NURS2006 Clinical Practice Improvement: Falls Prevention in Elderly

This NURS2006 assignment presents a clinical practice improvement project focused on falls prevention among elderly patients during and after hospitalization. The project aims to reduce fall-related incidents through educational interventions and strategic planning, utilizing the Plan-Do-Study-Act (PDSA) model. It highlights the relevance of clinical governance, particularly stakeholder participation and clinical risk management, in enhancing healthcare service quality. The report emphasizes the importance of addressing falls due to their significant impact on elderly morbidity and mortality, supported by WHO and CDC data. Key stakeholders, including healthcare professionals and patients, are identified. Proposed interventions include educational and adaptive strategies, addressing both patient awareness and environmental modifications. Barriers to implementation, such as healthcare professional understanding and patient compliance, are discussed, alongside the project's evaluation methods. The project provides a detailed overview of strategies, interventions, and clinical governance pillars necessary for preventing falls among elderly individuals.

NURS2006 ASSIGNMENT 5
Clinical Practice Improvement Project Report
Student Name, FAN and ID:
(Student details)
Project Title:
Falls prevention education among elderly patient during and after hospitalization
Project Aim:
This Project aims to provide concise strategies, educational interventions, and plans which is
necessary to address so that fall related episodes among elderly people before and after their
discharge could be prevented within 6 months of time and will be compared to their understanding
of this situation at the commencement of application of intervention. The project interventions or
strategies are relevant as it is feasible to apply those in geriatric ward for fall prevention education.
Relevance of Clinical Governance to your project
Clinical Governance is the aspect, which helps to promote upgradation of healthcare service by
reviewing, promoting, measuring and monitoring the quality of care which is received by patients. It
compares the existing standards or interventions with the modified versions so that the
improvement and upgradation could be understood and continuous improvement to the quality of
service could be achieved (Heyrani et al. 2012). In this project related to fall prevention education
among elderly people while receiving care or after their research, importance of two pillars of
clinical governance could be identified and these are participation of stakeholders and clinical risk
management. This is because to prevent fall among elderly people, it is important to provide them
with details about the risk, the lethality of the risk and ways using which their fall episodes could be
prevented (Dalton 2012). On the other hand, it is also important to improve or enhance the quality
of the healthcare process and provides a coordinated approach to the educational or intervention
related strategies which are to be implemented to prevent fall among elderly people before or after
their discharge from the facility (Heyrani et al. 2012). Further, these two pillars emphasizes on equal
participation of patients or elderly population with that of care professionals to determine that the
risk of fall could be prevented among elderly people (Ravaghi et al. 2013).
Evidence that the issue / problem is worth solving:
As per the reports of World Health Organisation (2018), fall is the second primary reason for

accidental or unintentional injury which leads to death among older population as the older
generation suffers primarily due to the fatal effects of fall. Reports further determine that 37.3
million falls were reported all over the world which were severe and required immediate medical
attention. As per the reports of Centers for Disease Control and Prevention (2018), fall is the primary
reason for injury related death among elderly population and the rate increased from 31% to 61.6%.
as per the Australian Statistics provided by the Australian Institute of Health and Welfare (2017), the
year 2012-13 witnesses more than 98,000 fall related cases within which 26% was for elder
population who experienced fall and more than 72% falls were recorded in healthcare facilities or
patient residence.
With increased age the risk of fall also increases, as it has been seen that after the age of 60,
functional abilities tend to decrease due to which people are unable to fulfil their activities of daily
life and suffers from the risk of falling. Further falls also decreases the abilities of people to perform
physical exercises, their mobility and increases their dependency on others.
Key Stakeholders:
Key stakeholders involved in the planning, implementation, evaluation and determination of
strategies related to fall prevention among elderly population is Australia are divided among two
sections, primary and secondary stakeholders. Primary stakeholders are directly involved in the
process such as governmental departments, healthcare professionals and patients, whereas
secondary stakeholders involves non-governmental organisations, communities, occupational
therapists and physiotherapists. The role of primary stakeholders to regulate the norms and upgrade
them so that elderly people with severe risk of fall could be provided with educational or
intervention related strategies so that episodes of fall could be prevented. Whereas, the role of
secondary stakeholders is to provide support and accepting the interventions so that
implementation of regulations related fall prevention could be properly implemented.
CPI Tool:
This project chooses and implements the Plan-Do-Study-Act or the PDSA model which aims to
decrease the fall episodes in elderly patients in healthcare facilities of Australia within 6 months of
period (Sutterfield and Daramola 2016). For This purpose, the PDSA model involves two important
strategies such as improving communication within healthcare facilities and professionals so that the
strategies and ideas could be transferred from one person to another. This CPI tool is an application
based tool which helps to identify the problem and then determines and provides ideas and
strategies using which the problems could be overcome (Gabrielian et al. 2013). One of the primary
things which should be remembered while using PDSA a CPI tool should be completed within the

