care organization after the implementation of the project. The next step is the development of training programs for. At the same time, the project involves the evaluation of current needs and possible improvements in facilities and equipment of Longhorn Village Nursing Home to identify specific changes needed in the facilities and equipment to decrease the risk of falls. The next step is the enrollment of nurses in the training program. In addition, the project involves the introduction of improvements in the facilities and equipment of the health care organization. The completion of training programs and improvements to facilities and equipment needed for securing patients and fall prevention. At the end of the implementation of the project, the final evaluation will show whether there are any positive changes after the implementation of the project within the health care organization. The project is supposed to bring positive changes and minimize the risk of falls among elderly patients.
The key activities of the project implementation include training of the nurses to conduct physical exercises among elderly patients to enhance their balance, training nurses to create safe environment, and to train nurses to provide medical aid in case of patient falls (See App. Table 1)
The measurement of the success of the project and effectiveness of its implementation will include the statistical analysis and interviews with patients and nurses. The statistical analysis will show whether the number of falls increased, decreased or remained the same as it was before the introduction of the project. The number of falls before and after the implementation of the project will reveal whether the project is successful or not. Interviews with elderly patients will reveal whether they have become aware of the risk and consequences of falls and whether they feel secure after the introduction of the project. Interviews with nurses will reveal whether nurses have noticed any positive changes after the introduction of the project concerning the fall prevention. In addition, nurses will pass the test to measure their knowledge of fall prevention methods and strategies and to determine their skills whether they are really proficient in fall prevention or not.
8.Timeline and schedule
|#/date||1 weeks||4 weeks||12 weeks||24 weeks|
|1.||Identification of goals of the project|
|2.||The preliminary evaluation of risks and threats associated with falls at Longhorn Village Nursing Home. The study of statistics of falls among patients to determine the frequency and number of falls among patients The need assessment also involves the assessment of nurses’ skills and expertise in terms of fall prevention among elderly patients.|
|3.||Development of training programs for e nurses|
|4.||The evaluation of current needs and possible improvements in facilities and equipment of Longhorn Village Nursing Home|
|5.||The enrollment of nurses in the training program|
|6.||The introduction of improvements in the facilities and equipment of the health care organization (better lighting, anti-slippery flooring, low steps, supporting equipment for patients)
Training of nurses to enhance their skills to prevent falls among patients.
|7.||The completion of training programs and improvements to facilities and equipment needed for securing patients and fall prevention|
|8.||The final evaluation of the effectiveness of the program: analysis of statistics of falls before and after the program’s implementation.|
The cost-benefit analysis is an effective tool that helps to determine whether the project is worth implementing. The cost-benefit analysis is particularly useful to apply in the health care setting because often health care organizations are constrained in financial resources available to them, especially, if they implement projects that are non-profitable by their nature as is the case of the prevention of falls among elderly patients project. The project is expected to bring a consistent reduction of health care costs due to the reduction of falls among elderly patients. This is why the health care organization may allocate resources which used to be spent on the treatment of consequences of falls among elderly patients on other issues, including the training of the nursing staff and elderly patients, acquisition of new equipment and improvement of facilities to make them safer for elderly patients in terms of the fall prevention.
The cost-benefit analysis of the project oriented on the prevention of falls among elderly patients reveals the fact that the costs of the project are lower compared to benefits the implementation of the project will bring to patients of the health care organization. To put it more precisely, the successful implementation of the project will bring the consistent reduction of falls among elderly patients. The reduction of falls means the reduction of health care costs for patients and the more efficient use of funds for the health care organization because patients will not need the treatment of patients after falls. Falls may cause serious injuries among elderly patients because falls can cause serious health problems and may even lead to disability of elderly patients. In such a way, patients will face lower risk of falls that means the improvement of their quality of health. Falls may cause substantial decline of patients’ health. This is why falls prevention will improve the effectiveness of treatment of elderly patients, reduce the time they have to spend in the hospital, and the quality of life of elderly patients after their treatment in the health care organization.
