Risk management plan for falls : Assignment
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Added on 2020-09-08
Risk management plan for falls : Assignment
Added on 2020-09-08
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Relevance of clinical issueFalls in people aged 65 years and over are very common and may result to physical harm(NSW Health 2011). The incidence of falls increases with age (Kenny et al. 2012).Approximately one third of adults aged 65 and over fall every year and after the age of 80,this proportion rises to a half (Saccomano & Ferrara 2015). A fall is an unexpected event inwhich a person comes to rest on the ground, floor or lower level without known loss ofconsciousness (Kenny et al. 2012). Falls in elderly are a major health concern but arepreventable in most of the cases. Complications of falls includes physical harm, such asfractures, traumatic head injury and also negative psychological and functional impacts, suchas loss of confidence in undertaking daily activities and inappropriate activity restriction(NSW Health 2011). Falls are associated with an increased length of stay in a hospital,increased in healthcare costs and lawsuits against hospitals (Choi et al. 2011). Literature reviewThere are various factors that contribute to increase risk in falls of patients in a hospitalsetting. The risk factors for falls include intrinsic and extrinsic factors, and a complexinteraction of such factors. Some of these are physical issues which involves visualimpairment, weakness of lower extremities, balance disorders, postural hypotension;environmental factors and mental or cognition factors (Saccomano & Ferrara 2015).AssessmentFalls risk assessment tool are used to identify patients who are at a greater risk of fall. It isused to identify falls’ risk factors. According to Stenvall et al. (2007), the use ofcomprehensive geriatric assessments and treatment of falls risk factors and post-operativecomplications can successfully prevent inpatient falls and injuries, even in patients withdementia. Some of the assessment tools used in the study were Mini Mental StateExamination (MMSE), Organic Brain Syndrome Scale (Obs scale), and Geriatric DepressionScale (GDS-15). The activities of daily living of the patients were also assessed. After thefalls assessment risk, the team formulated and implemented a plan based on the patient’sdata, to prevent new falls and its complications. A multifactorial interventional program wasdeveloped to address the issues identified which then decreased the incidence of falls of theelderly patients in this study. (Stenvall et al. 2007) This study proves that the effectiveness ofa fall prevention programme greatly relies on comprehensive assessments by the healthcare workers.Risks assessment is essential in developing and increasing patient’s awareness may reducerisk of falling in a hospital setting. People with a history of fall should be assessed to identifyand address future risk and individualised intervention (Short 2006).
Education and information givingA study by Hill et al. (2015) showed that individualised education to patients decreased fallsand injurious fall incidents in a rehabilitation ward. The hospital’s falls incident data hassignificantly decreased in number after the patient education sessions. Either presented withother complementary programmes or as a single intervention, providing fall-preventioneducation to patients resulted to reduce number of fall incidence. Information about patient’spersonal risk factors, fall epidemiology and falls-prevention strategies were included in thehealth teaching. Educators also helped each patient identify their risk factors, set theirpersonal goals and develop their own fall-prevention strategies. Health care staff weresupported through trainings and provided with feedbacks from the patients. (Hill et al. 2015)EnvironmentAnother factor that greatly affects the risk for fall of elderly patients is the environment. In astudy conducted by Barry et al. (2001), there was a significant decrease in percentage offalls after implementing a fall prevention programme. This programme mainly focused on theenvironment in a hospital setting. In the first year, there was a decrease of 21% fall incidentsand 49.3% lesser after two years of the programme. An occupational therapist helped theteam identify environmental hazards in the unit. As a result, hand rails were installed alongthe corridors, grab rails and arm rests in the bathrooms. Environmental hazards weremodified. Obstructive furniture in the busy area were removed, poor lighting and loosecarpets were repaired or changed. Commode chairs without wheels were purchased andemergency patient call buzzers were checked and repaired. Special rubber tiling was fitted inan outdoor patio where patients spent most of their time. For the patients, visual aids suchas glasses and mobility aids e.g. walkers and sticks were provided. Replacement ofunsuitable footwear and provision of special footwear was also implemented. After the fallsrisks assessment for each patient, the team categorised the patients as low, medium or highrisk of falling. Those identified as high risk were encouraged to wear hip protector pads.(Barry et al. 2001)Exercise Not only awareness and education important in preventing falls in a hospital setting, but wealso need to know how to enhance the mobility of the elderly patients. One of the identifiedrisk factors for falls among elderly is their functional disability due to ageing. It is also knownthat exercise may be effective in preventing, delaying or reversing the frailty process amongelderly. In a study by Faber et al. (2006), it was found that functional walking and in balanceexercise programmes were effective in reducing the falls risk among pre-frail elderly. Thetwo main domains that the researchers focused on were balance and functional strength of
the participants. The exercises adopted in this study “were tailored to the functional needs ofthe participants, maintaining a moderate intensity that focuses on long-term sustainabilityand enjoyment” (Faber et al. 2016, p. 888). Functional walking exercises consisted ofstanding up from the chair, heel and toe stands, stepping on and over an obstacle, reachingand stepping forward and sideward, staircase walking, single-limb standing and tandem footstanding. Meanwhile, in balance exercises was mainly based from the principles of Tai Chi.As a result, the exercise group also showed increase in mobility and physical performancescore. The authors recommended that exercise programmes be included in falls-preventionintervention for non-frail and pre-frail elderly. (Faber et al. 2006)MedicationElderly patients with higher vitamin D levels have been identified to have increased musclestrength and lower number of falls. The findings of a paper by Bischoff et al. (2003) indicatethat vitamin D and calcium supplementation reduced the number of falls per patient by 49%,improved musculoskeletal function, increased vitamin D status and decreased parathyroidhormone secretion and bone resorption within 3 months of treatment in elderly women withvitamin D deficiency. (Bischoff et al. 2003) The possibility of developing adverse reactionsand overdosing are the potential issues in this study. However, only two participantsreported increased constipation but they did not withdraw from the study. None of thesubjects developed hypercalcaemia or any other reaction from the vitamin D and calciumsupplements. In addition, the authors argued that this programme is less expensive and hasa short period of treatment, three months, compared to other multifactorial interventions(Bischoff et al. 2003).One can conclude that falls among elderly admitted to hospital setting is quite common. Riskfactors for falls such as physical, mental, emotional, social, cognitive, and financial could beidentified through a comprehensive and thorough risk assessment. There are sufficientnumbers of interventions that can prevent falls. These programmes should be tailored,specific and patient centred to be able to maximise their purpose. By effectively addressingthe various risk factors for falling, the incidence of falls in the hospital setting will definitelydecrease.Application to nursing practiceIt is known that there is a lack of awareness about falls risk across all health care sectors. Astudy by Tzeng & Yin (2013) revealed that hospital nursing staff’s perceptions about themost frequently adopted and most effective interventions were mostly inconsistent. These
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