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Evidence based practice in a clinical setting
Evidence based practice in a clinical setting
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Falls are the leading cause of injuries, disabilities, and deaths among community-dwelling older adults (Moyer, 2012). According to the Center for Disease Control and Prevention (CDC, 2016), each year one out of three community-dwelling older adults aged 65 years or above falls at least once. There is a need to identify effective interventions pertinent to the primary-care setting to prevent falls among older adults living in the community. The guideline titled “Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task Force recommendation statement” is focused on determining the effectiveness and harms of different fall-prevention interventions relevant to primary care for adults aged 65 years or above (Moyer, …show more content…
Preventive Services Task Force (USPSTF). This guideline is an updated version of the 1996 USPSTF recommendation statement on “counseling to prevent household and recreational injuries including falls” (Moyer, 2012, p. 197). Clinicians can find the guideline in the website of the USPSTF (www.uspreventiveservicestaskforce.org), National Guideline Clearinghouse (www.guideline.gov), and journal of the Annals of Internal Medicine volume 155 issue 3 (Moyer, 2012) (annals.org). The purpose of this paper is to critique the guideline using a guideline appraisal tool known as the Appraisal of Guidelines for Research and Evaluation (AGREE II). The paper will also discuss the strengths and weaknesses of this guideline, and recommendations for the implementation …show more content…
The guideline did not disclose whether the guideline had been disseminated among the targeted users. However, it mentioned that the recommendation will be available in the journals and other printed forms along with electronic version on the USPSTF’s website. The USPSTF (2012) believes that the target users will be able to access USPSTF material easily and adapt the guideline per their needs when material is available in both printed and electronic copy. Similarly, it did not disclose any details regarding the pilot testing of the guideline with a subsample of target users to promote its implementation and measure the
In over-all, 65 years and older suffer from many geriatric symptoms, due to psychotropic and anti-psychotropic medications, including Electroconvulsive therapy (ECT), mobility challenges, incontinence, poor balance, disorganization and confusion which all lead to high falls. According to a study in the International Journal of Geriatric Psychiatry, patients with the highest risk for falls presented with one or more of the following variables such as Parkinson’s syndrome, Dementia, female gender, mood stabilizers, cardiac arrhythmia, and ECT. Edmonson et. al established, “The Edmonson Psychiatric Fall Risk Assessment Tool (EPFRAT) specific to the psychiatric, geriatric population and found initial testing of EPFRAT to have higher sensitivity in assessing fall risk in the geri-psych inpatient population” (Edmonson, Robinson, & Hughes, 2011). This project purpose is to investigate and explore whether an Edmonson Fall risk assessment Toll decreases patient falls in inpatient geri-psych units. Stakeholders and Change
As people age, they face difficulties with seeing and also with mobility, declines in their physiological systems impact balance, range and speed. These physiological problems can result in falls, which tend to be really problematic for the elderly living alone at home. The Hendrich II Fall Risk Model (HFRM) was used on Mr. T.C to assess his fall risk; this tool is used in acute care facilities to estimate the risk for falls in adults (Hendrich, 2013). The client scored a 6, any score exceeding a 5 is considered a high risk for fall. Being a male is one of the predetermined risk points that make one susceptible of falling as well their symptomatic depression, both which the client falls under. The Get-Up-and-Go Test is also a predetermined risk factor of HFRM; it determines the client’s ability to rise from a seated position. It took the client 3 attempts to fully stand up from a seated position.
Peel, N. M., Travers, C., Bell, R. R., & Smith, K. (2010). Evaluation of a health service delivery intervention to promote falls prevention in older people across the care continuum. Journal Of Evaluation In Clinical Practice, 16(6), 1254-1261. doi:10.1111/j.1365-2753.2009.01307.x
The nurse would firstly identify if Mrs Jones is at risk of falls by conducting a falls risk assessment using an evaluation tool such as the Peninsula Health Falls Risk Assessment Tool (FRAT) (ACSQHC, 2009). The falls risk assessment enables the nurse to identify any factors that may increase the risk of falls (ACSQHC, 2009). The falls risk assessment tool focuses on areas such as recent falls and past history of falls; psychological status for example, depression and anxiety; cognitive status; medications including diuretics, anti-hypertensives, anti-depressants, sedatives, anti-Parkinson’s and hypnotics; as well as taking into account any problems in relation to vision, mobility, behaviours, environment, nutrition, continence and activities
The National Patient Safety Goal (NPSG) for falls in long term care facilities is to identify which patients are at risk for falling and to take action to prevent falls for these residents. (NPSG.09.02.01). There are five elements of performance for NPSG: 1. Assess the risk for falls, 2. Implement interventions to reduce falls based on the resident’s assessed risk, 3. Educate staff on the fall reduction program in time frames determined by the organization, 4. Educate the resident and, as needed, the family on any individualized fall reduction strategies, and 5. Evaluate the effectiveness of all fall reduction activities, including assessment,
From the literature researched, the writer thinks that environmental modifications along with multifactorial interventions can make a difference for falls that an elderly can receive. Still, he thinks that there should be more research done on environmental assessment tools, flooring, and effective behavioral interventions. On his last thoughts, he believes that strategies should be patient focused and environmental modifications should be developed for that individual.
