Falls Prevention in Aged Care Facilities: A Clinical Governance Report

This report presents an investigation into falls prevention within aged care facilities, emphasizing the application of clinical governance and clinical practice improvement (CPI) tools. The study aims to address falls as a significant issue, supported by statistical data and evidence of its impact on patient safety and healthcare costs. The relevance of clinical governance is explored, highlighting its role in establishing high standards of care, managing accountability, and fostering continuous improvement. Key stakeholders, including registered nurses, patients, management, and family members, are identified, with their respective roles in mitigating fall risks. The report suggests the adoption of CPI tools like the Program of Experience in the Palliative approach and Plan-Do-Study-Act to enhance care practices. Proposed interventions include consistent assessment tools, staff education, and a multidisciplinary approach. The report also acknowledges potential barriers to implementation, such as resistance to change and financial constraints. The evaluation of the project is discussed, emphasizing the importance of monitoring and adapting strategies to ensure sustained improvements in patient safety within aged care settings.

AN INVESTIGATION OF A CLINICAL GOVERNANCE OR
CLINICAL PRACTICE ISSUE
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TABLE OF CONTENTS
Title of the project...........................................................................................................................3
Aim of the project............................................................................................................................3
Relevance of clinical governance to the project..............................................................................3
Problem is worth solving.................................................................................................................4
Key stakeholders..............................................................................................................................5
CPI tool............................................................................................................................................6
Summary of proposed intervention.................................................................................................7
Barriers to implementation and sustaining change..........................................................................7
Evaluation of the project..................................................................................................................8
References........................................................................................................................................9
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TITLE OF THE PROJECT
Clinical Practice Improvement Project Report
AIM OF THE PROJECT
The main aim of the present research study is to prevent falls in aged care facility.
RELEVANCE OF CLINICAL GOVERNANCE TO THE PROJECT
Clinical government is considered as a systematic approach that helps in maintaining and
improving the quality of patient care within a health care system. It is a basic framework through
which health care organizations are can continually improve the practices through adding quality
aspects in the service provision (Pearce, Phillips, Dawson and Leggat, 2013). High standard of
care services can be added in the care dimension which creates an environment in which
excellence in clinical care could be flourished. The three major attributes of clinical governance
is recognising high standards of care, managing transparent responsibility and accountability for
health care standards and adopting constant dynamic of improvement. Since, it applies only to
health and social care organizations; therefore the concept is entirely related to delivery of care
to the patients.
The concept of clinical governance is relevant in the present case as application of the
concept could assist health care entities to adopt new and preventive measures to reduce the issue
of falls in the aged care facility. Further, this is also useful in improving the quality of care and at
the same time the issue of falls in Australian aged care facility can be managed. In this case, the
major components of clinical governance can also be applied; hence all the risks and
uncertainties can be managed respectively (Halton and et.al., 2016). Risk management is
essential to include about it is all about identifying the factors that influence the care provision.
Hence, appropriate actions can be taken to minimize the identified risks. Further, clinical
auditing could also be developed wherein practitioners should appropriately measure the quality
of care they offer. Health care practitioners must get prominent training and education so that
they can emphasize more on professional development.
As per the guidelines determined by The National Institute for Health and Clinical
Excellence, health care entities should provide evidence – based care to the patients so that to
promote good health for the patients. In the issue of falls, staffing and staff management should
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be appropriate so that to provide high- quality care. Lastly, the pillar of clinical governance
articulates that feedback should be included in carer experience so that areas of improvements
can be identified.
PROBLEM IS WORTH SOLVING
Falls is a major issue prevailing in Australian aged care facilities and it is also regarded as
one of the adverse events; however it is preventable if appropriate actions are taken. In the year
2009 – 2010, there were about 20,000 cases wherein falls were recorded as major issues in health
service area (Sherrington and et.al., 2016).
