Clinical Practice Improvement Project Report on Accidental Fall Prevention among Older Adults

This report highlights the importance of accidental fall prevention among older adults and provides strategies to reduce the chances of fall among the older adults in residential care and hospital care settings. The report also discusses the relevance of clinical governance to the project and the evidence that the issue is worth solving. The proposed interventions, project design, and evaluation of the project are also discussed.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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NURS2006 ASSIGNMENT 5
Clinical Practice Improvement Project Report
Student Name, FAN and ID:
Project Title:
To educate the nursing professionals about the importance of accidental fall prevention
among the older adults and train the nursing professional under the presence of occupational
therapists in order to reduce the chances of fall among the older adults in residential care and
under hospital care settings.
PICO Format
1. Population: Nursing professionals
2. Intervention: Older adults fall prevention education and strategies
3. Context: Residential care or aged care or hospital care settings for the older adults
4. Outcome: Decrease in the tendency of accidental fall among the older adults and thereby
improving their quality of life
Project Aim:
The aim of the project is to educate and provide training (Interventions)to the nursing
professionals who are working under residential care and aged care settings about the
strategies of older adults fall prevention for a tenure of 1 week (Time) in order to reduce the
incidences of accidental falls(Measurable).
Relevance of Clinical Governance to your project
The four pillars of clinical governance include clinical effectiveness, clinical risk
management, patient’s experience and professional development (Australian Government
Department of Health, 2012). Here, risk management, coincides, with the scope of this
project. The reason behind this is, the project aims to show how education and training of the
nurses about the strategies of the accidental fall prevention of older adults helps to reduce the
risk of fall in older adults. According to Vlaeyen et al. (2015), educating the nurses about the
strategies of fall prevention helps to reduce the chances of recurrent fall among the older
adults who suffer from gait problems, visual impairments, neuronal complications or other

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healthcare problems. Vlaeyen et al. (2015) further highlighted that proper training of the
nursing professionals about the interventions of the fall prevention must be provided under
the presence of occupational therapist. This will help to increase in knowledge of the nursing
professionals, operating in the residential ward to perform proper risk assessment of the older
adults who are above 65 years of age and accordingly implement the interventions to prevent
the chances of accidental falls. The presence of occupational therapists further helps in better
risk management (Vlaeyen et al., 2015).
Evidence that the issue / problem is worth solving:
According to the Australian Institute of Health and Welfare (2017) on an annual basis nearly
1014 elderly people over 65 years of age lose their life due to accidental fall under residential
or aged care settings in Australia. This accidental fall among the older adults also results in
injury-related hospitalization among this age group. The statistics published by Australian
Institute of Health and Welfare (2012), mentions the fall incidence ratio among male and
female is 1:3. Women who are aged 65 years and above are 2.8 times more vulnerable than
older men in encountering accidental fall due to gait problems or slippage. According to
Australian Institute of Health and Welfare (2012), in order to reduce the chances of fall
among the older adults,
(i) It is important to generate a low-risk population and thereby promoting independence
(ii) improvement of the outcomes through facilitating local partnerships
(iii) Creating safer environment for the older adults
(iv) Increasing the capacity of the healthcare workers towards preventing fall and fall-
associated injury among the older adults
(v) Proper development and management through research, information dissemination and
training.
The main project is based on the point highlights under (iii), (iv) and (v).
The review of the literature highlighted that one of the effective strategies for improvement of
the fall prevention among the older adults was providing proper training to the healthcare
professionals especially the nurses to improve the compliance of the preventive strategy
towards fall prevention (Stephenson et al., 2015). The systematic review conducted by
Sherrington et al. (2017) showed that exercise can be regarded as a single intervention for the
prevention of fall among the community dwelling older people. In order to increase the