At the same time, the cost-benefit analysis reveals the fact that the reduction of falls will also open opportunities for increasing the number of patients, who may receive health care services at the health care organization. Patients will be in the safe environment and the minimization of falls will allow treating patients, who need treatment of their health problems rather than consequences of their falls. As a result, the recovery of patients will also occur faster because patients will not have complications caused by falls. In such a way, the implementation of the project will improve the effectiveness of the organizational performance and treatment of patients.
The costs of the project include training costs and costs needed to improve the facilities and equipment to minimize the risk of falls among elderly patients. This is why the project team should conduct the assessment of physical capabilities of the target population to determine their ability to get enrolled into the project and to take part in the training program on the regular basis
The budget of the project is as follows:
|Category||Details||Costs per year|
|Training of nurses||The development of training programs and enrollment of nurses in training programs||$20.000|
|Training of elderly patients||The development of training programs and enrollment of elderly patients in training programs||$20.000|
|Reconstruction of facilities||Better lighting, bars, anti-slippery flooring, etc.||$45.000|
|Equipment||Training equipment for elderly patients to improve balance||$15.000|
|Revenues increased by 40%||$65.000|
|Re-allocation of costs||$30.000|
- Risk management plan
The implementation of the project is vulnerable to numerous risks which the project team has to address. One of the main risks is the resistance to the change from the nursing staff caused by the frustration of the staff; the lack of awareness and understanding of the significance of the problem. The communication of the importance of the project to the nursing staff and rise of their awareness about the necessity of the project’s implementation can help to mitigate the risk along with the encouragement of the nurse training and offering free training program.
Furthermore, costs may be too high and the nursing home may suffer from the shortage of funds to cover costs of the project. To address this risk, the project team should attract sponsors and optimize costs of the project to make it more affordable for the health care organization. In addition, it is possible to minimize costly changes of facilities and equipment, volunteer training. Also, there is a risk of misunderstanding of the purpose of the project by the nursing staff. This risk emerges because of the lack of the proper understanding of the purpose of the project may occur because of the underestimation of risks associated with falls of elderly patients. Nurses may believe that the prevention of falls is already a part of their professional duties and they are doing well. To mitigate the risk the project team should focus on the communication with nurses and revelation of their skill gaps through the analysis of current fall rates among elderly patients.
There are other risks but they are less significant and less likely to occur in the course of the implementation of the project, including objections to the project from the part of family members of elderly patients, challenges with the improvement of facilities and the installment of new equipment to secure environment, and shortage of time for the development and implementation of the project among nurses (See App. Table 2). Nevertheless, all these risks may be addressed through better communication, rescheduling of the project and accurate needs assessment and identification of priorities of the project.
Hendriks, M. R. C., Evers, S. M. A. A., Bleijlevens, M. H. C., van Haastregt, J.,C.M., Crebolder, H. F. J. M., & van Eijk, J. T.,M. (2008). Cost-effectiveness of a multidisciplinary fall prevention program in community-dwelling elderly people: A randomized controlled trial (ISRCTN 64716113). International Journal of Technology Assessment in Health Care, 24(2), 193-202. doi:http://dx.doi.org.molloy.idm.oclc.org/10.1017/S0266462308080276
Kannus, P., Sievänen, H., Palvanen, M., Järvinen, T., & Parkkari, J. (2005). Prevention of falls and consequent injuries in elderly people. The Lancet, 366(9500), 1885-93. doi:http://dx.doi.org.molloy.idm.oclc.org/10.1016/S0140-6736(05)67604-0
Karlsson, M. K., Magnusson, H., von Schewelov, T., & Rosengren, B. E. (2013). Prevention of falls in the elderly–a review. Osteoporosis International, 24(3), 747-62. doi:http://dx.doi.org.molloy.idm.oclc.org/10.1007/s00198-012-2256-7
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"The terms offer and acceptance." freeessays.club, 17 May 2016
"The terms offer and acceptance." freeessays.club, 17 May 2016