In order to minimize the issue of falls in aged care facility, Australian Commission on
Safety and Quality in Health Care have developed several provisions for the purpose of
coordinating improvements in the safety and quality of health care nationally. Falls are one of the
largest causes of harm in aged care facility and during care episodes, older people needs to go
through a period of intercurrent illness because of unfamiliar setting (Sherrington and et.al.,
2016). Residents in a residential aged care facility experienced an incidence of falls nearly five
times more than people of same age in their own home. In the year 2005 – 2006, 21% of serious
falls occurred in residential aged care facility; hence this is considered as the one of the most
frequent places to fall.
Every year around 30% of the Australians above the age of 65 years fall wherein 10% of
these falls leads to injury. However, it has also been analysed that the 80% of falls- related cases
remain in home. In terms of impact, this increases the issues of decreased muscle tone along with
physical inactivity (Dugue and et.al., 2016). Moreover, falls rates in residential aged care facility
differ from 4 to 10 per 1000 resident bed days; while on the other rates between one and five
falls per resident per year have also reported. Fall injury rates in residential aged care facility in
people over the age of 65 years and older are approximately 7200 falls per 1,00,000 people. The
hip and thigh are the most common injured areas in both men and women sustaining falls. Falls
may increase the risk of complications which also includes the likelihood of getting a fear of
falling or loss in confidence while standing, walking and other activities (Preventing Falls and
Harm From Falls in Older People. 2009).
Additionally, it has also been observed that the total estimated health cost is attributed to
falls- related injury and this also keeps on increasing almost threefold from A$ 500 million. In
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order to maintain the current health costs, there is a need to reduce the incidence of falls- related
hospitalizations. In this context, proper communication is required to be followed in the health
care entities so as to address the issue of falls. Registered nurses should give more consideration
to intrinsic and extrinsic factors because that increases risk of falling in residential aged care
facilities (Falls prevention in Australia. 2012). Australian Government Aged Care Quality
Agency have developed varied accreditation standards so as to enhance the quality of services as
it includes management systems, staffing and organizational development. Focus has also been
laid on physical environment and safe systems. However, at the same time, specific concern
should be given to service user’s rights and responsibilities.
KEY STAKEHOLDERS
Stakeholders like registered nurses, practitioners, patients, management of (RACF)
residential aged care facility and family members play crucial role in promoting the health
standards and as a result it can prevent falls related issues (Hewitt and et.al., 2014). Patients are
one of the main stakeholders of residential aged care facility as they are the sole users of the
health care amenities. Patients have to ensure that registered nurses are providing all the
appropriate sources and assistance while moving from one place to another. Further, patients can
also give their feedback regarding the services as that can also assist in facilitating improvements
in the care provision (Lee and et.al., 2013). In residential aged care facility, patients fall because
of many reasons; thus it is crucial for the registered nurses to ensure that they are providing
appropriate assistance to the care users in all spheres.
Registered nurses are significant stakeholders in residential aged care facility as they are
entirely responsible to provide prominent services to the patients. Hence, it is vital for the
registered nurses to ensure that walking aids, bed rays and other facilities are provided to the
patients. Registered nurses should always assist them while moving from one place to another so
as to reduce the probabilities of falls (RNs in aged care: stakeholders make their case to inquiry.
2015). They are required to play diverse roles in the care practices and they should also adopt
new practices to improve the issues of falls in the registered aged care facilities. Further,
practitioners working in the same area also need to ensure that proper medication is being
provided to the patients so that their health issues could be reduced. Similarly, practitioners
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should also analyse the measures that are followed in the residential aged care facility for the
purpose of encouraging the efficiency of health care services (Towne and et.al., 2016).
Management of residential aged care facility should also ensure that appropriate tools and
mechanism are being followed at the time of moving the patients to different places.
Management has to develop several health standards and that needs to be prominently adhered
by the practitioners so that the issue of fall can be prevented (Silva, Eslick and Duque, 2013).
Management should also adopt new practices for monitoring the practices of nurses so that the
possibilities of falls can be minimized in the residential aged care facility. Along with better
quality service provision, it is also crucial for management to adopt new practices so that they
can minimize the issues related to falls.
Further, family members also play crucial role in the same domain wherein they have to
ensure that patients are getting safe and secured residential services while staying in aged care
facility (Duque and et.al., 2016). It is also their responsibility to observe the improvements
coming in the patients. They also have to prominently guide the patients to adopt proper
measures to reduce the possibilities of falls. Hence, in this way health standards can be promoted
to higher extent.
