Implementing a Fall Prevention Program in Healthcare Organizations

Inpatient falls is one the most commonly encountered clinical situations in healthcare settings, all across the globe. Falls of patients, during their length of hospitalization are associated with an increased length of stay, increased healthcare costs, and greater usage of healthcare resources. This calls for the need of implementing change management in a healthcare organization, in relation to the implementation of a fall prevention program.

Running head: NURSING
JLP1 — JLP TASK 1: LEADERSHIP EXPERIENCE
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Author Note

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A.
1. Inpatient falls is one the most commonly encountered clinical situations in
healthcare settings, all across the globe. Falls of patients, during their length of
hospitalization are associated with an increased length of stay, increased
healthcare costs, and greater usage of healthcare resources (Morris & O’Riordan,
2017). This calls for the need of implementing change management in a
healthcare organization, in relation to the implementation of a fall prevention
program.
a. While caring for patients in the hospital, it has been found that falls among
the elderly patients are a matter of serious concern. Most incidents of
inpatient falls generally occur amid the older adults who are aged more
than 75 years (Anderson, Postler & Dam, 2016). These falls eventually
lead to complex interaction between acute illness, frailty, pre-morbid
conditions, and environmental risks, concomitant with a range of
behavioral issues as well. Presence of an unfamiliar healing environment
at the hospital increases the risk of falls. Moreover, the impacts of falls are
associated with substantial physical and psychological complications, and
an apprehension of recurrence, thereby making the identified group of
patients vulnerable (van Loon et al., 2019). Hence, it is necessary to
modify the healthcare environment in a manner that the incidence of
inpatient falls will get considerably reduced. This can be accomplished not
only by changing the layout of the hospital, but by modifying the
perception and approach the healthcare staff have towards the issue.
2. According to Khalifa (2019) falls are an important issue since they lead to internal
bleeding, lacerations or other injuries that augment healthcare utilization and

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affect the health and wellbeing of patients. It has been established that healthcare
leaders play a pivotal role in ensuring hospital safety and are also accountable for
disseminating appropriate information about the risks of inpatient falls, while
establishing a range of safety standards for fall prevention. It is imperative for the
healthcare leaders to identify the urgency of bringing about change in fall
prevention practice, in addition to formulating a plan of action that needs to be
followed by the staff (Markle-Reid et al., 2017). The medical officer is expected
to identify the risk factors, following which they are expected to help the staff
understand the impact of inpatient fall on mortality and morbidity. Similarly, fall
prevention programs cannot be successfully accomplished without the
collaborative efforts of the physiotherapist, nurse, pharmacist, occupational
therapist, and podiatrist.
a. According to the World Health Organization (2018) falls are the second
most common reason for unintentional or accidental injury or death
globally and every year around 646 000 individuals die due to falls. With
adults aged more than 65 years being most susceptible to such incidents,
these falls result in more than 17 million loss of DALYs (disability-
adjusted life years). This calls for the need of managing the risk factors
and changing the environment and physical design of the hospital.
3. Every year around 700,000-1,000,000 individuals suffer from falls in hospitals, in
the US. Falls generally occur at a rate of 3-5 patients per 1000 bed-days, and it is
estimated that roughly half of 1.6 million residents in nursing homes fall every
year (AHRQ, 2019). In the USA, every year an estimated $50 billion gets spent
for management of non-fatal fall injuries, together with $754 million for

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management of fatal falls (AHRQ, 2019). For the non-fatal falls, around $29 and
$9 billion gets paid by Medicare and Medicaid, respectively (CDC, 2018).
a. According to () there are a range of risk factors that increase the likelihood
of inpatient falls, particularly amid the elderly patients. The faller
generally lives with numerous risk factors for such incidents, and only
encounter problems when an additional factor appears (Franco et al.,
2020). Therefore, fall management is habitually customized to address the
factor that triggered the fall, in place of other factors. Inappropriate gait
and balance due to stroke, Parkinson’s disease, neuropathy or other
conditions, effect of polypharmacy and sedatives, visual impairment due to
glaucoma, cognitive problems, and orthostatic hypotension are some
intrinsic factors that increase fall risk. The most common extrinsic factors
are poor lighting, absence of handrails, uneven floor surfaces and rugs,
poorly fitted shoes and clothes, and lack of walking aid (Ek et al., 2019).
4. An analysis of the risk factors and burden of inpatient falls suggest that fall
prevention programs are the best solution for addressing the concern. The
principle aim of fall prevention programs is to identify the inciting reason, such
that it can be averted in near future. Not only do these programs increase the
knowledge and awareness of the healthcare professionals about fall prevention,
but also facilitate the introduction of steps that enhance the health and wellbeing
of the patients, by providing them resources and referrals. These programs
generally focus on providing safety devices, offering wearable sensors, training
the staff, continuous patient monitoring, encouraging patients to perform lower
limb exercise, and changing the structural layout of the healing environment.