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overall effect of exercise interventions, proper training must be provided to the nursing
professionals. The presence of the occupational therapists helps to increase the overall
outcome of the interventions. Thus, from the analysis of the evidence it is clear that rate of
fall is higher among older adults and this hampers their overall quality of life due to increased
fatal risk and injury related hospitalization. Proper research and training of the healthcare
professionals will be helpful in creating a safer environment for the older adults and thereby
helping to reduce the risk of falls. Thus, it can be said that the problem is worth solving as it
will help to reduce the risk of fall among the older adults.
Key Stakeholders:
The main stakeholders for this project are
1. Nursing professionals: This is because according to the professional code of conduct of the
Nursing and The Midwifery Board of Australia, the nurses are required to practice as per the
prevailing standards and that too in a safe and competent manner
2. Occupational therapist: According to Robertson and Gillespie (2013) occupational
therapists are best suited in order to reduce the chances of accidental fall of the older adults
3. Family of carers of the patients: The family of carers are inherently associated with the
patients and thus their training is also crucial (Robertson & Gillespie, 2013)
CPI Tool:
According to NSW Health (2018), CPI is an abbreviated form of Clinical Practice
Improvement (CPI) tool, which promotes improvement and training. This training program
aims to provide assistance to the healthcare professionals in order to succinctly address the
clinical problem which is negatively hampering the quality of life of the patients. In this way
this kind of training helps to improve the health-related quality of life of the patients. This
education and skills gained from such training can be applied under a variety of clinical
settings and thus helping to ensure the patient’s security overall quality of care. NSW Health
report (2018) also highlights that this kind of clinical practice training also helps to increase
the overall skills of the healthcare professionals. The CPI tool that can be taken into account
for this project is PDSA cycle or Plan, Do, Study, Act Cycle. NSW Government Department
of Health (2018) stated that PDSA helps to narrow the clinical focus and can be easily
implemented over diverse clinical settings be it small or large for continuous improvement.
“P” or “Plan” means identification of principal measures of the project and the expected

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outcome. “D” and “Do” aims towards implementation of agreed plan with a proactive
approach to resolve the gaps in clinical practice. “S” or “Study: helps to study or analyse the
progress in the care and “A” or Act helps to drafting new modification in the training process.
In this said project, “P” signifies analysis of the nature and the strategies, which will be
incorporated in the training process. The expected outcome will be increase in awareness of
the nursing professionals in fall prevention approaches. To Do (D) is rigorous training and
awareness program of the nursing professionals or healthcare workers under the residential or
aged care settings under the governance of an occupational therapist. The training will be
conducted through power-point presentation and poster presentation along with informative
oration. Study (S) of the outcome will be done through questionnaire-based surveys in order
to judge the level of knowledge acquired by the participants of the training. A (ACT) in order
to bring change in the overall implementation process, feedbacks from the participants of the
training will be taken. Furthermore, in order to bring change in the overall implementation
process, the overall set up of the residential care or aged care will be revamped and nurses
will be educated in proper arrangements of the furniture, use of traction shoes and practice of
exercise for the prevention of fall(Stephenson et al., 2015).
Summary of proposed interventions:
Problem highlighted: Increase in the number of accidental falls among older adults under
residential care or aged care settings.
Intervention proposed: Training of the nursing professionals under the supervision of
occupational therapists in domains like exercise training of the older adults for the
improvement of the gut performance, training to provide assistance and maintenance of the
interior arrangement of the room to prevent fall arising from resistance
The successful application of the intervention will be done through proper education and
training of the nursing professionals along with the family of carers. The training and
education will help to increase the skills of the nursing professionals towards prevention of
fall.
Project design: Education and training of the nursing professionals about strategies of
preventing accidental fall among the older adults. Training will be given by occupational
therapist with the help of power-point presentation. The residential care settings or aged
settings with be selected for the training purpose. The family of carers and the nursing
professionals will be trained together. According to Hägvide, Larsson and Borell (2013) older

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adults with dementia suffers from falls due to over-crowded interiors that is stuffed with
furniture. Proper arrangements of the interior décor, use of proper lights ad slip resistant floor
or removing carpets can reduce fall among the older adults. Hägvide, Larsson and Borell
(2013) further highlighted proper physical exercise training helps to improve the gut
performance and thus increasing the mobility of the joints and prevention of accidental fall
among the older adults.
Project audit: Mid-point review of the training program will be done after 3 days of face-to-
face training in order make any amendments in the training process. The amendments will be
based on the quality feedbacks of the participants. Other audits will be conducted based on
the application of the MCQ or multiple-choice questions in order to access the level of
knowledge acquired by the participants. Additional audits will be done in order to analyse the
decrease in the occurrence of accidental fall among the older adults in the residential care
settings(NSW Government Healthy, 2018). This will further help to measure the outcome of
the training.
The time period of training is 1 week and evaluation of the outcome will be done post 3
months of training.
Barriers to implementation and sustaining change:
The main barriers in training implementation will be lack of financial resources, time limit
and lack of necessary skills. The structuring of the training will demand proper setup and
presence of a professional occupational therapists and this will require proper financial
funding. However, at times it becomes difficult to arrange proper funding and thereby
hampering the overall quality of training (Andrew Scanlon et al., 2014). Prolong training for
a period of one week can hamper the shift timings and job schedule of the nursing
professionals. Nurses can be unwilling to practice or to take part in the audit process creating
a barrier in effective training (Andrew Scanlon et al., 2014). The educators can lack the
necessary skills leading to decrease in the overall quality of training (Andrew Scanlon et al.,
2014).
Evaluation of the project:
Evaluation of the CPI project will be done with the help of surveys and the use of open or
close ended questionnaire.