CPI TOOL
In order to reduce the issues occurring from falls in residential aged care facility, it is
essential to make certain changes in the clinical practice improvement. Several new practices
needs to be adopted as CPI tools which can also assist in delivering better services to the
patients. In this respect, Program of Experience in the Palliative approach can be adopted which
empowers health professionals to deliver quality end of life care. It offers free placements, free
workshops, reverse Program of Experience in the Palliative approach and etc (Sherrington and
et.al., 2016). It can be adopted in Australian residential aged care facility for the purpose of
promoting the full integration and utilization of advanced nursing practice knowledge, skills and
expertise from all role dimensions that are associated to clinical practice, education, research,
organizational leadership and professional practice. It is also essential in promoting ongoing
advanced nursing practice role development and model of care enhancement through evaluating
outcome- based goals on continuous manner (Tiedemann, Sherrington and Lord, 2013).
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Further, in the same area, Plan-Do-Study-Act can also be adopted since it is a useful tool
for documenting a test of change. Hence, residential aged care facility could analyse all the
activities through testing it on regular basis. This is highly important for the purpose of
facilitating improvements in the care plan (Cassell and Clapperton, 2013). Several other
interventions and strategies can be adopted to enhance the level of practices in nursing. In order
to overcome the injuries, it is vital for the management of residential aged care facility to adopt
all such interventions. This is also crucial in promoting the health standards especially for aged
people.
SUMMARY OF PROPOSED INTERVENTION
It can be stated that the above mentioned tools can be adopted to underpin the standards
of health care services in residential aged care facility. In terms of intervention, registered nurses
are required to adopt consistent tools of assessment wherein proper monitoring and controlling is
required. Staff management of residential aged care facility also needs to provide suitable
education and training to the staff members (Vlaeyen and et.al., 2015). At the same time, nurses
should also identify the risk factors that leads to falls as according to that only, the issues of falls
can be prevented. Coordinated multi-disciplinary approach can also be adopted to analyze the
practices that can be included to reduce the risks of falls prevailing in older people in residential
aged care facility. Moreover, CPI should be promoted on higher extent to reduce the same risk
(Aama, 2011).
BARRIERS TO IMPLEMENTATION AND SUSTAINING CHANGE
While implementing the above mentioned interventions, several barriers and constraints
may occur that could also hamper the sustainability of change. Registered nurses might resist for
this change due to lack of support from other practitioners or from management. At the same
time, resistance could also come due to unavailability of financial resources that not only hinders
the service capability; but also it may enhance the cases of falls in residential aged care facility.
However, at the same time patients (residents) may also resist for this; hence in order to
overcome this aspect, registered nurses need to consider stern actions (Kuys and et.al., 2014).
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EVALUATION OF THE PROJECT
The success of the project will be identified on the basis of collecting data about the
effectiveness of the intervention and fall prevention strategies. Information will be included
about the patients who are getting benefitted from these strategies (Balzer and et.al., 2012). This
will assist in identifying the benefits of the strategy and along with that, focus will also laid on
feedback from the registered nurses who provide residential care to residential aged care facility
patients. Furthermore, in this respect statistics will be collected regarding the number of patients
that are protected due to all the mentioned fall prevention strategies.
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REFERENCES
Cassell, E. and Clapperton, A., 2013. A decreasing trend in fall-related hip fracture incidence in
Victoria, Australia. Osteoporosis international. 24(1). pp.99-109.
Falls prevention in Australia. 2012. [Online]. Available through:
<http://www.hospitalhealth.com.au/content/aged-allied-health/article/falls-prevention-in-
australia-1035992765 >. [Accessed on 13th January 2017].
Halton, K., Hall, L., Gardner, A., MacBeth, D. and Mitchell, B. G., 2016. Exploring the context
for effective clinical governance in infection control.American Journal of Infection
Control.