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a. It has been found that “A Matter of Balance” program was effective in
reducing fear of falling amid English and Spanish patients, thereby
improving their rate of fall in hospitals, increasing exercise levels, and
promoting better management of fall incidents (Wolfe, Arabian, Breeze &
Bugaev, 2018). Similarly, on implementing Fall and Fracture Prevention
Program across nursing homes, a significant decrease was observed in the
rate of femoral fractures, with a positive correlation with patient
characteristics and fracture rates (Schulz, Lindlbauer, Rapp, Becker &
König, 2017). Not only are these fall prevention programs cost effective,
but also help in enhancing the health-realted quality of life of the patients
(Olij et al., 2019).
5. In order to implement an effective fall prevention program, it is necessary to
conduct a needs assessment of the patient that will help to understand the nature of
the issue, the services required for effectively addressing the concern, and those
patients who require the services. Some major resources that will help in
successful implementation of the program are namely, NCOA Map of Partners
and Programs, Falls Prevention Conversation Guide for Caregivers, Eldercare
Locator, and Find your state's Assistive Technology Program (Administration for
Community Living, 2019). A team comprising of nurses, physiotherapists,
occupational therapists and podiatrist is essential. It is essential to conduct a cost
benefit analysis for the proposed fall prevention program. The financial
information related to the program could be measured, analyzed, interpreted and
communicated by financial accounting. In addition, investing in this program will
help in decreasing healthcare resource spending in future and would also reduce
the number of fall related cases.

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6. The presence of a timeline provides all stakeholders a clear overview of the
intended project and describes the chronological sequence of events that will be
undertaken in the project. This program will be conducted over a period of 12
months. While the first two months would involve convincing the stakeholders, in
the succeeding six months changes will be made in the environment, healthcare
staff will be provided training, and the patients will be given safety devices. The
remaining four months will be spent analyzing the impacts of the program on the
patient. At the end of each month (beginning from the third month), a clinical
audit will be conducted to determine the impact on fall rate.
7. Major stakeholders in this program will include physicians, nurses, nurse
manager, administrative officials, family members, medical officer,
physiotherapist, occupational therapist, other allied healthcare staff, marketing and
sales team, and members of medical insurance agencies.
a. It is essential to ensure that the implemented fall prevention strategies are
efficiently translated for and distributed to important stakeholders, with the
aim of increasing awareness and encouraging appropriate action (Baris &
Seren Intepeler, 2019).
b. Following identification of the stakeholders, I will try to establish
conviction, and maintain continuous contact with them. I intend to
understand the constraints and vision and communicate the goals of the
program in a manner that there are no misconceptions.
8. Implementation of the program will be based on collaborative efforts of all
stakeholders. After identifying the unique roles and responsibilities of the
stakeholders, the staff will be educated and trained on fall prevention strategies.
The patients will be provided safety devices like high friction footwear, walking

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stick and wearable sensors (Ji, Guo, Song & Xi, 2018). They will then be
encouraged to participate in regular exercise for increasing their muscle strength
(Sherrington et al., 2017). Apart from regular monitoring of the patients,
environmental modification will be initiated like installation of non-slip decals,
grab bars in bathrooms and stairs, improved lighting, even floors, and removal of
cluttered spaces.
B. As a scientist, I explored all intrinsic and extrinsic risk factors that make the elderly
patients more likely to suffer from falls in hospitals. I also searched for scholarly
evidences to inform my practice. As a detective, I analyzed the rate of inpatient falls
across the world and the US and also tried to determine the impacts they create on
patient health, safety, and expenditure. By using my critical thinking skills, I was able
to identify the importance of stakeholders in fall prevention. As a manager of healing
environment, I was able to identify the environmental changes that can help in
decreasing rate of inpatient falls. I also comprehended that if patients are not treated
in a safe and supportive environment, their health and safety are at risk, which in turn
make them more prone to fall incidents.

