Clinical Audit Proposal: Acute Ward Fall Incidents - Analysis

This clinical audit proposal focuses on fall incidents within the acute care ward of a hospital. The introduction highlights falls as a major public health problem, emphasizing the increasing mortality rates and the high incidence of falls in hospitals, leading to injuries. The proposal outlines the components of the audit cycle, including issue identification, defining standards, data collection, performance comparison, implementing changes, and re-auditing. The identified issue is falls, particularly among elderly patients, and the audit plan aims to identify incident types, common contributors, and generate data for future quality improvement. The proposal details the audit's objectives, criteria, standards, and design, including observational studies and surveys. It also covers the setting, population, sample size, time period, inclusion and exclusion criteria, recruitment of participants, data collection methods (prospective and retrospective), data analysis techniques (Microsoft Excel and SPSS), data presentation, ethical considerations, and recommendations. The audit aims to improve patient safety and healthcare quality by addressing the factors contributing to falls and implementing effective prevention strategies. The proposal also uses the APA 6th referencing style.

Running head: CLINICAL AUDIT PROPOSAL
Name of the Student
Name of the University
Author Note

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Introduction:
Fall is a major public health problem with minor bruises and abrasions to more serious
consequence such as laceration, fracture, head injury, and even death. Mortality rate associated
with accidental fall has increased in recent years (Potter et al., 2016). More than one million
inpatient experience injuries associated with sudden fall in an Australian hospital, responsible for
85% of all hospital-acquired conditions (Barker et al., 2016). Epidemiological studies suggested
that the falls occur in a clinical setting at a rate of 3 to 5 beds per 1000bed-days. As discussed by
Breimaier et al. (2015), in long term care setting, 29 percent to 55 percent of residents are
reported to fall during their stay. The acute care patient may be at increased risk of falling
because of side effects of medication effects, histories of frequent fall, altered mobility (Callis,
2016). Although significant preventive measures have been taken in order to reduce the
incidents of fall, the fall prevention strategies as well as the performance of health
professionals, are not impressive enough to reduce the prevalence of fall prevention (Potter et
al., 2016). The purpose of the report is to plan clinical audit, focusing on the falls in the acute
ward of the hospital. A clinical audit is a crucial tool for evaluating the quality of care. This
paper will discuss the component of Audit Cycle, Identification of the Issue/Problem, and
Planning in the following paragraphs.
The audit cycle:
An audit is a systematic as well as independent examination process which is defined as
the process of quality improvement. It is integrated into the health care sectors in order to
improve the outcome through evaluation (Boughey & McKenna, 2017). It aims to maintain a
high quality of clinical care for the patients and brings yearly revenue. There are six steps of the

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audit cycle such as identification of issues, defining a standard, collecting the data, compare
performance with the standard, implement change and re-audit (Rose, Kwong & Pang, 2016).
While the first step is to identify an issue to focus on the issues in a clinical setting, the second
step defines a benchmark to measure the collected data such as performance report. The third
step is to collect data through a survey, field inspection and fourth step is to compare the
collected data with the standard in order to identify the gap. The fifth step is to publish the data
for providing an overview of the identified gap to other employees and the sixth step is to re-
audit with an intention of identifying the further gap.
Identification of issue:
Falls are a common and devastating complication of health care, particularly in elderly
patients. While fall injuries are the common phenomenon in the hospital with severe
consequences, the acute care patient may be at increased risk of falling because of side effects of
medication effects, histories of frequent fall, altered mobility (Barker et al., 2016). As discussed
by Porter et al. (2015), reported that the cost of treating acute care patients who are subjected the
sudden and on average they stay in the hospital up to 34 days, especially frail older adults. While
sudden fall in acute care as result of patient associated factors, the performances of the nurses are
highly associated with the falls in the acute care (Radecki, Reynolds & Kara, 2018).On acute
care, lack of early identification of risk of sudden fall, assisting in heavy physical activities,
attending other patients, difficulties in reporting fall are factors behind sudden fall (Kempegowda
et al., 2017).
Audit plan:
Aim and object:

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The aim of this clinical audit is to identify the type of incidents of fall in the acute care,
identify common contributors of sudden fall in acute care, to generate data for future quality
improvement of care in reducing sudden fall.
Objectives:
To identify the type of incidents of fall in the acute care and identify common
contributors of sudden fall in acute care. Moreover, to generate data for future quality
improvement of care in reducing sudden fall and implement it in the organization.
Criteria:
The systematic review would be conducted in order to obtain the key criteria of clinical
audit.
The criteria for clinical audit would be the following:
The first criteria would be collection of fall rate data of three types of patients from the acute
ward of the hospital would be done in order to gain the idea of frequent fall. Patient history of
previous falls, as well as fall risks, nursing performance and compliance with national guideline
of fall, medical histories of patients, would be collected within the fall rates and directors of the
organization would be informed the rationale behind collecting data of audit. The quality
standard would be decided according to guideline of Australian commission on safety and
quality in health care. According to Australian commission on safety and quality in health care,
fall rate per 1000 beds would be the quality standard where fall rate more than this would
consider as issue in quality of care (safetyandquality.gov.au. (2019). On-field observation

