Nursing Assessment Report | Nursing Quality

Running head: NURSING
QUALITY IMPROVEMENT PLAN
Name of the Student:
Name of the University:
Author Note:

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Project Title: ‘Reducing incidence of falls among the elderly within healthcare setting
and ensuring quality improvement.’
Introduction:
Falls among elderly account for a major health issue that results in associated
comorbidities. The evidence base in this regard reveals that approximately 30% of the old age
adults aged 65 and above experience one episode of fall in a year. Research studies further
state that the incidence rate is expected to rise from 14% as reported in the year 2010 to 23%
within 2050 (Anzfallsprevention.org, 2019). In addition to this, it should also be noted that
the associated medical cost of fall is expected to rise up by $1.4 billion by the end of the year
2051 (Anzfallsprevention.org, 2019). Also, the financial expenditure pertaining to the cost of
injuries caused due to falls is expected to rise up to 1.8 million (Breimaier et al., 2015). The
background information suggests that falls among elderly enhances the disease burden that
subsequently diminishes the quality of life which in turn stresses upon the need to introduce
quality improvement programs within healthcare setting in order to control the prevalence of
falls and related accidents among the elderly.
Project Proposal:
The project proposal intends to reduce the incidence of falls among the elderly within
the geriatric unit of XYZ hospital. The rationale for proposing the project can be explained as
the rise in the rate of recurrent hospitalization due to falls among the old age patients aged 65
years and older post discharge, considering the 6 months patient data. The proposed project is
aligned to the six domains of healthcare as mentioned in the STEEP framework and intends
to improve the quality of care services offered by ensuring a safe, effective and patient-
centered care delivery. In addition to this, the proposed project also intends to enhance the

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quality of services provided so as to render timely, efficient and equitable service delivery to
the old age patients.
Significance of the Problem:
The evidence base reveals that advanced age is invariable accompanied with the
manifestation of one or more chronic health disorders such as Diabetes or cardiovascular
disorders (Vlaeyen et al., 2015; Kim et al., 2015). The symptoms of the disorders lead to a
number of physiological complications such as interference with proper eyesight and poor
neuro-muscular coordination (Park, 2018). In addition to this, senescence is also
accompanied with other physiological complications such as lack of bone density that leads
to osteoporosis and results in lack of bone and muscular strength (Kaminska et al., 2015).
These factors lead to falls and accidents that subsequently diminishes the quality of life of the
elderly. In addition to this, recurrent hospitalizations due to fall increase the overall medical
cost and deteriorates the quality of life of the family members of the patients (Luk et al.,
2015, Bhattacharya et al., 2016). In this regard, it can be stated that evaluating the evidence
base to integrate the best strategy for prevention of falls among the elderly can help to
improve quality and acquire positive patient outcome.
Project Aim:
The aim of the project proposal is to reduce the frequent rate of hospitalization by
30% among the elderly on account of falls and related injuries within 6 months. The SMART
objectives for the proposed project is explained as under:
Specific: To reduce the recurrent rate of hospitalization among the elderly within the geriatric
unit of XYZ hospital
Measurable: The incidence rate would be reduced by 30%

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Attainable: The achievable reduction rate would be 10% to 15%
Realistic: Incorporating evidence based fall prevention strategies as per the available
resources and allocated budget
Timely: The quality improvement program would be implemented within 6 months
Current State:
The current patient data suggests that the rate of recurrent hospitalization on account
of fall and associated injuries among the elderly within XYZ hospital is equivalent to
47.25%. In addition to this, increase in the prevalence of fall has also aggravated the disease
burden and has contributed to a rise in the medical expenditure and has significantly
diminished the quality of life for the affected patients as well as their family members. The
proposed project intends to introduce a quality improvement fall prevention program within
the geriatric unit of the XYZ hospital so as to improve patient safety and acquire positive
patient outcome.
Establishing Measures:
According to Leis and Shojania (2017), while implementing a project, it is integral to
establish the assessment or evaluation parameters based on which the success rate of the
proposed plan can be scrutinised. In order to determine the success rate and feasibility of the
project, the documented reduction rate of recurrent hospitalizations due to falls is expected to
decrease by 30%. A 30% reduction in the rate of recurrent hospitalization due to falls among
the elderly will reveal that the implemented plan has been successful.
Project Details:
In order to implement the proposed plan the PDSA framework would be utilised. The
PDSA or the Plan, Do, Study and Act framework allows to test and integrate a change within

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the process by planning, analysing and evaluating the proposed plan and its related outcome.
The proposed quality improvement project plan would involve the following steps:
Plan: For the purpose of devising a service quality improvement fall prevention program for
the elderly, the annual patient data for hospitalization on account of fall and related injuries
would be analysed and compared. Furthermore, the recurrent patient hospitalization data on
account of falls and related injuries would also be evaluated and contrasted in order to track
the percentage of increase with respected to recurrent hospitalizations due to falls and
associated injuries.
Do: In order to implement the fall prevention program, the evidence base needs to be
analysed thoroughly so as to retrieve evidenced based strategies that can help to reduce falls
among the elderly. Typically, the evidence based strategies suggest that inclusion of group
exercise activities, home exercise activities, mild tai chi exercise activities and conducting
individual risk assessment can help to significantly reduce the incidence rate of falls. The
proposed plan would therefore include a set of fall prevention interventions that would be
administered to patients during the time of discharge so as to ensure safety and reduce the
episodes of fall and related injuries. The strategies would comprise of conducting a
mandatory risk screening, imparting health literacy to the patient and family members about
risk factors that could result in falls, imparting mild multi component fall prevention exercise
training and provision of appropriate footwear to prevent the incidence of falls.
Study: The proposed set of interventions would be delivered to the vulnerable old age
patients as well as the old age adults who were admitted on account of fall related injury
during the time of their discharge. The patients and their family members would be educated
about the risk factors that trigger a fall episode. The patient would be provided with the
correct footwear or compression stockings that could help in ensuring comfort while

