Clinical Audit: Fall Prevention Strategies in Elderly Care Settings

This clinical audit proposal addresses the critical issue of fall prevention in the elderly population, highlighting the significant impact of falls on morbidity and mortality. The proposal outlines a clinical audit cycle, including identifying the issue, selecting desired standards, data collection and analysis, implementing changes, and re-auditing. It focuses on risk factors such as balance impairment, decreased muscle strength, and medication use. The audit aims to collect patient-level data to assess fall prevention interventions and improve healthcare outcomes. Ethical considerations and the importance of patient consent are also emphasized. The proposal concludes that effective implementation of interventions can improve fall prevention in elderly care settings, reducing costs and improving patient well-being. Desklib provides access to this document and many more resources for students.

Running head: PRACTICE EVALUATION STRATEGY
PRACTICE EVALUATION STRATEGY
Name of the student:
Name of the university:
Author note:

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Introduction:
The issue of falls amongst the elderly population has been documented and also
studied for several of years which includes numerous analyses that are concerning the
assessment and the prevention of the falls in the elderly population (Shema et al., 2017). One
of the study explores the association between the approved mechanism of fall as well as the
outline and the severity of the injury in the aged patients when related with the younger
patients, and it concluded that the falls in the patients were the mechanism of the injury in
around 48% of the elderly patients those who come under the age group of 65 and even older
which is included in the research associated with around 7% in the younger population
(Thaler-Kall et al, 2015). Further, approximately 32% of the falls in the elderly population
resulted in the severe injury, while it was factual of only around 4% of the falls in the
younger people collection (Rodger, Hussey & Murphy, 2017). The Auditing is found to be a
major part of any clinical practice (Mirelman et al., 2016). A clinical audit is a valuation of
the limited practice and the performance in contradiction of a recognized standard.
Principally, a clinical audit is a type of quality reassurance and also an improvement process.
It can also be measured as a consideration of what is being performed to what must be
practised (Coyne et al., 2016). The assignment will focus on developing a clinical audit cycle
for the fall prevention in the elderly population.
The Audit Cycle:
Clinical audit is said to be a critical systematic study of the presentation of an
individual, a group, or any organisation's clinical effort (Coyne et al., 2016). It is found to
involve the assortment and calculation of clinical activities and also their diverse outcomes,
and it also delivers the patients with the appropriate confidence in the value of services that

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they are provided with. The outcomes of a clinical audit are mainly inferred with the
discussion and the peer analysis (Fong et al., 2018).
The analysis and the comparisons performed using the acknowledged standards, the
performance signs, and the effective outcome parameters is observed to later become an
essential motivation in the process of identifying the areas for the learning and also for the
development and better delivery of patient care (Chambers & Wakley, 2016).
Figure: The audit cycle
Identify the topic
The identification of the topic is on of an important issue in the clinical auditing cycle
as it supports the entire auditing field (Coyne et al., 2016). Few of the examples of the
important issues are found to include those which are at high-risk for the patients, areas of
patient worry, the high prices for the trust, which can be collected from a survey conduction
or from the areas of the high volume capacity. It is also a necessary factor to register the
IdentifythetopicSelectthedesiredstandardsCollectionofdataAnalysisofthedataImplimentationofchnagesAllowingthechangestotakeplaceRe-audit

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proposed clinical audit with Local Clinical Audit Team and get it approved by the applicable
Audit Lead (Ullman et al., 2018).
Select the desired standards
Selection of desired standards states the selection of an established guideline which
can be either national or international, which is considered to be best-practice. the next
process is to extract the necessary amount of the targets from these selected guidelines which
can be that 100% of the patients should be accessible to smoking cessation (Advani et al.,
2015).
Collection of data
The collection of data can be reflective or may be prospective. It can have features to
be beneficial to perform the retrospectively in order to prevent any performance partiality
from the healthcare professionals or the staff members who are attentive of any prospective
clinical audit. Additionally, these data can also be collected from the physical or the computer
records (Johansson et al., 2017).
Analysis of the data
It is a process of analyse of the collected data and then assess whether the clinical
ward of the hospital meets the guideline standards. It explores on the fact that how well the
selected standards were achieved and also discuss any kind of reasons for the low agreement
(Coyne et al., 2016).
Implementation of changes
It states the presentation of the results of the clinical auditing at the local healthcare
departmental meetings and also probably at some of the local or regional conferences. It also
majors the development of an action plan charting on the basis of what needs to be completed
and then generate the changes (Ullman et al., 2018).

