Clinical Governance Report: Analysis of Falls in Healthcare Settings

This report examines the issue of patient falls within the healthcare sector, emphasizing the role of clinical governance in improving patient safety and care quality. The introduction defines clinical governance as a systematic approach to enhance service quality and minimize risks. The report investigates the prevalence of falls, particularly among older adults, highlighting the increasing cost burden associated with fall-related hospitalizations. A PICO framework is used to structure the research question, focusing on patients over 65 and fall prevention. The report then reviews five articles, critically appraising each study's methodology, findings, strengths, and limitations. The articles explore various aspects of falls, including the views of nurses, the effectiveness of fall prevention toolkits, and the impact of different interventions. Based on the findings, the report suggests actions to prevent falls, such as safety companions and regular patient monitoring. It also evaluates potential improvements to service provision, emphasizing the need for regular monitoring and cost-effective practices. The report concludes by providing a list of references used in the study.

AN INVESTIGATION OF A CLINICAL GOVERNANCE
CLINICAL PRACTICE ISSUE
1

TABLE OF CONTENTS
Introduction......................................................................................................................................3
PICO............................................................................................................................................4
Searching the evidence....................................................................................................................4
Critical appraisal..............................................................................................................................7
What actions to take from the findings............................................................................................7
Evaluate new and amended practice................................................................................................8
References........................................................................................................................................8
2

INTRODUCTION
Clinical governance is regarded as a systematic approach that is used to maintain and
improve the quality of patient care within a health care system. Basically, it is a framework
through which health care entities can adopt new measures to improve the quality of services and
this can also be done by safeguarding the standard of care Ebrahimpour, Yaghubi and Zahedi
(2016. pp.75-83). In the present research study, discussion has been made about the issue of falls
in health care sector which needs appropriate prevention. In the subsequent issue, clinical
governance is relevant because it assists the health care entities to ascertain what actions can be
taken to minimize risks and incidents related to falls. Furthermore, in the study, several articles
have been reviewed to specify the aspects concerned with falls Fisher and et.al. (2016. pp.14-16).
Fall related hospitalization is particularly common among older people and in the year
2011 – 2012, around 96,385 people aged 65 and over were hospitalized in Australia. Moreover,
the increasing rate of fall- related hospital admission reflects that the issue of cost burden is
increasing rapidly. In older people, the ratio has been increased to 2.3% from last 10 years.
(Source: Falls in older people, 2017)
Australians aged over 65 injured in a fall and they spent a total of 1,397,589 days in
hospitals and these patient bed days accounted for 10.5% of all hospital patient days for this age
group. In has been analysed that in terms of morbidity and mortality, the most serious of these
fall related injuries is fracture of the hip. The cost burden of Australian hospitals have been
3

increasing because sometime nurses fail to give prominent care to the patients and as a result this
increases the issues related to falls (Falls in older people. 2017).
PICO
Population – Patients in the hospitals above the age of 65 years
Outcome – Prevention of falls
SEARCHING THE EVIDENCE
Articl
e
Author /
Year /
Country
Aim of the
study
Sample
setting
Design/
Methods
Main
findings
Strengths
and
Limitation
s
Articl
e 1
Dykes,
C. P. and
et.al.,
2009.
Obtain the
views of
nurses and
assistants as
to why
patients in
acute care
hospitals
fall.
4 focus
groups with
nurses
(n=23) and 4
assistants
(n=19)
Basic content
analysis
methods were
to interpret
descriptive
data
Patient
report,
information
access and
signage are
some of the
reasons that
leads to
falls.
The method
seems to be
feasible for
the research
work
because it
helped in
identifying
reasons for
falls;
however
only a
certain
reasons are
identified.
Articl
e 2
Dykes,
C. P. and
et.al.,
2010.
To
investigate
whether a
fall
prevention
4 urban US
hospitals in
units that
received
usual care (4
Cluster
randomized
study
Primary
outcome
acquired
was patient
falls per
The study’s
major
limitation is
that it was
conducted
4

tool kit
(FPTK)
using health
information
technology
(HIT)
decreases
patient falls
in hospitals
units and
5104
patients) or
the
intervention
(4 units and
5160
patients).
1000
patients
adjusted for
site and
patient care
unit;
however
secondary
outcome
was fall-
related
injuries.
in 4
hospitals
with single
health care
system.
Further,
sample size
was not
effective to
analyse the
effectivenes
s of fall
prevention
technique.
Articl
e 3
Hempel,
S and
et.al.,
2013.
To analyse
the
effectivenes
s of
published
fall
prevention
approaches
in U.S.
acute care
hospitals
US acute
care
hospitals
Incidence rate
ratios (IRR,
ratio of fall
rate post
intervention
or treatment
group to the
fall rate
preinterventio
n or control
group
Effectivenes
s of
approaches
have been
found out
along with
the
evidence.
The
methods
used were
appropriate
and
systematic
review was
also
performed.
However,
only a
specific
sources
have been
used to
showcase
the
5