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mobilising and reduce the risk of falls. Also, multiple component exercise activities would
also be taught to the patients so as to ensure safety and reduce the risk of a fall (Donath et al.,
2016, Sosnoff & Sung 2015). The fall prevention interventions would be administered to the
patient during the time of discharge as a wellness package and it is expected that the rate of
recurrent hospitalization due to fall would reduce by at least 15%, however the expected
outcome is to reduce the incidence rate by 30%.
Act:
On the basis of the success rate of the implemented program, further steps would be
undertaken to improvise or terminate the program. If the expected reduction in the percentage
of recurrent hospitalization is acquired, further steps would be undertaken to enhance the
impact of the program. In order to improve the quality of the proposed program other
advanced non-pharmacological therapies would also be introduced that would include
assistance from a physiotherapy and an occupational therapist. Specific interventions applied
by physiotherapists and occupational therapists would help to improve independence level
while performing activities of daily living. This would further alleviate the quality of life of
the senior adults.
Budget:
In order to implement the proposed project, a number of resources in the form of
appliances and manpower would be needed. In addition to this, the implementation of the
project would also require the sanctioning of a budget. The brief explanation of the proposed
project budget is provided below:
Required Resources Approximate Cost
Multidisciplinary team including RN,
Community Nurses, Physiotherapist,
$ 5000

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Occupational therapist and Physical expert
Discharge Room $00.00 (space already available within the
geriatric unit)
Health Literacy leaflet containing
information about risk of falls and injuries
$ 1000
Stock of Compression stocking and Safe
shoes
$ 1000- $ 2000 (viariable)
Support devices such as cane and crutches
and exercise devices
$ 1000- $ 2000 (variable)
$ 8000- $ 10000 (Approx.)
Dissemination:
Upon implementation of the program if the expected outcomes are acquired, the
project would be implemented on a larger scale. In addition to this findings of the project
would along with the efficacy of the project would be discussed with the board of directors
and after acquiring the approval would be forwarded to the health officer. The rationale for
the same can be explained as convincing the policy makers to introduce quality reforms
within the healthcare sector so as to enhance the quality of life for the senior adults within the
Australian territory (Moghaddam et al., 2017). This would help to ensure sustainability of the
project and help to acquire improvement on a larger scale.
Project Evaluation:

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The project evaluation would be conducted with the use of statistical analysis. The
ANOVA test would be conducted to compare and analyse the relationship between the
dependent and the independent variables (Brosey & March, 2015, Cameron et al., 2016). The
dependent variables would include frequency of recurrent hospitalization and episode of falls
within the hospital setting. The independent variable would comprise of patient safety and
quality of life. Also, a survey would be conducted on the patients who would be enrolled
under the proposed program during their follow up session (Borowicz et al., 2016, Lachance
et al., 2016). The acquired survey responses would help to evaluate the effectiveness of the
program and also help to assess the quality of life of the senior adults post the
commencement of the prevention program (Zhang et al., 2017). It is expected that the survey
response would reveal a positive result in terms of reduction of fall episodes, improved
independence in carrying out activities of daily living and improved quality of life (Brosey &
March, 2015, Blain et al., 2016).
Risk Management Strategy:
As stated by Brosey and March (2015), while conducting a program it is integral to
assess the risks involved and adapt an efficient risk management strategy. This helps to
achieve positive patient outcome and at the same time also helps to make use of planned
strategies to mitigate risks encountered while the project is being executed (Rodrigues &
Figueiredo, 2017, Rimland et al., 2016). On assessing the objectives of the program, the
following risk events can be anticipated:
 Unwillingness of the patient to participate in the program
 Injuries sustained by patients while exercise training is being given
 Unwillingness on the part of the care profession to correctly deliver the planned
interventions

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 Failure to secure the expected outcome
The following mitigation strategies would be used to mitigate the anticipated risks:
 Imparting awareness about the objectives and the rationale for referring the patient to
the program during the discharge planning
 Immediate first aid assistance by team of enrolled nurses
 Setting key performance indicators to assess the quality of the performance of the care
professionals involved in the program and recognising efficient performance with
incentives
 Analysis of the key issues that contributed to the failure and terminating the program
Project Summary:
The project intends to commence a fall prevention wellness program at XYZ hospital
in order to reduce the rate of recurrent hospitalizations on account of frequent falls among the
elderly and reduce the rate of recurrent hospitalization rate up to 30%. The program would
involve a set of fall prevention interventions that would be delivered to elderly patients
during the time of discharge. The interventions would majorly include health literacy about
risk factors that contribute to fall, mild exercise training and information about support
devices that can help to reduce falls and improve the quality of life of the senior adults. The
evaluation of the project would be done on the basis of reduction of recurrent hospitalization
rate on account of falls and acquired survey responses.
Conclusion:
Therefore, to conclude, it can be stated that the proposed project included evidence
based interventions that can positively help to curtail the incidence of falls and recurrent

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hospitalizations among the elderly. In addition to this, the proposed program is also expected
to alleviate the quality of life of the old age patients and promote positive patient outcome.
On the basis of the success rate of the program, further steps would be undertaken to
implement the project on a larger scale.

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References:
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