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Allowing the changes to take place
It is an important factor to permit a sufficient amount of time to pass in order to allow
the uptake of the newly induced changes. Clinical auditing is found to be having the capacity
that may undervalue the major impact of the newly proposed interventions, as they did not
have had enough time to yield the full effect (Mirelman et al., 2016).
Re-audit
It aims to conduct the clinical audit process again in order to assess the data regarding
whether the practice has witnessed any improvement in the light of changes from the audit
previously performed.
Identify the Issue:
Self-determining risk factors for the falling are found to include the balance
impairment, decreased muscle strength, previous falls, visual impairment, psychoactive
drugs, or polypharmacy includes more than 4 type of medications, gait impairment as well as
walking depression, difficulty, orthostatic functional limitations, or dizziness. People who age
above the age group of 80 years face incontinence, cognitive impairment, diabetes, arthritis,
and pain (Laflamme et al., 2015). The risk of fall in the elderly people increases with the
increase in the number of risk factors: 1-year risk of fall every year doubles with each added
factor, which is starting from around 8% with none, and then reaching around 78% with the 4
risk factors (Ullman et al., 2018). A recent study on the issue identified the resulting risk
factors as they are having the toughest association with the fall risk: gait problems, history of
falls, vertigo, walking aid use, antiepileptic drug use and Parkinson disease (Johansson et al.,
2017). Shock is the fifth most leading causes of death in the people who are aging more than
65 years of age, and falls risk are found to be responsible for about 70 percent of the cases of
accidental deaths in people above 75 years of age and even older (Mirelman et al., 2016). The

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elderly people, who represent approximately 12 percent of the population, are found to
account for almost 75 percent of the demises from falls (Evans et al., 2015). The number of
falls cases are found to be increasing progressively with the increasing age in both the sexes
as well as all the racial and the ethnical groups (Said et al., 2016). The injury rate due to falls
is seen to be the highest among people above 85 years of age and the estimation is about 171
deaths in every 100,000 people who fall in this age group (Boltz et al., 2015).
Plan of audit:
Aim:
The aim of the clinical audit is to provide a better understanding and interventions to
prevent fall risks in the elderly populations.
Objective:
The objective of the proposal is to collect patient-level data in order to categorize
whether suitable assessments and fall prevention interventions can serve to prevent falls and
it had been conducted and accomplished within a reasonable time duration (Francis-Coad et
al., 2017).
Criterion:
The criteria for selecting the issue is that, the fall risk is one of the major health
complications in the elderly population and are one of the sever health effecting conditions.
The elderly populations are more susceptible to fall risks and are sometime seen to be leading
to morbidity (Hatamabadi et al., 2016).

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Settings:
The participants will be selected from the nearby, clinical ward of the hospital,
monitoring of the participants will be conducted under supervision of the professionals and
all the data will be collected at the same place (Rodger, Hussey & Murphy, 2017).
Population and sample size:
The population that will be selected are the elderly populations that are facing fall
risks and are at the early stage. The population must belong to the age group of 65 to 75
years. The sample size should be around 10-15 people, in order to provide proper attention
and error free monitoring (Advani et al., 2015).
Time period:
The time duration can be taken of 12 months in order to observe the effectiveness of
the interventions in th selected elderly population.
Inclusion:
People those who have been witnessing early signs of fall risk will be selected and the
age group that will be selected must be 65 years of age to 75 years.
Exclusions:
People above the age of 75 years will not be selected as they deal with a very delicate
health condition and trying intervention and study would not be safe. Also, elderly population
who are at a stage of sever fall risks will be also excluded (Rodger, Hussey & Murphy, 2017).
Recruitment of participants:
The recruitment of the participants will be performed over telephony, their details will
be obtained from the clinical ward of the hospital and then they will be contacted to
participate.

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Data collection:
Data will be collected over observation and medical examination of the elderly
patients. Their health condition will also be monitored and after the application of specific
interventions, the changes will be again observed and the data will then be collected
(Mirelman et al., 2016).
Data analysis:
The data that will be collected will be analysed based on the monthly fall rates of the
patients, sever fall cases, the effects of fall and other health complication, assessment for the
medications that has been increasing the falls risk. The measurement of the lying and
standing condition blood pressure will also be conducted, and suitable movement aid in
influence of the elderly patient (Rodger, Hussey & Murphy, 2017).
Presentation of results:
The presentation of the result will be proposed in the clinical ward of the hospital in
both recorded as well as written format.
Ethical considerations:
The ethical considerations that must be followed are that, before conducting the
practise, a detailed consent of the patients should be attained, the should be willing to take art
in every step of the practise, no laws should be violated and the safety of these patients
should be the first priority (Advani et al., 2015).