relative pace and should encourage the momentum of the acceptance of the interventions (Farrar
2015). The primary reason, due to which PDSA is successful in implementing the change it requires,
is its narrower focusing and quick implementation strategy which helps to develop the continuous
improvement for work (Siracuse et al. 2012).
To prevent fall among elderly population of Australia before and after their hospital stay, it is
important that they are aware of the fall related risks, the strategies of fall management and the
severe implication of fall in their health so that fall could be prevented (Sutterfield and Daramola
2016). as the CG pillars chosen for the project focuses on the implication of involvement of
stakeholders in the intervention and managing the risk of clinical risk of fall within the healthcare
facility so that people with severe risk of fall could be provided with intervention to protect them of
fall episodes (Klee et al. 2012).
Application of this tool could easily implement the interventions which can prevent fall in elderly
people after their discharge. Implementation of healthcare education related intervention requires
the healthcare professionals to plan, do action, study or evaluate the positive and negative aspects
and then act as per the requirement of the patients for the fall prevention process (Klee et al. 2012).
Due to this purpose, it helps to achieve a specific measurement and assesses the difference in a
specific time so that the effectiveness of the intervention could be determined. As per Cameron et
al. (2012), planning is an important part of the patient education and training session as without
proper planning of the session patients are unable to understand the implication of the
interventions. Therefore, this CPI tool will be implemented in the project for fall prevention among
elderly population after their discharge (Sutterfield and Daramola 2016).
Summary of proposed interventions:
The interventions which will be used in case of fall prevention among elderly population could be
divided in two sections, educational intervention and adaptive interventions (Inouye, Westendorp
and Saczynski 2014). In case of educational intervention, elderly patients, who are at severe risk of
fall, are provided with educational sessions and trainings so that all the risk related to fall or
circumstances which can lead to fall could be shared with the patients (Gillespie et al. 2012). Further,
the strategic intervention such as taking help of healthcare professionals, using the walker provided
by the healthcare professionals for their mobility or taking their each step properly should be
mentioned in the strategies so that each smaller and bigger risks could be avoided (Siracuse et al.
2012). On the other hand, they should be provided with physical exercise instructions such as cardio
exercises, walking, jogging so that they can enhance their mobility and prevent fall related episodes
(Gillespie et al. 2012).

These two intervention categories are completely related to the two Clinical Governance pillars
which were chosen and connected with the fall prevention related strategies for elderly people after
their discharge from healthcare facilities (Karlsson et al. 2013). As the healthcare professionals tried
to include the patients in the care process, they were provided with educational interventions and
provided with all the data regarding the process so that conflict related situation among healthcare
professionals and others could be avoided and patients could be educated about the fall and its
severity and importance of its prevention for their health and wellbeing (Gillespie et al. 2012).
Similarly, in this project, the healthcare professionals provided the patients with healthcare
management so that the risks related to management process could be avoided. The risks involved
severe fall injury among elderly population which increases with increased complexity of their health
and wellbeing status (Krumholz 2012).
This is the clinical practice and integration tool which is used for the panning implementation and
determination of the healthcare intervention related to fall prevention related intervention in their
healthcare facility stay or after their discharge (Ambrose, Paul and Hausdorff 2013). All the
professionals working in the healthcare facility has several responsibilities which will be fulfilled if
the older patients are provided with educational intervention to prevent fall related injury (Karlsson
et al. 2013).
Barriers to implementation and sustaining change:
The barriers which are associated to fall prevention related interventions for elderly population in
Australia should be provided with several enablers as social, physical, healthcare related barriers are
always present which decreases the effectiveness of the intervention and the educational and other
interventions are not spread among the elderly population correctly. The primary barrier can be the
inability of the healthcare professionals to understand the implication of fall prevention in elderly
population. Majority of the geriatric department applies the fall prevention strategies but in this
does not includes the patients in the healthcare preventive intervention study, planning evaluation
and implementation due to which the intervention does not reach its success. The second barrier of
this project was the patients and their ignorance towards these fall preventive strategies. They were
unable to understand the implication of the fall related risk and then understand the implication of it
for their growth and development.
Evaluation of the project:
The entire project of fall prevention among healthcare facilities for elderly people who are
discharged from the healthcare facilities. The project provides a detailed idea about the clinical
governance and determined the pillars of clinical governance which is required to change or upgrade

the healthcare facilities and the quality to healthcare. In this course, it also provided some of the
interventions and hence the application of CPI tools in the incidence were inferred and the
application of PDSA or the planning, doing, act, strategies and action were mentioned in the aspect.
Further, the mention of several barriers mentioned in the project overcoming which could be
avoided so that complete success for the intervention could be achieved.

