CHEE6420 Safety and Risk Management

Part 1

I was working in the Healthcare Setting As Nursing professional and witnessed an incident that has resulted in poor health outcome and complications. It has been known and understood that the healthcare setting needs to implement adequate fall prevention strategy that would result in poor delivery of outcome. A patient was admitted who was ageing around 85 years old and have the medical history of multiple falls. Therefore, for eliminating the threats of risk, she was using walking for seeking the adequate support. Her son has explained the needful medical condition to the team and poor strengths towards mobility. Thus, I have observed that the team has considered as highly vulnerable category under the fall along with the essential impaired mobility. She was seeking adequate treatment plan and was recovering from her health conditions.

The healthcare setting is considered as the busiest surgical wards and it is 45-bedded settings. According to me, there is continual needs and demands towards the healthcare staffing and that result in multiple health complications along with performing the responsibilities adequately. Working in the setting imposes stress as there is continual workload and pressure to enhance the patient outcome.  The poor policy towards teg fall prevention has resulted in adverse events of fall encountered by the patient admitted and receiving the essential treatment plan. It has resulted in increasing the length of stay in the healthcare setting and reduce the health status. I have witnessed that the fall would bring negative impact on the health status of the patients and towards the overall administrative of delivering patient care by the healthcare providers. The cause of fall of patient was due to inability of warning signs that was lacking within the policy of hospital. The patient experiences the fall due to slip and wet floors in the corridors.

Part 2

Introduction

In hospital and healthcare settings, there are multiple adverse situations and incidents that results in poor delivery of healthcare services. The fall within the healthcare premises is considered as the most common incidents that results in physical injuries, fractures and sometime result in multiple health complications (Gettens et al., 2018). It would also delay the recovery period and increases the length of stay within the healthcare settings. In the paper, the case is being considered where an older adult encounter falls due to poor environment within the hospital (Sherrington et al., 2019). The concept of fall is also represented as the unintentionally way of falling down in the lower level such as ground or fall. The paper intends to analyse and evaluate the essential management approach that would reduce the overall prevalence of falls.

Identification

The risks of fall can be identified in multiple approaches and in the previous section, seeking the feedback and effective communication with the family of patient have provided the insight of the patients who is highly vulnerable towards fall. Among the older population, there are series of multiple clinical risk factors that would increase the potential for falling among the older adults (Hill et al., 2015). Some of them include mobility problems, dealing and managing with chronic illness, balance disorders, and finally impaired vision that act as contributory factors among older population towards falls (Gazibara et al., 2017). It is essential to impose the fall risk assessment as it would assist in developing the adequate strategy that would focus on improving the certain key issue and concern of fall within the hospital. The risk assessment for fall would reduce the overall clinical risks associated with the risk and it would include the approach of screening (Phelan et al., 2015). It is essential to understand that there is a continual need towards imposing the screening test specifically towards the older population as they are considered as the most vulnerable group towards the fall. The assessment would focus on understanding the ability of the patient or individual with strength, balance, along with gait that would reflect the potential risks towards the falls. Thus, it has been understood adequately that the clinical risks would be identified and monitored with the help of fall risk assessment tool or model. The monitoring approaches would focus on understanding certain key elements that would impose higher risk such as dizziness, along with the light-headedness as well as irregular and rapid heartbeats would result in imposing the poor outcomes (Vottis et al., 2018).

Analysis

It is essential to understand the purpose and purpose for developing the fall risk assessment tool and implementing it within the healthcare settings for reducing the overall prevalence of health outcomes. The fall due to wet floors, dark room or poor warning signs or posters are the most common contributory factors towards increasing the fall among the patients. It would also result in common patient outcome that may result in physical injuries along with increasing the length of stay (Park, 2018). Therefore, the development of fall risk assessment approach would help in identifying and understanding the overall primary care that would reduce certain potential poor health outcome.

The fall risk assessment would include multiple parameters or indicators that have been developed to design the overall assessment. The initial element is ‘time up and go’ indicators that would focus on understanding the ability of patient towards walking and ability towards standing up from chair. The excessive time consumption in doing the activity would result in higher risks of fall. Another important indicator is ’30 second chair stand test’ and it would focus on understanding the strength of the patient towards continual proves of standing and sitting in chair without any support (Matarese et al., 2015). The poor ability would again consider as the vulnerable towards the risks of falling. The last indicator is ‘balance test’ that would focus on multiple types of position that would assess the overall balance among the patients. Thus, in the section, the analysis towards the risk assessment model has been discussed.

Evaluation

The evaluation would focus on understanding the health condition of the patient and develop certain care plan that would focus on most vulnerable group of patients. In this paper, the older population is considered as vulnerable group and thus, they need to impose adequate approaches that would mitigate the identified risks and hazards. The patients who are at higher risks towards the fall should be evaluated with the essential benefits that are associated with the physical therapy along with the occupational therapy. Hence, the physical therapy would work on developing the intervention program that would focus on enhancing the strength, exercise along with balance training along with the education as well as safety precautions (Thomas et al., 2019). Thus, it would include managing the risky behaviours of the patients and providing complete assistance and support for reducing the potential risks.

The occupational therapy would include developing certain activities that would improve the balance and ability towards adequate mobility among the patients. It would involve the strategy to improve the overall cognitive impairment, visuospatial impairment and enhance the knowledge towards handling adaptive equipment that would reduce the overall risks of falls (Elliott & Leland, 2018). Some of the most common adaptive equipment are toilet seat risers, shower chairs along with any other grab bars.