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Conclusion:
The practise of Clinical audit has the effective potential of benefiting the patients, the
healthcare workers, and the clinicians, but as per the observations, in the present arrangement
the overall result of the clinical audits can be used to the detriment of the junior doctors.
Altering the manner in which the audits are executed and are used could consequently bring a
drastic amount of benefits. Falls risk in the elderly population are associated with the higher
levels of depression and anxiety and also the loss of confidence for the patient suffering.
They later lead to amplified costs for the patients and the clinics and hospitals. The feelings
of guilt and/or anxiety among the nursing members and the healthcare staff members may
follow. Eventually, the fall risk in the elderly can result in criticisms or even trial from the
patients or the patient’s families (Advani et al., 2015). The outcomes of this clinical audit
demonstrated that the interventions that were proposed to promote the best practice can be
positively implemented in the healthcare settings and the hospital settings in order to improve
the falls preventions in the elderly population in a supportable manner (Rodger, Hussey &
Murphy, 2017). In order to tackle the continuing issue of the falls in the elderly population,
large-scale application of these strategies which are knowledgeable by the overall available
evidence and also which are applicable for the daily clinical practice are in account of
requiring improvement of the quality and the safety of care for all the elderly patients and
also to reduce the burden of falls in the selected population.

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References:
Advani, R., Stobbs, N. M., Killick, N., & Kumar, B. N. (2015). “Safe handover saves lives”:
results from clinical audit. Clinical Governance: An International Journal, 20(1), 21-
32.
Boltz, M. M., Podany, A. B., Hollenbeak, C. S., & Armen, S. B. (2015). Injuries and
outcomes associated with traumatic falls in the elderly population on oral
anticoagulant therapy. Injury, 46(9), 1765-1771.
Chambers, R., & Wakley, G. (2016). Clinical audit in primary care: demonstrating quality
and outcomes. CRC Press.
Coyne, I., Comiskey, C. M., Lalor, J. G., Higgins, A., Elliott, N., & Begley, C. (2016). An
exploration of clinical practice in sites with and without clinical nurse or midwife
specialists or advanced nurse practitioners, in Ireland. BMC health services research,
16(1), 151.
Evans, D., Pester, J., Vera, L., Jeanmonod, D., & Jeanmonod, R. (2015). Elderly fall patients
triaged to the trauma bay: age, injury patterns, and mortality risk. The American
journal of emergency medicine, 33(11), 1635-1638.
Fong, J. Y. M., Tan, V. J. H., Lee, J. R., Tong, Z. G. M., Foong, Y. K., Tan, J. M. E., ... &
Pau, A. (2018). Clinical audit training improves undergraduates’ performance in root
canal therapy. European Journal of Dental Education, 22(3), 160-166.
Francis-Coad, J., Etherton-Beer, C., Bulsara, C., Nobre, D., & Hill, A. M. (2017). Using a
community of practice to evaluate falls prevention activity in a residential aged care
organisation: a clinical audit. Australian health review, 41(1), 13-18.

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Hatamabadi, H. R., Sum, S., Tabatabaey, A., & Sabbaghi, M. (2016). Emergency department
management of falls in the elderly: A clinical audit and suggestions for improvement.
International emergency nursing, 24, 2-8.
Johansson, J., Nordström, A., Gustafson, Y., Westling, G., & Nordström, P. (2017). Increased
postural sway during quiet stance as a risk factor for prospective falls in community-
dwelling elderly individuals. Age and ageing, 46(6), 964-970.
Laflamme, L., Monárrez-Espino, J., Johnell, K., Elling, B., & Möller, J. (2015). Type,
number or both? A population-based matched case-control study on the risk of fall
injuries among older people and number of medications beyond fall-inducing drugs.
PLoS One, 10(3), e0123390.
Mirelman, A., Rochester, L., Maidan, I., Del Din, S., Alcock, L., Nieuwhof, F., ... &
Abbruzzese, G. (2016). Addition of a non-immersive virtual reality component to
treadmill training to reduce fall risk in older adults (V-TIME): a randomised
controlled trial. The Lancet, 388(10050), 1170-1182.
Rodger, D., Hussey, P., & Murphy, C. (2017). Falls reduction following implementation of a
falls prevention programme in a residential care setting.
Said, C. M., Batchelor, F., Shaw, K., & Blennerhassett, J. (2016). Preparing patients at high
risk of falls for discharge home after rehabilitation: Do we meet the guidelines?.
Geriatrics & gerontology international, 16(5), 570-576.
Shema, S., Bezalel, P., Sberlo, Z., Yannai, O., Giladi, N., & Hausdorff, J. M. A. (2017).
Improved mobility and reduced fall risk in older adults after five weeks of virtual
reality training. Journal of Alternative Medicine Research supl Special Issue Virtual
Reality and Technologies for Rehabilitation [Internet], 9(2), 171-5.

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Thaler-Kall, K., Peters, A., Thorand, B., Grill, E., Autenrieth, C. S., Horsch, A., & Meisinger,
C. (2015). Description of spatio-temporal gait parameters in elderly people and their
association with history of falls: results of the population-based cross-sectional
KORA-Age study. BMC geriatrics, 15(1), 32.
Ullman, A. J., Ray-Barruel, G., Rickard, C. M., & Cooke, M. (2018). Clinical audits to
improve critical care: Part 1 Prepare and collect data. Australian Critical Care, 31(2),
101-105.