effectivenes
s of fall
prevention
approaches.
Articl
e 4
Victor, C
and
et.al.,
2014.
To evaluate
the
effectivenes
s offal
prevention
intervention
s for older
people with
mental
health
problems
being cared
for all
settings.
17 RCTs and
four
uncontrolled
studies were
selected. 11
were
involved in
single
intervention
and ten were
multifactoria
l.
Electronic
database and
lateral
searches have
been utilized
to identify
studies on
falls and
related
injuries.
The study
found out
that changes
are required
in terms of
increased
supervision
or sensory
stimulation
can also be
added in
care
provision.
The study
highlights
the lack of
robust
evidence to
support
practitioner
to
implement
practices
that prevent
people.
Articl
e 5
Spoelstra
, L. S.,
2012.
Thirteen
articles were
retrieved that
focused on
fall
interventions
in the
hospital
setting
Data were
obtained from
published
studies
Hospitals
need to
reduce falls
by using
multifactori
al fall
prevention
programs.
With the
help of
single
intervention
studies,
appropriate
use of the
fall
prevention
program is
not
ascertained.
6

CRITICAL APPRAISAL
According to Dykes (2009, pp.299–304), patients falls is a serious problem in acute care
hospitals and is also used as a standard metric of nursing care quality. In the study, author
analysed several reasons that works as challenges and that also increases the risk of fall among
patients. However, in the study evidence regarding the effectiveness of fall prevention programs
in inconclusive.
The study conducted by Dykes (2010, pp.1912–1918), states that falls cause injury and
death for persons of all ages; however risk of falls increases with age. The author analysed that
fall risk assessment and health information technology have been underused in fall prevention
efforts. In addition to this, author also recorded a significant number of errors that occur in
hospitals. Thus, in the research work, effectiveness of a fall prevention tool kit has been
analysed.
Further, the study done by Hempel (2013, pp.483–494), contends that health care entities
should use several strategies and approaches for the purpose of reducing the issue of falls.
However, while conducting the study through meta- regression, it showed no systematic
association amid implementation intensity and adherence levels. These programs are typically
complex and involve multiple components that depends on organizational policies and
framework.
However, the research work done by Victor (2014), articulates that fall prevention
techniques should be utilized for older people suffering from dementia and mental illness.
Researcher in this context also analysed number of people fell while hospitalized in England;
similarly researcher also reported number of falls and injuries in mental health settings in other
countries like Australia and USA. Thus, in the research journal, several therapies are also
discussed that could be utilized to prevent falls in health care settings.
Spoelstra (2012) states that prominent standards should be developed for patient’s care so
that the ratio of fall can be reduced. Researcher emphasized more on differences in physical
environment because that seems to increase falls and although 80-90% of falls are witnessed in
hospitals due to environment of the hospital.
7

WHAT ACTIONS TO TAKE FROM THE FINDINGS
 There are several actions that can be taken to prevent falls in the hospitals such as safety
companions, alertness in patients and safety rounds.
 After conducting the research studies, researchers ascertained that fall prevention
techniques are highly useful to minimize the cases of falls; however at the same time,
nurses should also adopt proper care while moving the patients to diverse areas.
 Researcher also analysed that falls can be minimized through conducting suitable rounds
in terms of inspection after every hour. This will also assist to keep eyes on patient’s
activities.
EVALUATE NEW AND AMENDED PRACTICE
 Several changes could be implemented in the service provision in terms of improvements
so that the issue of falls can be minimized. Adoption of fall prevention technique would
assist the nurses to manage cost effective practices.
 Further, this is also useful in preventing patient’s health and safety aspects.
 However, regular monitoring and controlling is a time consuming process which could
hamper the service delivery procedure.
8

REFERENCES
Dykes, C. P. and et.al., 2009. Why Do Patients in Acute Care Hospitals Fall? Can Falls Be
Prevented?. J Nurs Adm. 39(6). pp.299–304.
Dykes, C. P. and et.al., 2010. Fall Prevention in Acute Care Hospitals. JAMA. 3. 304(17).
pp.1912–1918.
Hempel, S and et.al., 2013. Hospital Fall Prevention: A Systematic Review of Implementation,
Components, Adherence, and Effectiveness. J Am Geriatr Soc. 61(4). pp.483–494.
Victor, C and et.al., 2014. Preventing falls among older people with mental health problems: a
systematic review. BMC Nursing.
Spoelstra, L. S., 2012. Fall Prevention in Hospitals: An Integrative Review. [Pdf]. Available
through: <http://scholarworks.gvsu.edu/cgi/viewcontent.cgi?
article=1028&context=kcon_articles>. [Accessed on 12th January 2017].
Falls in older people. 2017. [Pdf]. Available through: <http://www.aihw.gov.au/injury/falls/>.
[Accessed on 12th January 2017].
Ebrahimpour, H., Yaghubi, N. and Zahedi, S. S., 2016. Organizational Learning Capacity and
Clinical Governance Implementation in Social Sequrity hospital (A Case Study). Journal
of Hospital, 15(2), pp.75-83.
Fisher, C. A. and et.al., 2016. Shared governance: The way to staff satisfaction and
retention. Nursing Management, 47(11), pp.14-16.
9