Registered Nurses’ Association of Ontario (RNAO). (2005). Prevention of falls and fall injuries in the older adult. Retrieved from http://rnao.ca/sites/rnao-ca/files/Prevention_of_Falls_and_Fall_Injuries_in_the_Older_Adult.pdf
A fall is an “untoward event which results in the patient coming to rest unintentionally on the ground” (Morris & Isaacs, 1980). When it comes to patient safety in health care, there isn’t any subject that takes precedence. Patient falls are a major cause for concern in the health industry, particularly in an acute-care setting such as a hospital where a patient’s mental and physical well being may already be compromised. Not only do patient falls increase the length of hospital stays, but it has a major impact on the economics of health care with adjusted medical costs related to falls averaging in the range of 30 billion dollars per year (Center for Disease Control [CDC], 2013). Patient falls are a common phenomenon seen most often in the elderly population. One out of three adults, aged 65 or older, fall each year (CDC, 2013). Complications of falls are quite critical in nature and are the leading cause of both fatal and nonfatal injuries including traumatic brain injuries and fractures. A huge solution to this problem focuses on prevention and education to those at risk. ...
A fall is a lethal event that results from an amalgamation of both intrinsic and extrinsic factors which predispose an elderly person to the incident (Naqvi et al 2009). The frequency of hospital admission due to falls for older people in Australia, Canada, UK and Northern Ireland range from 1.6 to 3.0 per 10 000 population (WHO 2012). The prevalence of senior citizen’s falls in acute care settings varies widely and the danger of falling rises with escalating age or frailty. Falls of hospitalized older adults are one of the major patient safety issues in terms of morbidity, mortality, and decreased socialization (Swartzell et al. 2013). Because the multi-etiological factors contribute to the incidence and severity of falls in older society, each cause should be addressed or alleviated to prevent patient’s injuries during their hospital stay (Titler et al. 2011). Therefore, nursing interventions play a pivotal role in preventing patient injury related to hospital falls (Johnson et al. 2011). Unfortunately, the danger of falling rises with age and enormously affect one third of older people with ravages varying from minimal injury to incapacities, which may lead to premature death (Johnson et al. 2011). In addition, to the detrimental impacts on patient falls consequently affect the patient’s family members, care providers, and the health organization emotionally as well as financially (Ang et al. 2011). Even though falls in hospital affect young as well as older patients, the aged groups are more likely to get injured than the youth (Boltz et al. 2013). Devastating problems, which resulted from the falls, can c...
The Joint Commission was founded in 1951 with the goal to provided safer and better care to all. Since that day it has become acknowledged as the leader in developing the highest standards for quality and safety in the delivery of health care, and evaluating organization performance (The Joint Commission(a) [TJC], 2014). The Joint Commission continues to investigate ways to better patient care. In 2003 the first set of National Patient Safety Goals (NPSGs) went into effect. This list of goals was designed by a group of nurses, physicians, pharmacists, risk managers, clinical engineers, and other professionals with hands-on experience in addressing patient safety issues in a wide variety of healthcare settings (TJC(b), 2014). The NPSGs were created to address specific areas of concern in patient safety in all health care settings.
Because of the growing concern associated with disability in the elderly, many researchers have examined factors that may be associated with the risk disability in the elderly. These factors have ranged widely, including functional limitations6-9, level of physical activity10, 11, depression12-15, cognitive status13, 16, 17, comorbidities18, 19, falls6, 20, self-rated health21, 22, social interaction23 and others24.
Patient falls in the hospital is a serious issue and challenging problem that could lead to prolonged hospital stay, longer recovery time for patients, increased costs for hospitals, and a source of distress and anxiety for patients, nurses, and families. Patient falls can cause minor or major serious physical injury depending on the situation and the age of the client. In addition to the physical harms, patients can suffer from psychological injuries which make them lose their independence and confidence on themselves and build a lot of anger, distress and fears of falling.
Fall prevention needs to be the target of many hospitals. Falls occur each year in hospitals and can be detrimental to the patient, especially the elderly patient (Peel, Travers, Bell, & Smith, 2010). Falls can lead to broken bones, longer stays in the hospital and potentially can lead to death. Falls are expensive to both the patient and the hospital (Trepanier & Hilsenbeck, 2014). This paper would like to take a look at a strategic action plan that would help to prevent falls. This plan of action will includes organizational changes that are geared towards fall prevention. The second part of this paper will include an evaluation plan that is designed to measure and monitor the plan.
Over 1.7 million traumatic brain injuries are reported each year. According to reports the leading cause of brain injuries are from falls followed by motor vehicle accidents, and accidents that were a result of being struck by something. Falls account for 32.5% of traumatic brain injuries in the United States. 50% of all child brain injuries are from falling. 61 % of all traumatic brain injuries among adults are 65 years old or older. Traumatic brain injuries are very violent blows or jolts to the head or body that result in the penetration of the skull. Mild traumatic brain injuries can cause brief dysfunction of the brain cells. Serious brain injuries can cause bleeding, bruising, physical damage to other parts of the body and torn tissues. Brain injuries are more prevalent with males rather than females. Causes of brain injuries include:
When taking steps to analyze and apply intervention strategies for falls, we must examine the factors that cause these occurrences. There are numerous reasons that falls occur, such as intrinsic and or extrinsic risk factors. Intrinsic risk factors for falls may be due to changes that are part of the normal aging process and acute or chronic conditions. According to Zheng, Pan and Hua et al. (2013), about 35-45 percent of individuals who are usually older than 65 years and other 50 percent of the elderly individuals report cases of fall every year. Extrinsic factors are those related to physical environment such as lack of grab bars, poor condition of floor surfaces, inadequate or improper use of assistive devices (Currie). Patient falls is not an easy thing to eliminate. With many clinical challenges, there’s no easy answer to the challenges posed by patient falls; howe...