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would be conducted in order to identify the reason behind fall. It would be conducted in the acute
medical ward for reason behind fall such as evaluating the performance of nurse, environmental
hazard and patients with a history of other health illness. Survey on the health professionals
would be conducted in order to gain the idea of standard practice followed by the health
professionals. The survey of clinicians, nurse leaders, and registered nurses would be included
in the audit
Standard:
Fall rate data would be collected from fall rates of the previous five years (2014-2019) in
the acute care setting for the three types of patients (anticipated, unanticipated and accidentals).
According to Australian commission on safety and quality in health care, it is recommended that
fall rates of 4–12 per 1000 bed days would be considered as bench mark. Fall rate more than this
would be considered as discrepancy in care (safetyandquality.gov.au. (2019). On field
observation would be done over 12 weeks in the acute medical setting for observing the scenario
of fall and each type of fall would be evaluated for 12 weeks. In order to gain an idea of practice
followed by the health professionals, a survey would be conducted for 3 weeks which would be
forwarded to the mail chain of individuals.
Clinical audit design:
An observational study, as well as survey, would be conducted using both perspectives
as well as retrospective data collection method in order to identify the accidents in the acute care
setting bad common contributor of the fall in a medical ward. As discussed by Matsumoto et al.
(2017), it would be an effective audit design to identify types of fall frequent in the acute care
ward and common contributor of falls for this clinical setting such as environmental hazards,

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high risk of fall in patients, lack of accurate application of standards in nursing practice. The
reason behind using this study design is that it provides an opportunity to directly observe the
situation which further helps to biases of the obtained result (Matsumoto et al., 2017). The
survey would be an effective method since it represents a large number of population and have
statistical significance with low bias.
Setting:
The audit would be conducted the acute care medical ward of local health care facilities
for gaining the idea of falls.
Population and Sample Size:
For obtaining an idea regarding the incidents of fall, the population would be patients
with fall injuries, registered nurse working close with acute care, nurse leaders who are involve
in the incidents of falls. For conducting a survey, a total of 38 registered nurses and 12 nurse
leaders would be the sample and patients with fall injury admitted as well as care in the acute
care setting of the hospital.
The time period of the audit:
The time period of the audit would be 12 weeks which is from 27 May to 28 July 2019.
The inclusion criteria and exclusion criteria:
In order to recruit the participants for identifying the types of fall and contributing
factors the inclusion criteria would be:
Patients with fall injuries such as anticipated, unanticipated and accidental injuries over 65 years
and immediately admitted because of injury would be included as well as the patients who are

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already admitted in the hospital would also be included. Registered nurse with at least one year
of experience of handling patients with fall injury and Nurse leaders working in the organization
for 6 years would be included in the study.
Exclusion criteria would be:
Patients with injuries other than fall injuries would be excluded, registered nurses with
experience of less than 1 year would be excluded and nurse leader working in an organization
less than 6 years would be excluded
Recruitment of Participants:
Registered nurse and Nurse Leaders will be recruited for survey with the assistance of
mail chain where the request would be sent to every nurse to participate and management would
be appointed to provide reminders to them. The patients would be recruited randomly would be
present in the acute care in these three months of period.
Data collection:
The prospective as well as retrospective data collection method would be adopted for
collecting data. For the observational study, data would be collected in a prospective method that
since it is more reliable to collect data during their process of care. The survey also conducted
using the prospective method using survey monkey software where questionnaire would be sent
to the email of each registered nurse and nurse leader. Data of fall rates for these categories of
patients from the previous five years would be collected using the respective method to identify

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the contributing factors and nursing guidelines to mitigate it. This data would be collected over
12 weeks and at the end of six weeks the data would be stored in the IT system
Data analysis:
The observational report, as well as an assessment of fall rate report of the previous
years, would be analyzed using Microsoft Excel with the assistance of skilled professionals to
obtain the result. In order to obtain the result of the survey, the quantitative analysis would be
done using software such as SPSS which is cheap and cost-effective software and interpret data
within a shorter period of time.
Presentation of data:
The data of the audit would be represented in the tabular format as well as in graphical
format in order to provide an overview of types of fall in the acute care and contributing factors
behind fall and possible lack in the clinical practice. The opportunity of oral presentation would
be arranged to represent the data. It would help the staffs of the hospital to acquire the idea of the
possible contributing factors and gap in nursing practice. It would help to design the strategies
to mitigate these issues associated with fall (Domhoff & Fox, 2015)..
Ethical consideration:
Maintaining ethics is crucial in order to conduct any research-based studies, especially
clinical audit (Domhoff & Fox, 2015). In order to maintain proper ethics, ethical consent would
be obtained from the local ethical committee and the hierarchy of health care facilities. The
informed consent would be obtained from the authority of health care regarding the analysis of