Hewitt, J., Refshauge, K.M., Goodall, S., Henwood, T. and Clemson, L., 2014. Does progressive
resistance and balance exercise reduce falls in residential aged care? Randomized
controlled trial protocol for the SUNBEAM program. Clinical interventions in aging. 9.
Kuys, S.S., Peel, N.M., Klein, K., Slater, A. and Hubbard, R.E., 2014. Gait speed in ambulant
older people in long term care: a systematic review and meta-analysis. Journal of the
American Medical Directors Association.15(3). pp.194-200.
Pearce, P., Phillips, B., Dawson, M. and Leggat, S. G., 2013. Content of clinical supervision
sessions for nurses and allied health professionals: a systematic review. Clinical
Governance: An International Journal. 18(2). pp.139-154.
Preventing Falls and Harm From Falls in Older People. 2009. [Pdf]. Available through:
<http://www.activeandhealthy.nsw.gov.au/assets/pdf/RACF_Guidelines.pdf/>. [Accessed
on 13th January 2017].
RNs in aged care: stakeholders make their case to inquiry. 2015. [Online]. Available through:
<http://www.australianageingagenda.com.au/2015/07/29/rns-in-aged-care-stakeholders-
make-their-case-to-inquiry/>. [Accessed on 13th January 2017].
Sherrington, C., and et.al., 2016. Exercise and fall prevention self-management to reduce
mobility-related disability and falls after fall-related lower limb fracture in older people:
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protocol for the RESTORE (Recovery Exercises and STepping On afteR fracturE)
randomised controlled trial. BMC geriatrics. 16(1). p.1.
Silva, R. B., Eslick, G. D. and Duque, G., 2013. Exercise for falls and fracture prevention in long
term care facilities: a systematic review and meta-analysis. Journal of the American
Medical Directors Association. 14(9). pp.685-689.
Tiedemann, A., Sherrington, C. and Lord, S. R., 2013. The role of exercise for fall prevention in
older age. Motriz: Revista de Educação Física. 19(3). pp.541-547.
Vlaeyen, E. and et.al., 2015. Characteristics and Effectiveness of Fall Prevention Programs in
Nursing Homes: A Systematic Review and Meta‐Analysis of Randomized Controlled
Trials. Journal of the American Geriatrics Society. 63(2). pp.211-221.
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APPENDIX
Articl
e
Author /
Year /
Country
Aim of the
study
Sample
setting
Design/
Methods
Main
findings
Strengths
and
Limitation
s
Article
1
Lee, A. D.
and et.al.,
2013.
To assess the
effectiveness of
patient education
in reducing falls,
promoting
behavioural
change and the
uptake of
prevention
activities in older
adults during and
after
hospitalization.
A
systematic
search of
five health
science
databases
Systematic
review and
meta-
analysis.
Falls
prevention
programme
s that
contained
patient
education
were
effective in
reducing
fall rates
amongst
hospital
inpatients
and post-
discharge
populations
With
secondary
research,
suitability of
tools have
identified.
Article
2
Balzer, K
and et.al.,
2012.
To ascertain falls
prevention in
elderly
31
Literature
reviews
were
searched
Systematic
literature
searches
were
performed in
31 databases
Positive
effects of
exercise
intervention
s may be
expected in
relatively
young and
healthy
seniors,
while
Effectivenes
s of
intervention
techniques
are
identified.
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studies
indicate
opposite
effects in
the fragile
elderly.
Article
3
Aama, T.
A., 2011.
To provide
family physicians
with a practical,
evidence-based
approach to fall
prevention in the
elderly
Literature
reviews
were
researched
MEDLINE
was searched
using
relevant
terms
family
physicians
have a
pivotal role
in screening
older
patients for
risk of falls,
and
applying
preventive
strategies
for patients
at risk
Article
4
Duque, G
and et.al.,
2016
Treatment of
Osteoporosis in
Australian
Residential Aged
Care Facilities:
Update on
Consensus
Recommendation
s for Fracture
Prevention
Participants
were
selected by
the scientific
committee
on the basis
of their
practice in
an
residential
aged care
facility
and/or major
published
This article
provides an
update on
the most
relevant
evidence on
osteoporosi
s in older
people
living in
residential
aged care
facility
graded
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