Reduction of Fall Rates Among Elderly Population in Hospital Ward

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:
Reduction of fall rates among the elderly population in a hospital ward.
Project Aim:
The aim of the project is to bring about 30% reduction in fall rates among the elderly population in
a hospital ward within a six-month time frame by implementing exercise.
Falls are the most common causes of morbidity, mortality and disability among the elderly. Falls in
the elderly are a major concern and approximately 30% of falls occur each year (Milisen et al.
2013, pp. 495-507). Postural stability depends on the ability to coordinate the sensory and motor
nerves, which in turn helps to perceive the environment and respond accordingly by controlling
the movement of the body. Cognitive impairment has been identified as a risk factor associated
with falls among the elderly, however, other diseases like dementia, depression and Parkinson’s
disease have also been associated with falls among the elderly (Montero Odasso‐ et al. 2012, pp.
2127-2136). Subtle changes in cognition like executive function has also been associated with falls
among the elderly. Recent research has revealed the importance of impairment of executive
function is association with falls among the elderly people in hospitals. Assessments of executive
function in the elderly needs to be carried out and should be a apart of the fall risk assessment
carried out in the hospitals (Snyder 2013). There are various consequences associated with falls in
the elderly. Injuries associated with falls in the elderly involve fractures of the hip, broken bones
and broken hips, soft tissue injury, damages to the head, among others. These injuries in turn can
give rise to serious consequences. Falls among the elderly results in loss of independence and
many of the elderly population have to permanently reside in long-term care facilities. The risks
associated with falls prevent them to carry out physical activities or any other daily activities,
thereby restricting their movements. They feel isolated and this isolation can give rise to various
mental disorders like anxiety, depression, among others. They become dependent on others to
carry out their daily activities. The individuals who suffer falls have increased chances of
succumbing to falls again (Muir, Gopaul and Montero Odasso 2012, pp. 299-308; Winter, Watt and

Peel 2013, pp. 215-227). Exercises have been shown to be beneficial as it helps to attain balance
and build physical stability and strength, which is highly essential for such elderly population to
lead a healthy life. According to Sherrington and Tiedemann (2015), various multi-component
group based exrcises, gait and balance or functional training exercises have been shown to reduce
falls among the elderly. Therefore, the aim is to increase the balance and physical strength among
the elders by carrying out different strength building exercises.
Relevance of Clinical Governance to your project
Clinical Governance is a framework, which is used by the National Health Service Organizations,
who are responsible for carrying out continuous improvements in quality of service and providing
high quality care by providing an environment that encourages development of excellence in
clinical care (Brennan and Flynn 2013, pp. 114-131). The seven pillars of clinical governance are
clinical effectiveness and research, risk management, audit, education and training, involvement
of patient and public, usage of information technology and staff management. The most relevant
pillar is the pillar that deals with risk assessment and management. The nurses are required to
assess the risk factors, critically analyse them and determine the probability of occurrence of any
event that can cause harm to the patients. Moreover, they also need to implement approaches to
reduce the risks and the impacts associated with such risks. The pillar of Clinical Governance that
defines the identification of risk factors can be linked to this project as the nurses have to assess
the risk factors associated with the falls of the elderly patients and provide necessary evidence
based intervention strategies to reduce such fall rates in the hospital ward ( Heyrani et al. 2012,
pp. 84). Exercise programs will enable the elderly population to regain their balance and strength
and in turn lead an active and independent life.
Evidence that the issue / problem is worth solving:
This issue is worth addressing, as exercises are known to reduce falls in the elderly. Exercises help
to maintain balance and in turn provide strength and physical stability. Exercise can also improve
heart functions and also help in maintaining good mental health, which in turn contributes to
healthy and safe living (Blake and Hawley 2012, pp. 19-27).
In 2015 and 2016, falls were the most reported incidents in acute and community care hospitals
and was the third most reported incidents in mental healthcare hospitals. About 250000 fall cases
were reported in hospital settings. Falls among the hospital patients usually range between 2.3 to
7 falls per 1000 patients. The fall associated injuries include fractures, bleeding, subdural
hematomas and death. Injuries associated with falls also increase the healthcare costs. A recent
research revealed that during the research duration, the researchers observed 315817 falls, of