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data on fall rate, the nurses and nurse leaders regarding a survey where the detailed objective and
aim of the audit would be explained and then the consent would be obtained to avoid the ethical
dilemma.
Recommendation:
In this audit, the survey response of the nurses and nurse leaders would be collected to
identify the types of falls and observational study would be conducted on the patients with fall
injury. No patient’s response would be collected for preparing this clinical audit. In order to
obtain a more accurate result of the audit and improving the next audit, the response of patients
would require to collect (Radecki, Reynolds & Kara, 2018). It would help to gain the idea of
experience patients are experiencing, their point of view on the fall injury in the acute care, care
practice of nurse. The policies, interventions would be amended according to it.
Conclusion:
On a concluding note, it can be said that clinical audit is crucial, especially in the clinical
setting order to identify the adverse accidents and contributing factors behind these contributing
factors. As a health professional, the successful accomplishment of this research audit would
help to identify core issues in the acute ward such as whether it is because of nursing practice or
high risk of fall or environmental hazard. It would also help to gain an understanding of the gap
in practice. Consequently, health professionals would be able to improve my practice while
attending patients with high-risk injury or patients with serious illness. Health professionals
would be able to assess patients for fall risk and engage me in the training process for best
practice. The health professionals would be able to identify the need for amendments of
important policies and innovative preventive measures to reduce the fall injury.

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Bala, H., Labonté-LeMoyne, E., & Léger, P. M. (2017). Neural correlates of technological
ambivalence: a research proposal. In Information Systems and Neuroscience (pp. 83-89).
Springer, Cham.https://link.springer.com/chapter/10.1007/978-3-319-41402-7_11
Barker, A. L., Morello, R. T., Wolfe, R., Brand, C. A., Haines, T. P., Hill, K. D., ... &
Sherrington, C. (2016). 6-PACK programme to decrease fall injuries in acute hospitals:
cluster randomised controlled trial. bmj, 352, h6781. : https://doi.org/10.1136/bmj.h6781
Boughey, C., & McKenna, S. (2017). Analysing an audit cycle: A critical realist account. Studies
in Higher Education, 42(6), 963-975.
https://srhe.tandfonline.com/doi/abs/10.1080/03075079.2015.1072148
Breimaier, H. E., Halfens, R. J., & Lohrmann, C. (2015). Effectiveness of multifaceted and
tailored strategies to implement a fall-prevention guideline into acute care nursing
practice: a before-and-after, mixed-method study using a participatory action research
approach. BMC nursing, 14(1), 18.
https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-015-0064-z
Callis, N. (2016). Falls prevention: Identification of predictive fall risk factors. Applied nursing
research, 29, 53-58. https://doi.org/10.1016/j.apnr.2015.05.007
Domhoff, G. W., & Fox, K. C. (2015). Dreaming and the default network: A review, synthesis,
and counterintuitive research proposal. Consciousness and cognition, 33, 342-353.
Kempegowda, P., Coombs, B., Nightingale, P., Chandan, J. S., Al-Sheikhli, J., Shyamanur, B., ...
& Ghosh, S. (2017). Regular and frequent feedback of specific clinical criteria delivers a

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sustained improvement in the management of diabetic ketoacidosis. Clinical
Medicine, 17(5), 389-394.
Matsumoto, H., Tanimura, C., Tanishima, S., Osaki, M., Noma, H., & Hagino, H. (2017).
Sarcopenia is a risk factor for falling in independently living Japanese older adults: A 2‐
year prospective cohort study of the GAINA study. Geriatrics & gerontology
international, 17(11), 2124-2130.
https://onlinelibrary.wiley.com/doi/abs/10.1111/ggi.13047
Porter, R. B., Cullen, L., Farrington, M., Matthews, G., & Tucker, S. (2018). CE: Original
Research Exploring Clinicians’ Perceptions About Sustaining an Evidence-Based Fall
Prevention Program. AJN The American Journal of Nursing, 118(5), 24-33.
https://encompass.eku.edu/cgi/viewcontent.cgi?article=1029&context=dnpcapstones
Potter, P., Allen, K., Costantinou, E., Klinkenberg, W. D., Malen, J., Norris, T., ... & Wolf, L.
(2017). Evaluation of sensor technology to detect fall risk and prevent falls in acute
care. The Joint Commission Journal on Quality and Patient Safety, 43(8), 414-421.
Retrived from: https://doi.org/10.1016/j.jcjq.2017.05.003
Radecki, B., Reynolds, S., & Kara, A. (2018). Inpatient fall prevention from the patient's
perspective: A qualitative study. Applied Nursing Research, 43, 114-119.
https://doi.org/10.1016/j.apnr.2018.08.001
References:
Rose, N., Kwong, G. P., & Pang, D. S. (2016). A clinical audit cycle of post‐operative
hypothermia in dogs. Journal of Small Animal Practice, 57(9), 447-452.
https://adc.bmj.com/content/103/Suppl_1/A151.1.abstract

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safetyandquality.gov.au. (2019). Retrieved from https://www.safetyandquality.gov.au/wp-
content/uploads/2012/01/Guidelines-COMM.pdf. Accessed on [ 1june, 2019]
Vijayakumar, C., Maroju, N. K., Srinivasan, K., & Reddy, K. S. (2016). Clinical audit system as
a quality improvement tool in the management of breast cancer. International Journal of
Surgery, 35, 44-50.
https://www.sciencedirect.com/science/article/pii/S1743919116308597