References
Ambrose, A.F., Paul, G. and Hausdorff, J.M., 2013. Risk factors for falls among older adults: a review
of the literature. Maturitas, 75(1), pp.51-61.
Australian Institute of Health and Welfare 2017. Hospitalisations due to falls by older people,
Australia: 2009-10, Table of contents - Australian Institute of Health and Welfare . [online] Australian
Institute of Health and Welfare. Available at:
https://www.aihw.gov.au/reports/injury/hospitalisations-falls-older-people-2009-10/contents/
table-of-contents [Accessed 26 Dec. 2018].
Cameron, I.D.G.L., Gillespie, L., Robertson, C., Murray, G., Hill, K., Cumming, R. and Kerse, N., 2012.
Interventions for preventing falls in older people in care facilities and hospitals. Cochrane database
of systematic reviews, 12, pp.CD005465-1.
Centers for Disease Control and Prevention 2018. Older Adult Falls | Home and Recreational Safety |
CDC Injury Center. [online] Cdc.gov. Available at:
https://www.cdc.gov/homeandrecreationalsafety/falls/index.html [Accessed 26 Dec. 2018].
Dalton, M., 2013. Developing an evidence-based practice healthcare lens for the SCONUL Seven
Pillars of Information Literacy model. Journal of Information Literacy.
Farrar, F.C., 2015. Transformational Tool Kit for Front Line Nurses, An Issue of Nursing Clinics of North
America, E-Book(Vol. 50, No. 1). Elsevier Health Sciences.
Gabrielian, S., Yuan, A., Andersen, R.M., McGuire, J., Rubenstein, L., Sapir, N. and Gelberg, L., 2013.
Chronic disease management for recently homeless veterans: a clinical practice improvement
program to apply home telehealth technology to a vulnerable population. Medical care, 51(3 0 1),
p.S44.
Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Sherrington, C., Gates, S., Clemson, L.M. and Lamb,
S.E., 2012. Interventions for preventing falls in older people living in the community. Cochrane
database of systematic reviews, (9).
Gillespie, L.D., Robertson, M.C., Gillespie, W.J., Sherrington, C., Gates, S., Clemson, L.M. and Lamb,
S.E., 2012. Interventions for preventing falls in older people living in the community. Cochrane
database of systematic reviews, (9).
Heyrani, A., Maleki, M., Marnani, A.B., Ravaghi, H., Sedaghat, M., Jabbari, M., Farsi, D., Khajavi, A.
and Abdi, Z., 2012. Clinical governance implementation in a selected teaching emergency
department: a systems approach. Implementation science, 7(1), p.84.
Inouye, S.K., Westendorp, R.G. and Saczynski, J.S., 2014. Delirium in elderly people. The
Lancet, 383(9920), pp.911-922.
Karlsson, M.K., Magnusson, H., von Schewelov, T. and Rosengren, B.E., 2013. Prevention of falls in
the elderly—a review. Osteoporosis International, 24(3), pp.747-762.

Klee, K., Latta, L., Davis-Kirsch, S. and Pecchia, M., 2012. Using continuous process improvement
methodology to standardize nursing handoff communication. Journal of pediatric nursing, 27(2),
pp.168-173.
Krumholz, H.M., 2013. Post-hospital syndrome—an acquired, transient condition of generalized
risk. New England Journal of Medicine, 368(2), pp.100-102.
Ravaghi, H., Heidarpour, P., Mohseni, M. and Rafiei, S., 2013. Senior managers’ viewpoints toward
challenges of implementing clinical governance: A national study in Iran. International journal of
health policy and management, 1(4), p.295.