Management

Nursing professional have wide varieties of roles and responsibilities in managing the fall prevention programs. It would include the adequate approaches towards screening as well as imposing the assessment within the clinical practices. Some of the key managerial responsibilities of nursing professional in managing and reducing the risks of falls are to keep the beds of patients in lower position with adequate brakes on, and also ensure that the side rails are raised in appropriate way based on the needs of the patients. Patients who are vulnerable and poor ability in mobility then it is essential to provide the non-slip footwears. Nursing staffs would also have adequate responsibilities towards educating patients along with families towards certain intervention programs and strategies that would reduce any potential adverse outcomes (Opsahl et al., 2017).

Nursing staffs should also manage certain factors such as an appropriate lightening of the corridors, implementing the waring signs whenever there are spills of water or any hazardous elements and reporting any identified hazards that may impact on the health status of the patients.  Continual supervision is essential for critical care patients along with the highly vulnerable patients (Keuseman & Miller, 2020). Nursing staffs should also ensure that patients need to follow and participate in the risk assessment tools that would focus on improving the overall outcome among the patients. The assessment can be done during the initial level of admissions that would assist the nursing staffs to understand the condition along with the essential changes within the condition of the patients (Fahlström et al., 2018). Hence, nursing staffs need to manage key areas such as environmental issues, age, mental state, mobility, length of stay, diagnosis of medicines and bedrest along with detail information towards the history of falls.

Conclusion

From the above discussion, it can be concluded that the paper has identified the causal factors towards the falls and enhance the overall outcome. The paper has discussed multiple key areas that would ensure the patient safety and develop the adequate intervention for preventing the falls in hospital.

References

Elliott, S., & Leland, N. E. (2018). Occupational Therapy Fall Prevention Interventions for Community-Dwelling Older Adults: A Systematic Review. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 72(4),7204190040p1–7204190040p11. https://doi.org/10.5014/ajot.2018.030494

Fahlström, G., Kamwendo, K., Forsberg, J., & Bodin, L. (2018). Fall prevention by nursing assistants among community-living elderly people. A randomised controlled trial. Scandinavian journal of caring sciences, 32(2), 575–585. https://doi.org/10.1111/scs.12481

Gazibara, T., Kurtagic, I., Kisic-Tepavcevic, D., Nurkovic, S., Kovacevic, N., Gazibara, T., & Pekmezovic, T. (2017). Falls, risk factors and fear of falling among persons older than 65 years of age. Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society, 17(4), 215–223. https://doi.org/10.1111/psyg.12217

Gettens, S., Fulbrook, P., Jessup, M., & Low Choy, N. (2018). The patients’ perspective of sustaining a fall in hospital: a qualitative study. Journal of clinical nursing, 27(3-4), 743-752. https://doi.org/10.1111/jocn.14075

Hill, A. M., McPhail, S. M., Waldron, N., Etherton-Beer, C., Ingram, K., Flicker, L., Bulsara, M., & Haines, T. P. (2015). Fall rates in hospital rehabilitation units after individualised patient and staff education programmes: a pragmatic, stepped-wedge, cluster-randomised controlled trial. Lancet (London, England), 385(9987), 2592–2599. https://doi.org/10.1016/S0140-6736(14)61945-0

Keuseman, R., & Miller, D. (2020). A hospitalist's role in preventing patient falls. Hospital practice (1995), 48(sup1), 63–67. https://doi.org/10.1080/21548331.2020.1724473

Matarese, M., Ivziku, D., Bartolozzi, F., Piredda, M., & De Marinis, M. G. (2015). Systematic review of fall risk screening tools for older patients in acute hospitals. Journal of advanced nursing, 71(6), 1198–1209. https://doi.org/10.1111/jan.12542

Opsahl, A. G., Ebright, P., Cangany, M., Lowder, M., Scott, D., & Shaner, T. (2017). Outcomes of Adding Patient and Family Engagement Education to Fall Prevention Bundled Interventions. Journal of nursing care quality, 32(3), 252–258. https://doi.org/10.1097/NCQ.0000000000000232

Park S. H. (2018). Tools for assessing fall risk in the elderly: a systematic review and meta-analysis. Aging clinical and experimental research, 30(1), 1–16. https://doi.org/10.1007/s40520-017-0749-0

Phelan, E. A., Mahoney, J. E., Voit, J. C., & Stevens, J. A. (2015). Assessment and management of fall risk in primary care settings. The Medical clinics of North America, 99(2), 281–293. https://doi.org/10.1016/j.mcna.2014.11.004

Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. The Cochrane database of systematic reviews, 1(1), CD012424. https://doi.org/10.1002/14651858.CD012424.pub2

Thomas, E., Battaglia, G., Patti, A., Brusa, J., Leonardi, V., Palma, A., & Bellafiore, M. (2019). Physical activity programs for balance and fall prevention in elderly: A systematic review. Medicine, 98(27), e16218. https://doi.org/10.1097/MD.0000000000016218

Vottis, C. T., Mitsiokapa, E., Igoumenou, V. G., Megaloikonomos, P. D., Galanopoulos, I. P., Georgoudis, G., Koulouvaris, P., Papagelopoulos, P. J., & Mavrogenis, A. F. (2018). Fall Risk Assessment Metrics for Elderly Patients With Hip Fractures. Orthopedics, 41(3), 142–156. https://doi.org/10.3928/01477447-20180501-07

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