which 26.1% gave rise to injuries. Patients above 80 years of age are more prone to succumb to
falls, however patients of 65 years of age and below have also been found to succumb to falls.
Falls are the leading causes of accidental death among the elderly population (Bouldin et al. 2013,
pp. 13). The fall related injuries in Australia are reported to be over 60 in the year 2013. Studies
have shown that exercises can decrease the rate of falls among the elderly and balance is
considered to be an essential element of physical activity programmes (Tiedemann, Sherrington
and Lord 2013, pp. 541-547).
Key Stakeholders:
The key stakeholders of the project could be the nurses or the care givers and the patients
themselves. The nurses or the care givers can participate in the project by carrying out
assessments of the risk factors of the patients that can give rise to the falls, analysis of the data
and providing necessary intervention strategies in order to reduce the risk of falls among the
elderly population. The nurses can educate the patients about the importance of exercises. The
nurse can obtain feedback from the patients about the quality of care and develop or bring about
improvements in their strategies in order to enhance patient satisfaction by giving rise to
favourable outcomes. Other stakeholders may include the doctors and physiotherapists, help in
designing the exercise program and determine the health issues during and after the exercise
program.
CPI Tool:
Clinical Practice Improvement or CPI is a method for carrying out improvements and thereby
providing high quality care. Clinical Practice Improvement ensures the quality, safety and
efficiency of the provided care, enables accountability for the care either individually or as a group
and brings about continuous improvements in the already established procedures. Clinical Practice
Improvement provides a framework, which can be used by the healthcare professionals to carry
out assessments regarding the causes associated with process failures, which in turn can cause
harm to patients and bringing about solutions in order to carry out continuous improvements in
care and patient outcomes (Rosenfeld, Shiffman and Robertson 2013, pp. S1-S55). The clinical
practice improvement tool applied in the project will be the Plan Do Study Act. Plan Do Study Act
or PDSA cycle involves undertaking small tests in order to bring about improvements. The PDSA
cycle can be used to test a change by designing a plan, then carrying out the plan and
subsequently observing and understanding the consequences of the plan. The PDSA cycle also
involves determining the modifications that can be brought about in the plan to further improve
it. The PDSA is an essential component of improvement practices in the healthcare settings. The

stages of the PDSA cycle involves critical analysis of data that highlights poor performance,
identifying the necessary causes associated with the poor performances, implementing small
changes and monitoring the impact of the changes. Those changes that bring about positive
outcomes are defined and established in order to be followed by all. The use of clinical practice
improvement tools is a fundamental part of clinical governance. The benefits of PDSA involves
establishment of new processes, involves the use of learning to bring about improvements, helps
to reduce the costs of resources, provides scope for continuous development and improvement,
helps to solve the problems associated with a large amount of data, increase process
understanding, bring about improvements in outcomes and enhance teamwork. It can also
provide customer or patient satisfaction and provide motivation to staff (Knudsen et al. 2017, pp.
45). In this project the PDSA tool can be used by the nurses to critically analyse the risk factors
associated with patient falls, identifying the causes, planning an exercise or physical therapy
program, implement the exercise programs, monitoring the success associated with the exercise
program and subsequently establishing the exercise programs in the daily routine of the elderly in
the hospital ward (Taylor et al. 2013, pp.bmjqs-2013). The small-scale strategies employed by the
nurses can be the strength and balance building exercises that they can implement in order to help
the elderly lead a health life.
Summary of proposed interventions:
The elderly patients with cognitive impairment suffer from falls on a regular basis and this is as a
result of impairment in their motor functions preventing them to properly analyse the
environment and carry out necessary changes in the body movements. This in turn affects their
balance, stability and gait (Morse, Merry and Bloswick 2016, pp. 341).
The first phase of the plan will involve the designing of the project and the necessary resources
and the finances involved with it will be provided to the necessary finance department and the
Director of the hospital, where the elderly succumb to such falls. Funds will be requested in order
to carry out the project.
Exercise programs will be organized for the patients of the hospital ward and conducted under the
supervision of physiotherapists. Exercises has been shown to reduce the risk factors associated
with falls such as impaired balance and or mobility. Exercise programs that are aimed to bring
about improvements in balance, strength and gait have been shown to reduce the occurrence of
falls among the elderly (Cameron et al. 2012, pp. 1-121; Gillespie et al. 2012, pp. 1-299). It is
necessary to educate the nurses about the importance of these approaches or intervention
strategies. The exercise program will be carried out for six months under the supervision of the