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References
Administration for Community Living. (2019). Falls Prevention Resources for Older Adults
and Caregivers. Retrieved from https://acl.gov/FallsPrevention
Agency for Healthcare Research and Quality. (2019). Falls- Background. Retrieved from
https://psnet.ahrq.gov/primer/falls
Agency for Healthcare Research and Quality. (2019). Preventing falls in hospitals. Retrieved
from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/index.html
Anderson, D. C., Postler, T. S., & Dam, T. T. (2016). Epidemiology of hospital system
patient falls: a retrospective analysis. American Journal of Medical Quality, 31(5),
423-428. https://doi.org/10.1177%2F1062860615581199
Baris, V. K., & Seren Intepeler, S. (2019). Views of key stakeholders on the causes of patient
falls and prevention interventions: A qualitative study using the international
classification of functioning, disability and health. Journal of clinical nursing, 28(3-
4), 615-628. doi: 10.1111/jocn.14656
Centers for Disease Control and Prevention. (2018). Cost of Older Adult Falls. Retrieved
from https://www.cdc.gov/homeandrecreationalsafety/falls/fallcost.html
Ek, S., Rizzuto, D., Fratiglioni, L., Calderón‐Larrañaga, A., Johnell, K., Sjöberg, L., ... &
Welmer, A. K. (2019). Risk factors for injurious falls in older adults: the role of sex
and length of follow‐up. Journal of the American Geriatrics Society, 67(2), 246-253.
https://doi.org/10.1111/jgs.15657
Franco, M. R., Sherrington, C., Tiedemann, A., Pereira, L. S., Perracini, M. R., Faria, C. R.
S., ... & Pastre, C. M. (2020). Effect of Senior Dance (DanSe) on fall risk factors in

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older adults: a randomized controlled trial. Physical therapy.
https://doi.org/10.1093/ptj/pzz187
Ji, J., Guo, S., Song, T., & Xi, F. J. (2018). Design and analysis of a novel fall prevention
device for lower limbs rehabilitation robot. Journal of back and musculoskeletal
rehabilitation, 31(1), 169-176. http://dx.doi.org/10.1136/bjsports-2016-096547
Khalifa, M. (2019). Improving Patient Safety by Reducing Falls in Hospitals Among the
Elderly: A Review of Successful Strategies. Studies in health technology and
informatics, 262, 340-343. Retrieved from https://books.google.co.in/books?
hl=en&lr=&id=1mawDwAAQBAJ&oi=fnd&pg=PA340&dq=elderly+patient+falls+h
ospital&ots=dI7WLzybMt&sig=aqVHA5uNBVmNI7-
M1FF_GbjWnQc#v=onepage&q=elderly%20patient%20falls%20hospital&f=false
Markle-Reid, M., Dykeman, C., Ploeg, J., Stradiotto, C. K., Andrews, A., Bonomo, S., ... &
Salker, N. (2017). Collaborative leadership and the implementation of community-
based fall prevention initiatives: a multiple case study of public health practice within
community groups. BMC health services research, 17(1), 141.
https://doi.org/10.1186/s12913-017-2089-3
Morris, R., & O’Riordan, S. (2017). Prevention of falls in hospital. Clinical Medicine, 17(4),
360. doi: 10.7861/clinmedicine.17-4-360
Olij, B. F., Ophuis, R. H., Polinder, S., van Beeck, E. F., Burdorf, A., Panneman, M. J., &
Sterke, C. S. (2019). Cost-effectiveness of falls prevention programs for older adults:
A systematic review. Quantifying Efficiency in the Field of Injury, Mental Healthcare
and Prevention, 66(11), 52. Retrieved from
https://repub.eur.nl/pub/116601/Thesis_Ophuis_EMBARGO.pdf#page=59

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Schulz, C., Lindlbauer, I., Rapp, K., Becker, C., & König, H. H. (2017). Long-term
effectiveness of a multifactorial fall and fracture prevention program in bavarian
nursing homes: an analysis based on health insurance claims data. Journal of the
american medical directors association, 18(6), 552-e7.
https://doi.org/10.1016/j.jamda.2017.03.012
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. DOI: 10.3233/BMR-
169765
van Loon, I. N., Joosten, H., Iyasere, O., Johansson, L., Hamaker, M. E., & Brown, E. A.
(2019). The prevalence and impact of falls in elderly dialysis patients: Frail elderly
Patient Outcomes on Dialysis (FEPOD) study. Archives of gerontology and
geriatrics, 83, 285-291. https://doi.org/10.1016/j.archger.2019.05.015
Wolfe, E. S., Arabian, S. S., Breeze, J. L., & Bugaev, N. (2018). Evaluating the Effectiveness
of the Translated “A Matter of Balance” Fall Prevention Program Materials for Non-
English Speaking Participants. Journal of trauma nursing: the official journal of the
Society of Trauma Nurses, 25(5), 311. doi: 10.1097/JTN.0000000000000394
World Health Organization. (2018). Falls- Key facts. https://www.who.int/news-room/fact-
sheets/detail/falls