NURS2006 Assignment 3: Clinical Practice Improvement Project Report

NURS2006 ASSIGNMENT 3
Clinical Practice Improvement Project Report
Student Name, FAN and ID:
Type your assignment into the white spaces in the template and the rows will
expand as much as you need them to.ie Alex Smith smit0000 ID 1234567
Project Title:
Effectiveness of exercises to reduce fall rates among the community dwelling adult population
Project Aim:
To reduce the rate of fall related injuries among the community dwelling older adults by preparing a
thorough exercise regimen. This project would focus on reducing the falls up to 20% in the ward of X
clinical settings.
In order to reduce the rate of falls an exercise program has to taken up in the X clinical setting. The
patients will be imparted with education regarding the usefulness of the exercise and each patient
will be entrusted with specific exercises by the physiotherapists. The outcome will be evaluated by a
follow up of six months.
Falls and fall related injuries in adults are mainly caused due to the age, poor physical condition, and
lower functional status (Desure et al. 2013). Fall related injuries in elderly person decreases their
quality of life by lessening their confidence. Often older adults feel that in most of the cases, the
cause of the falls can be avoidable. According to Cadore et al.(2013), proper exercise regimens have
been found to decrease falls among the elderly people. Hence this paper aims to focus that exercises
can help to retain balance among the older adults.
Relevance of Clinical Governance to your project
Clinical Governance is the systematic approach to provide the quality of care to the client by
reducing the risks and complication. Clinical risk management involves improvement in the quality
and the safety of health (Heyrani et al.2012). This can be accomplished by detecting the
circumstances that put the patients at risk and then acting accordingly to mitigate that harm. In this
project the risk has been identified as fall among the elderly patients due to lack of balance,
cognitive disability and medication effect (Khoury et al.2013). The strategy in this case is effective
exercise. The staffs are responsible for their own actions and ensure client safety at highest level

(Granacher et al.2013). In this project an attempt has been made to reduce the fall rate in the
community. Therefore, the third pillar of clinical governance, which is risk management, is used to
analyse the risk factor and implement effective intervention to overcome the situation. The incident
of fall has been increasing due to diminish physical functioning and physical inactivity (Iwamoto et
al.2009). As exercise is the most effective way to improve the body balance and prevent falls in
elders in the community. (MS Kaminska et al 2015, p.3407).Exercise is a part of health care and it
gives an opportunity to have social interaction.(Shier.V et al.2016,p.3) . It has been found that
exercises that challenge balancing are far more effective in preventing falls, than those that do not
challenge the balancing program. It has been found that the older adults should practice how to
control the movements of their body's centre of mass (Heyrani et al. 2012). It is always not about fall
related injuries, proper balancing exercises can reduce the risk of some cardiovascular diseases and
many chronic diseases (Gillespie et al.2013). The ACHM and the (American heart association) AHA
recommends regular exercises for the adults aged 65 years and over. According to recent cochrane
review, risks and all rates can be decreased by 15% to 32% depending on the type of targeted
exercise (Horne et al.2013).
Evidence that the issue / problem is worth solving:
Source: (Gillespie et al.2012)
The following graph depicts that fall related deaths occurs among the older adults above the age of
65. Extensive search through literature have found that even a little bit of exercise can help in
prevention of falls among the older adults (Giné-Garriga et al. 2014). According to the
epidemiogical statistics about 30% of community dwelling elders over 65 aged and 50 % over 80
year, fall annually. Fall is the sing cause if disability and mortality. The admission rate of fall related
injuries in Australia were over 60 in Australia as 2,000,000 non fatal injuries are treated in hospitals

in 2013 (Hempel et al. 2013).The cost burden is increasing on health care sector. (Kaminska.MS et al,
2015, p.3407). According to Gillespie et al. (2012), fitness aerobic exercises, balance exercises can be
useful for the elderly people. After the age of 40 the strengths of the lower limb muscle decreases,
which has been considered as one of the driving factors for falls (Granacher et al.2014). Hence,
power exercises, balancing exercises, toe stands, knee curls. Leg extension exercises can be useful
for making the thigh muscles, leg muscles and lower back muscles stronger (Desure et al. 2013). All
these evidences prove that an exercise program is strongly needed in the X- hospital to reduce the
rate of falls and the decrease the chance of sentinel events due to falls.
Key Stakeholders:
The stake holders that play an important part of this project are the patients, the doctors, the nurses
and the physiotherapists.
Physiotherapists- They will review and device the treatment program by using manual therapies and
therapeutic exercises. They are the one to assign particular exercises to specific patients (Moyer
2012).
Patients- They will be giving the feedbacks regarding the interventions.
Nurses- Play the leading role in carrying out the interventions related to falls. A nurse should be able
to use the standard assessment tools for detecting the level of risks apart from the exercises; Some
of the common preventive measures that can be taken by the nurses are hourly rounds,
communication with the patient and medication review (Milisen et al.2012).
Doctors- The doctors will monitor if there is any adverse effect during or after the completion of the
exercise regimen.
CPI Tool:
Clinical practice Improvement is the means of improving and managing the quality of care provided
to the patient. It helps to evaluate the measure that has been taken to ensure a safe and quality care
(Taylor et al.2013). The CPI method is mainly dependent upon the following questions such as ' What
are we trying to accomplish?', How will one know that the setting requires a change?', 'what changes
has to be made that will bring about an improvement in the given problems?'. It is necessary to have
CPI training for learning the skills of comprehensive identifying, planning and identifying the issue.
There are is a couple of CPI tools among which the PDSA model (Plan- Do- Study- Act) are normally

used in the quality improvement strategies aimed at bringing out positive changes in a health care
setting. This model follows a cyclical pattern of impacting and assessing the changes (Taylor et
al.2013). The PDSA cycle is normally used to evaluate changes in the system by designing a plan, and
then carrying out the plan followed by the subsequent understanding and follow up of the plan
(Terroso et al.2013). It is necessary to answer 3 questions before using the PDSA cycle in this
project, The goal of this project, evaluation of the reached goals, interventions for reaching the
goals.
The goal of this project is to reduce the rate of falls among the older adults in the X hospital ward.
There will exercise programs for the elderly patients of the ward under the supervision of the
doctors, physiotherapists and the nurses (winter et al.2013). The outcome of the implemented plan
have been assessed and studied. A record plan is kept to jot down the names of the respondents
who have participated in the drills and the exercises (Gillespie et al.2013). Finally a feedback is taken
from both the parties receiving the benefits that are the patients and the parties giving the benefits
such as the physiotherapist and the nurses. All the records and the documentations of the feedback
were evaluated for implementing routine exercise plan for the fall prone persons in the hospital
ward.
PDSA tool
Tool: Patients feedback
Step: Exercise program for the elderly patients in the hospital ward, for preventing falls.