Fall Prevention in Residential Aged Care

NURS2006 ASSIGNMENT 3
Clinical Practice Improvement Project Report
Student Name, FAN and ID:
Project Title: (9 words)
Individualised balance exercise to prevent falls in nursing homes
Project Aim: (15 words)
To prevent falls in nursing homes by 20% in 12 months using
individualised balance exercise.
Relevance of Clinical Governance to your project: (216 words)
Individualised balance exercises would be achieved through the collaboration of
the specific patient and physical therapist or nurse assistants. Hence, the pillar of
consumer and community participation is relevant to the project. Based on
consumer and community participation pillar, an intervention is developed on
the principles of consent, autonomy and professional ethics. The patient at the
aged care home should offer consent before the therapist initiates therapy
session. On the other hand, the healthcare professional should practice
autonomy and observe professional ethics when treating the patient. Besides,
needs assessment, information provision and privacy are fundamental aspects of
the consumer and community participation pillar (Department of Health, 2012).
These principles are all pertinent to the proposed project. Another clinical
governance pillar that is pertinent to the project is service evaluation, quality
improvement and innovation. The structure of the project requires constant
evaluation and improvement based on the client’s outcomes and efficiency. The
pillar of service evaluation and quality improvement suggests that treatment
should be monitored progressively and updated to meet the envisioned or
desired results (Department of Health, 2012). In this project, the individualised
balance exercises will be continuously monitored, and deficiencies in relation to
the predetermined standards of care will be remedied. This analysis indicates
that clinical governance is relevant and indispensable to the proposed project.
Evidence that the issue / problem is worth solving: (774 words)
Falls in nursing homes is a significant problem that results in adverse health
outcomes and is a common occurrence in Australian aged care facilities.
Empirical evidence suggests that there is a high number of falls in nursing

homes. Ibrahim and colleagues, in their study conducted between 2000 and
2013, found that most deaths in accredited Australian nursing homes occur due
to falls. Specifically, they revealed that out of 21672 deaths 81.5 percent (2679)
are associated with falls. They concluded that falls cause premature deaths in
aged care facilities, which are preventable (Ibrahim et al., 2017).
One study conducted in New South Wales (NSW), shows that there is a high
number of falls in residential aged care that require medical treatment. The
study shows that between 2006 and 2007 5756 falls were requiring medical
attention in NSW. The number of falls that needed emergency department
attendance in nursing homes was about 6988. Lastly, the number of falls in
residential aged care that required non-hospital treatments was 29790 (Watson
et al., 2010).
Another justification for implementing a fall prevention strategy in nursing
homes is the incidence report of Queensland health facilities. Between 2007 and
2008, 11928 fall-associated clinical incidents in Queensland. 22 percent of these
incidences occurred in nursing homes. Some of these incidents led to mortality
or severe and permanent patient harm. Other incidents led to temporary loss of
function, while a few did not cause any harm (Black & Ferrar, 2011).
Chen and colleagues did a study to determine the prevalence of falls in nursing
homes in Australia. In this study, there were 1342 older males and females with
a mean age of 86 years. Over a period of 1.97 years, approximately 6646 led to
308 fractures. Some fractures resulted in long hospitalisation and disability. This
study shows that falls in nursing homes should be prevented to enhance the
quality of life for the residents (Chen et al., 2008).
Fall-associated ambulance attendances for Queensland also reveal the prevailing
problem of falls in aged care facilities. From 2007 to 2008, there was an average
of 1895 fall-linked attendances. About 24 percent of all the falls occurred in aged
care facilities around Queensland. The report indicates that most of these falls
needed treatment at the scene (Black & Quinn, 2010).
Nicholas and colleagues did a study in nursing homes in Sydney to investigate
the prevalence of falls linked to Drug Burden Index. The study found that there
are many falls in the aged care homes associated with the medication. In one
year, there were 998 falls in 330 clients. The analysis insinuates that the average
falls per person in a year is 1.74 (Wilson et al., 2011).
In a study conducted in Australia between 2009 and 2010, it was found that one
in five injurious falls involving an individual aged 65 years and older occurred in
nursing homes and led to hospitalisation. Within the same period, the prevalence
of fall injury cases in nursing homes was six times higher than in homes (Bradley,
2013).

Finally, this project is supported by the AIHW report of 2005-2006. Based on this
report, the largest number of fall injury incidences happened in nursing homes,
which was 21.8 percent. The falls in women were 23.6 percent, while in men the
falls were 17.5 percent. The report notes that in the number of falls in aged care
facilities was five times higher compared to the home environment (Bradley &
Pointer, 2008).
Recent literature suggests that individualised balance exercise is effective in
reducing falls in nursing homes. One review article asserts that balance training
using mechanical apparatus reduces falls in intermediate level nursing homes
(Cameron et al., 2012). Besides, research found that high-intensity exercise
reduces falls in older people living in aged care facilities if they enhance their
balance. This study involved 191 older people living in nursing homes
(Rosendahl et al., 2008). A meta-regression study found that interventions that
entail balance training, excluding walking training have a significant impact in
reducing falls in older adults. The meta-analysis recommends the balance
exercise to be performed for about two hours per week (Sherrington et al.,
2011). Raimunda and colleagues did a meta-analysis of 12 studies involving
1292 candidates to determine the effectiveness of exercise in fall and fracture
prevention. Their analysis notes that balance exercises have a preventive impact
on falls (Silva et al., 2013).
The problem: A fall is an act of collapsing without control. In nursing homes, falls
can be sudden and can happen at any place within the aged care facility.
Exercises are designed, structure and repetitive movements to enhance or
sustain certain components of physical fitness (Tiedemann et al., 2013).
Key Stakeholders: (135words)
Nurse assistants – Nurse assistants, will act as the primary caregivers for the
patients in nursing homes. They will identify residents within nursing homes who
should be included in the program.
Registered nurses (RNs) - RNs will be required to monitor residents who are
undertaking balance exercises. They will ensure the patients maintain
appropriate hygiene and receive proper nutrition.
Physiotherapists – These specialists will examine and treat residents who can
benefit from balance exercises. Their role will be restoring and maintaining
physical function within musculoskeletal systems.
Orthopaedic surgeon – This medical professional will be involved in examining
musculoskeletal system disease among the patients. They will determine
patients who are the risk of experiencing osteoporosis.