NURS2006 Assignment 3 - CPI paper Marking Rubric
Siracuse, J.J., Odell, D.D., Gondek, S.P., Odom, S.R., Kasper, E.M., Hauser, C.J. and Moorman, D.W.,
2012. Health care and socioeconomic impact of falls in the elderly. The American Journal of
Surgery, 203(3), pp.335-338.
Sutterfield, J.S. and Daramola, T.R., 2016. Using the Tools of Quality to Improve Production
Operations at Wilmington Textile. Journal of Management & Engineering Integration, 9(2), pp.118-
132.
World Health Organization 2018. Falls Prevention in Older Age. [online] World Health Organization.
Available at: https://www.who.int/ageing/projects/falls_prevention_older_age/en/ [Accessed 26
Dec. 2018].
PERFORMANCE STANDARD
CATEGORY &
WEIGHTING Excellent Work Good Work Passing Work Unsatisfactory work
Project Aim
and Evidence
the issue is
worth solving
20%
Aim succinct & clearly
defined. All evidence
relevant & rigorous.
Shows a very high level of
insight & relevance to the
issue.
(17-20) 
Aim well defined.
Some irrelevant
information but most
evidence relevant &
rigorous. Shows a very
good level of insight &
relevance to the issue.
(13-16.5) 
Aim stated with some
ambiguity. Some evidence
relevant and rigorous,
Acceptable level of
insight.
Quite a lot of irrelevant
information is present.
May be overlong/ too
brief
(10-12.5) 
Aim not clearly stated
Most evidence is not
relevant or rigorous.
Poor level of insight &
relevance to the issue.
Significant amount of
irrelevant/ missing
information.
(0–9.5) 
Relevance of
Clinical
Governance to
your project
10%
Succinct and highly
relevant discussion of the
relevant pillar of clinical
governance related to the
chosen clinical issue.
(9-10) 
Succinct and mostly
relevant discussion of the
relevant pillar of clinical
governance related to the
chosen clinical issue.
(7-8.5) 
Adequate discussion of
the relevant pillar of
clinical governance
related to the chosen
clinical issue.
Some parts not relevant
Overlong / too brief, may
be missing relevant
information.
(5-6.5) 
Inadequate discussion of
the relevant pillar of
clinical governance
related to the chosen
clinical issue. Overlong /
too brief, may be missing
a significant amount of
relevant information
(0-4.5) 
Key
Stakeholders
5%
Identifies most relevant
key stakeholders.
Discusses clearly how they
could be involved in the
project.
Succinctly and expertly
written. Very high level of
insight into the role of
stakeholders.
(4.5 - 5) 
Identifies some relevant
key stakeholders and
adequately discusses how
they could be involved in
the project.
Very well written. Good
level of insight into the
role of stakeholders.
(3.5-4.25) 
Identifies a few relevant
key stakeholders.
Mentions briefly how they
could be involved. Quite
well written but contains
some irrelevant
information, or minor
information is missing.
Adequate level of insight
into the stakeholder role.
(2.5 – 3.25- ) 
Contains irrelevant
information, or major
information is missing.
Inappropriate or no key
stakeholders are
identified Poor insight
into the stakeholder role.
(0-2) 
Clinical Practice
Improvement
Tool
20%
Describes a relevant CPI
tool Very clearly discusses
how it could be used to
address the aim and
implement the
interventions. Succinctly
and expertly written with
Describes a relevant CPI
tool Discusses quite
clearly how the tool could
be used to address the
aim and implement the
interventions. Well
written but may contain
Describes a relevant CPI
tool and adequately
discusses how the tool
could be used to address
the aim and implement
the interventions.
Not succinct, contains
A relevant CPI tool is not
identified. There is no
adequate discussion of
how the tool could be
used to meet the aim or
implement the
interventions.

no omissions of relevant
information.
(17-20) 
some irrelevant
information, or some
minor information is
missing
(13-16.5) 
irrelevant information,
significant information is
missing
(10-12.5) 
Contains irrelevant
information or some
major information is
missing.
(0–9.5) 
Summary of
proposed
interventions
20%
All relevant interventions
are discussed very well.
Project outline is very
clear and the relevance to
clinical practice is very
high.
(17-20) 
Most relevant
interventions discussed
quite well.
Project outline is clear &
relevance to clinical
practice is good. Contains
some irrelevant
information, minor
information may be
missing.
(13-16.5) 
Acceptable level of
relevant interventions
discussed.
Project outline mostly
clear, although it may be
unclear how the project
would actually be
implemented in clinical
practice due to
irrelevant/missing info
(10-12.5) 
Some elements missing or
incomplete. May contain
large amounts of
irrelevant information.
Project poorly described
and it is unclear what the
project actually entails or
its relevance to clinical
practice.
(0–9.5) 
Barriers to
Implementatio
n
15%
Identifies most potential
barriers to
implementation & clinical
change. Discusses in
depth how these barriers
could be overcome or
minimised.
(13-15) 
Identifies some potential
barriers to
implementation & clinical
change. Discusses how
these barriers could be
overcome or minimised.
(10-12.5) 
Identifies a few potential
barriers to
implementation & clinical
change. Discusses how
barriers could be
overcome or minimised.
Minor omissions and/or
some irrelevant
information present
(7.5-9.5) 
Relevant barriers not
identified. Poor or no
discussion about how
they could be overcome
or minimised. Major
omissions, much of the
information provided is
irrelevant / unrelated to
the CPI goal.
(0-7) 
Evaluation of
the project
10%
Succinct discussion of an
excellent and achievable
plan for how the
intervention/s could be
evaluated.
(9-10) 
Succinct discussion of a
very good and mostly
achievable plan for how
the intervention/s could
be evaluated.
(7-8.5) 
Discussion of an adequate
plan for how the
intervention/s could be
evaluated. Some parts not
relevant or achievable
Overlong / too brief, may
be missing relevant
information.
(5-6.5) 
Plan absent or not well
described. Most or all of
the plan is not relevant or
achievable
Overlong / too brief, may
be missing a significant
amount of relevant
information
(0-4.5) 
Name of Marker
Grade
Overall Comments