Assignment 5: Falls prevention education among elderly patient immediately after discharge. 2000 Words. This assignment extends the work undertaken in Assignment 4. You will be provided with: ·...

NURS2006 ASSIGNMENT 5
Clinical Practice Improvement Project Report
    Student Name, FAN and ID:
    21452
    Project Title:
    To reduce the risk of falls among old age people by implementing Exercise interventions before and after discharge.
    Project Aim:
    This Project aims to reduce the fall rate among community dwelling old age adults more than 65 years of age by approx. 30% within 6 months in acute ward of private local hospitals in South Australia.
    Relevance of Clinical Governance to your project
    Clinical governance refers to a framework which makes the clinicians and the organisations responsible for consistently improving the quality of care and reducing the risks to consumers (Mirza, McClelland, Bentley, Mazengarb & Jones, 2013,p.8). This clinical practice improvement plan will focus on the first pillar of clinical governance ‘Consumer and Community Participation’ – by involving the carers and family members in planning, maintaining and improving the outcomes of clinical program.
In this project, this pillar encourages the clinicians to prepare an exercise intervention plan to be implemented in the hospital and also a post discharge plan to be implemented by the home-based nurses to help the old age patients prevent the risk of falls both before and after discharge (Mirza et al. 2013, p.14). Prior to implementation, the Nursing staff will conduct risk assessment to identify the patient’s history of falls, his/her functional ability, and medication review (Tomasssini, 2011, p.3). The assessment of balance, gait, muscle weakness, mobility and fear of falling is also proposed (Gale, Cooper & Sayer, 2016, p.12). The patient’s visual impairment, cognitive impairment, urinary incontinence, and home hazards will also be assessed to plan the type of exercise interventions to be delivered along with other Multifactorial falls prevention interventions. The patient and his family will be actively involved in service planning, implementation and decision making of the intervention both in the hospitals and at home.
    Evidence that the issue / problem is worth solving:
    As per the reports of World Health Organisation (WHO) (2018), Falls are the second primary reason for accidental or unintentional injury which leads to death among the geriatric population. Falls are the most common incidents in old age people and have highly destructive consequences such as fractures of hips, arms and backbone, and head injuries (Kwan & Straus, 2014, p.2). More than 20% of old age adults who depict post fall body fractures usually die within one year and majority of the survivors do not return back to their normal healthy state (Kwan & Straus, 2014, p.2). According to Falls Prevention Statistics of South Australian Government in 2017 more than 22,576 people got admitted to public hospitals due to injury after a fall. Out of these, 67% people were over the age of 65 years. Falls are reported to be the most numerous incidents in South Australia in 2017 (Department of Health and Wellbeing, 2018, p.2). In Australia, around 83,800 people aged 65 years or over depicted to be hospitalised due to injury after a fall in 2009-10 (Australian Institute of Health and Welfare, 2013, p.1).
In South Australia (SA), there is observed a steady reduction in the serious falls from 2011 to 2017 by 442 cases, due to effective strategies such as quick post fall team reviews to prevent the recurrent falls, hourly rounding for dementia patients, and online E-Learning courses on fall prevention for healthcare staff (Department of Health and Wellbeing, 2018,p.2). In SA, more than 18,059 healthcare staff members have completed online e learning course on falls prevention since April 2014 (Centers for Disease Control and Prevention, 2018,p.3). However, still there is a remarkable prevalence of fall-related hospitalisations every year which requires a consistent check, due to the looming high cost of healthcare services (Kwan and Straus, 2014,p.5).
According to Farrar (2015,p.2) in the hospital care facilities, the exercise interventions can be combined with Vitamin D supplementation, providing additional physiotherapy and educational sessions provided by trained nurse targeting the factors of individual fall risk. After discharge, the exercise interventions may be performed under the guidance of learned physical trainers combined with home environment modifications like carpet flooring, installation of assistive devices etc.
    Key Stakeholders:
    This Project plan requires the collaborative involvement of following stakeholders to help achieve targeted aims.
· Doctors: In this intervention doctors will be decision makers of the plan. They will review the health status of person; will recommend right set of exercises which may vary at individual level; will recommend which other multifactorial interventions can be combined with exercise; and will prescribe appropriate medicines (Child, Goodwin, Garside, Jones-Hughes, & Boddy, 2012, p.5).
· Registered Nurses (RN): RN will assist the person in doing exercises in hospitals. They will perform gait assessment, assessment of patient’s functional ability, physical examination, and assessment of orthostatic vital signs using standardized tools such as Hendrich II Fall Risk Model or Morse Falls Scale (Gillespie, Robertson, & Gillespie,2012,p.7). RN will complete the documentation of all the examinations and care practices, will report the issues faced by the patient to the doctors, and will educate the patient and family members about how to practice easy steps of exercise. The nurse may also visit the patient home after his discharge to continue the delivery of programme for more sessions.
· Occupational Therapists: Occupational/Physiotherapists will deliver the exercise program training and usual care in the hospital and may also visit the patient home after discharge. They will train the patient for exercise program, gait related exercise training and will offer skilled therapy to enhance mobility in routine activities, like bathing and ambulation. Occupational Therapist will also perform home safety assessment and will recommend the use of appropriate assistive devices and their correct use.
· Family Members/ carers: They will maintain a good communication with the Nurse Aide in implementing the intervention, and will understand the requirements of the patient and report them to Nurse.
· Patient: Patient will learn to do physical exercise on his own, will report the health problems to the Nurse Aide and carer, will learn the use of assistive devices, and will support the medical team in delivering quality care.
    CPI Tool:
    This project plan will choose and implement the Plan-Do-Study-Act or the PDSA model repeating the cycles of change and further evaluation to reach the desired aim (Klee, Latta, Davis-Kirsch & Pecchia, 2013, p.2). With application of this tool the clinical staff will implement the Exercise Programme in the old inpatient adults of the private hospitals. The programme will emphasize on identifying the outcomes and key measures (plan), will deliver the intervention (do), will evaluate the collected outcomes (study) and will apply necessary modifications based on the results of previous stage (act).
1. PLAN
· The patient will be required to sign a consent form to ensure that the patient and his family have agreed to participate in the exercise intervention.
· Baseline subjective data will be collected to compare the patient health before and after the intervention.
2. DO
· The muscle strengthening exercise programme will be implemented.
· Regular surveys will be performed by all the involved stakeholders to assess the patient health.
· Regular monitoring of the intervention will be done and identified issues will be resolved through direct intervention.
3. STUDY
· Effectiveness of the intervention will be based on the analysis of objective data (collected from doctors, nurses and physiotherapists) and subjective data (collected from patients).
4. ACT
· Evaluation of existing exercise intervention will be done and better interventions will be planned on the basis of outcomes and collected results.
· Interventions having proven effectiveness to reduce falls rate will be proposed in clinical practice.
· Demanded changes in the existing interventions will be done to suit the requirements of the project.
The exercise intervention will be implemented for a period of 6 months for...