Keeping patients safe is one of the highest priorities in health care. Accidental falls can cause unnecessary pain and suffering, increase mortality and morbidity, and increase the cost and length of stay in the hospital. “A fall is conceptualized as unintentionally coming to rest on the ground, floor, or other lower level.” If the patient lost balance and was lowered to the ground by a helper or was found on the ground, both the attended and unattended situations are considered a fall” (Tzeng & Yin, 2010, p. 267). Patients in psychiatric facilities are often at high risk for falls related to many factors including decreased mental status, acute psychosis and antipsychotic medications. “Studies assessing fall rates in inpatient services have demonstrated a higher frequency of falls on psychiatric units” (Lavsa, Fabian, Saul, Corman, & Coley, 2010, p. 1274). Due to the high risk factors associated with this population, the Behavioral Health Services department I work for implemented a fall prevention program using evidence-based practice.
PICOT Question
Which nursing interventions are most likely to reduce the number of patient falls and associated injuries per month in Behavioral Health Services?
To find the right evidence to answer a focused foreground question it is advisable to formulate a PICOT question to assist in the search. A PICOT question is formulated by including the target population, intervention or issue of interest, comparison, outcome of the intervention and time frame associated with the outcome (Melnyk & Fineout-Overholt, 2011, p. 29). To assist in finding the latest evidence-based practice to incorporate in the the fall prevention program in the Behavioral Health Department the following PICOT ...
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...or the hospital to see if changes and improvements can be made to existing policy.
To evaluate the fall prevention program, the BHS unit keeps a daily fall record to indicate is a fall occurred on the unit. This calendar is colorful and displayed in the nurse’s station as a reminder for all staff to be mindful of fall prevention. Based on these statistics the fall prevention team can analyze if the program has reduced to number of fall monthly and even yearly when compared to last year’s results.
Based on the review of previous falls, the statistics indicate that falls and patient injuries have decreased from the previous year by ten percent. By utilizing evidence-based practice and synthesis of internal and external evidence the fall prevention program proved to be effective and results in increased patient safety and improved overall patient outcomes.
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
Jones, D., & Whitaker, T. (2011). Preventing falls in older people: assessment and interventions. Nursing Standard, 25(52), 50-55.
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
Theis, J.L., & Finkelstein, M.J. (2013). Long-Term Effects of Safe Patient Handling Program on Staff Injuries. Rehabilitation Nursing, 39, 26-35. DOI:10.1002/rnj.108
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. ...
In order for hospitals to be reimbursed from government based insure companies certain standards must be met. When standards are not met, any subsequent cost in relationship to preventable errors will not be remunerated (Youngberg, 2011). These preventable errors are termed never events. Never events are considered error that can be prevented if certain checklist and guidelines are in place are followed such as medication errors, falls with injury, wrong surgical site, and pressure ulcers (Agency for Healthcare Research and Quality, 2012). There are currently ten mandated never events (Youngberg, 2011). In order to avoid these preventable human errors, risk manager help implement policies and procedure. This process based on risk analysis and outcomes which helps to improv...
Safety is a primary concern in the health care environment, but there are still many preventable errors that occur. In fact, a study from ProPublica in 2013 found that between 210,000 and 440,000 patients each year suffer preventable harm in the hospital (Allen, 2013). Safety in the healthcare environment is not only keeping the patient safe, but also the employee. If a nurse does not follow procedure, they could bring harm to themselves, the patient, or both. Although it seems like such a simple topic with a simple solution, there are several components to what safety really entails. Health care professionals must always be cautious to prevent any mishaps to their patients, especially when using machines or lifting objects, as it has a higher
Fierce healthcare reported sometime in June of 2012 that hospitals across the country had received safety report cards from one Leapfrog group. They reported that most facilities got a C or below in the rankings. The report also showed that the biggest hospitals such as the Henry Ford Hospital in Michigan barely got a passing grade. The report cards were meant to inform patients and also to motivate improvements in patient safety, they were faced with a lot of criticism and controversy especially from hospitals that did not pass. This paper will discuss the controversy facing patient safety in the U.S. It will also analyze the effects of the issue and the solutions suggested and currently in place to solve the issue.
Every hospital is committed to ensuring that their patients in stroke rehabilitation wards and other facilities are safe from any form of harm that may occur as a result of the health care providers’ negligence. Firstly, every hospital integrates quality and safety approaches into its everyday’s operations to promote and enhance the safety and quality of its environment and services respectively (Garban, 2011). This is usually complemented by other strategies meant for enhancing organizational knowledge to improve efficiency and overall productivity. Some hospitals provide further training to their health care personnel to ensure that they efficiently incorpor...
To achieve better result the management ready to make changes if necessary after analyzing the data collected during rounds. The fall chart need to be evaluated by the nurse leaders and managers by checking number of falls, any nearly miss errors, requirements of the patients’ needs and patient satisfaction survey. If there is no significant reduction in the fall, consider checking the process and revising the initiative. Coclusion Today’s healthcare is looking for quality improvement evidence-based program in order to enhance patient safety and quality outcomes.
It is the hope and the goal of many hospital staff to help to decrease the number of falls in the hospital setting. The hope is to establish a plan that will assist nursing staff to decrease the number of falls. Falls can be extremely harmful to the elderly. Preventing falls is a much need goal that will bring better outcomes for the patient and the hospital. Evaluation of the action plan will also be planned for so that revisions can be made as needed to decrease the amount of patient falls.
As people age, risk of falls become common and it can occur while performing activity of daily living such as taking a shower or going to the bathroom. Many older people trip over electric wire, their own pet, and sometimes they blame the environment for their falls. At the hospital, nurses assist clients who have a history of falls to go to the bathroom in the middle of the night. In addition, clients do not want to be identified as falls risk even if they have history of falls, and have fallen during the last six months because of the negative image that comes with being labeled as the type of person who falls. In clients over 65 year old (P), how nurses labeling older people falls risk threat their identity as individual (I) compare to those
Adjust schedules for seasonal variations, (Mondays and Tuesdays)Evaluate routine care visits (vs.) urgent care cycle times
Keeping patients safe is essential in today’s health care system, but patient safety events that violate that safety are increasing each year. It was only recently, that the focus on patient safety was reinforced by a report prepared by Institute of medicine (IOM) entitled ” To err is human, building a safer health system”(Wakefield & Iliffe,2002).This report found that approx-imately 44,000 to 98,000 deaths occur each year due to medical errors and that the majority was preventable. Deaths due to medical errors exceed deaths due to many other causes such as like HIV infections, breast cancer and even traffic accidents (Wakefield & Iliffe, 2002). After this IOM reports, President Clinton established quality interagency coordination task force with the help of government agencies. These government agencies are responsible for making health pol-icies regarding patient safety to which every HCO must follow (Schulman & Kim, 2000).
Health care policy targets the organization, financing, and delivery of health care services. The reason for targeting these areas is for the licensing of health care professionals and facilities, to make sure there is protection of patients’ private health information, and there are measures of quality care, mistakes, malpractice, and efforts to control of health care cost (Acuff, 2010). There are several stages that one must take when creating a policy (see figure 1). The figure below shows the critical steps in the policy process. First, the problem must be identified, once the problem is identified potential policy solutions must be formulated, then the policy is adopted, and then implemented. After the policy is in place, an evaluation of the policy has to take place (This Nation, 2013).