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The close ended questionnaire like multiple choice questions will help to analyse the increase
the level of awareness and knowledge of the nursing professionals in fall prevention of the
older adults. For each correct answer score 1 will be allocated and incorrect answer will have
no score or zero score. The total score acquired will help to judge the final output of training
(Ross et al., 2013).
The effective implementation of the nursing knowledge in the field area will be judge through
the analysis of the residential care data in order to denote the ratio of fall among the older
adults. This will be done after 3 months of training cessation and last one month of the data
will be analysed(Ross et al., 2013).
The overall set-up of training will be judged as per the feedbacks gained from the participants
of the training. The feedbacks will be gained through confidential interview and with the
help of open-ended questionnaire(Ross et al., 2013).

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References
Andrew Scanlon, D. N. P., Denise Hibbert, R. G. N., Freda DeKeyser Ganz PhD, R. N.,
Linda East PhD, R. N., & Debbie Fraser MN, R. N. (2014). Addressing issues
impacting advanced nursing practice worldwide. Online Journal of Issues in
Nursing, 19(2), 1.
Australian Government Department of Health. (2012). 5.5 Clinical governance. Access date:
31st October 2018. Retrieved from:
http://www.health.gov.au/internet/publications/publishing.nsf/Content/mental-pubs-e-
evalnurs-toc~mental-pubs-e-evalnurs-b~mental-pubs-e-evalnurs-b-5~mental-pubs-e-
evalnurs-b-5-5
Australian Institute of Health and Welfare. (2012). Trends in hospitalisations due to falls by
older people, Australia 2002–03 to 2012–13. Access date: 31st October 2018.
Retrieved from: https://www.aihw.gov.au/getmedia/5f84eadd-6f25-4429-82fc-
5e9072278335/aihw-injcat-182.pdf.aspx?inline=true
Hägvide, M. L., Larsson, T. J., & Borell, L. (2013). Fall scenarios In causing older women's
hip fractures. Scandinavian journal of occupational therapy, 20(1), 21-28.
NSW Government Healthy. (2018). Clinical Practice Improvement (CPI) Training Program.
Access date: 29th October 2018. Retrieved from:
http://www.eih.health.nsw.gov.au/initiatives/clinical-practice-improvement-training-
program
NSW Government Healthy. (2018). Plan, Do, Study, Act Cycle. Access date: 29th October
2018. Retrieved from: https://www.health.nsw.gov.au/pfs/Pages/pdsa.aspx

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Nursing and Midwifery Board of Australia [NMBA]. (2018). Code of Professional Conduct
of Nurses in Australia. Access date: 31st October 2018. Retrieved from:
https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/
professional-standards.aspx
Robertson, M. C., & Gillespie, L. D. (2013). Fall prevention in community-dwelling older
adults. Jama, 309(13), 1406-1407.
Ross, A. J., Anderson, J. E., Kodate, N., Thomas, L., Thompson, K., Thomas, B., ... & Jaye,
P. (2013). Simulation training for improving the quality of care for older people: an
independent evaluation of an innovative programme for inter-professional
education. BMJ Qual Saf, 22(6), 495-505.
Sherrington, C., Michaleff, Z. A., Fairhall, N., Paul, S. S., Tiedemann, A., Whitney, J., ... &
Lord, S. R. (2017). Exercise to prevent falls in older adults: an updated systematic
review and meta-analysis. Br J Sports Med, 51(24), 1750-1758.
Stephenson, M., Mcarthur, A., Giles, K., Lockwood, C., Aromataris, E., & Pearson, A.
(2015). Prevention of falls in acute hospital settings: a multi-site audit and best
practice implementation project. International Journal for Quality in Health
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Vlaeyen, E., Coussement, J., Leysens, G., Van der Elst, E., Delbaere, K., Cambier, D., ... &
Dejaeger, E. (2015). Characteristics and effectiveness of fall prevention programs in
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