Fall Rate Reduction in a Nursing Home

Abstract

This paper will present a comprehensive quality improvement initiative focusing on minimizing the fall rate among patients in Nursing Home X. This nursing home is for exceptionally skilled nurses in Connecticut. The study will employ a macro-systems analysis to evaluate the facility’s mission, vision, and goals and connect these three elements to stakeholders’ interests and commitments. Influences of various factors, such as sociocultural, political, and economic elements, will be analyzed. This initiative will emphasize risk assessment and staff training as strategic priorities in creating an intervention model for the problem of the high rate of falling patients. The literature review is an explorative analysis of various variables surrounding patient fall rates. Some key themes captured in the literature review include fall prevention techniques—incorporating intervention tools, multifactorial interventions, and continuous education for healthcare staff. The selected methodology will aim to understand various factors contributing to falls in a nursing home. The mixed-method approach will be the model of research in the entire process. Some of the primary ethical considerations will entail privacy protection, informed consent and exemplary moral conduct. The paper will distinctively acknowledge and record potential limitations in the research process and emphasize the ethical considerations, patient-centred care and the potential to significantly improve fall prevention tactics in healthcare environments.

1. Introduction

Patient falls pose a significant concern in nursing homes due to the general expectation of quality care facilities. Addressing patient falls is supposed to be a priority issue, like many other issues pertaining to health in the facility. This research will explore an intervention initiation for the crisis of falling patients using a sample set, Nursing Home X, a Connecticut nursing home for specially skilled caregivers. The study will take a micro-analysis approach to contextualize the intervention strategies. Like a standard nursing home, the facility operates under a mission and vision that is ideally committed to ensuring patient safety in treatment and healing. The mission of Nursing Home X underscores the promotion of security and support for all patients. At the same time, the vision aspires to be the leading elderly care centre that sets standards at both local and federal levels.

A thorough macro-analysis in Nursing Home X will examine significant stakeholders, including patients, nurses, family members, administrative teams, and regulatory bodies responsible for overseeing the facility. Stakeholder evaluation is a generally adopted process due to its importance in ensuring that all individuals and bodies affected are aligned with the initiative. Through establishing a collaboration with stakeholders, every party involved can make a meaningful contribution to the initiative. Additionally, specific external influences affect Nursing Home X to determine the dynamics of healthcare provision in the facility. A range of sociocultural factors and societal expectations on the treatment of elders and government regulations encompass the challenges and opportunities involved in healthcare provision within the nursing home. The economic consideration entails budgetary constraints and how available resources influence the quality of service given. Moreover, specific opportunities like technological advancements provide groundbreaking solutions to patient falls.

2. Aims and Objectives

This research’s primary goal is to mitigate the high frequency of patient falls with Nursing Home X. To achieve this goal, the research is tasked with meticulous identification of problem areas that accurately pinpoint the causes of patient falls within the facility. The identification process will involve a rigorous evidence-based approach. This intervention initiative will have two main focus areas: risk assessment and staff training. Staff training is a good choice since professional inadequacies have been identified as a significant contributor to patient falls. Concurrently, the risk assessment is vital to ensure comprehensive, systematic, and evidence-based processes. Additionally, the initiative is meant to highlight the importance of interdisciplinary collaboration that will prompt clinical and administrative teams to join the effort.

3. Literature Review

The body of literature in this proposal acts as a preliminary pilot study to a more detailed body of research that will be included in the research. Several factors associated with patient falls were examined while exploring the literature. These factors include practice methods, materials, measurements and general suitability of the environment. For instance, the mobility of patients heavily depends on whether or not the design of the surroundings is friendly. Therefore, the environment plays a vital role in ensuring for not only patients but nurses as well.

Moreover, practitioners’ training level and expertise are another vital part of patient safety and avoidance of falls. According to Najafpour et al. (2019), more staff training and efficient risk assessment schedule routines must be needed. Therefore, environment and general practice models are the most dominant areas of concern regarding patient falls.

3.1.Factors Contributing to Falls in Nursing Home Residents

Inadequate nursing training emerges as a prominent contributor to falls among nursing home residents. According to a study conducted by Lamb et al. (2020), best practice within a hospital setting was a dominantly preferred means of reducing patient falls in various situations. The introduction of the Fall Reduction and Injury Prevention toolkit was a pivotal section of the program where structured program evaluation was used to enhance infrastructure and capacity. This demonstrates the relationship between organized education initiatives, worker involvement, and efficient fall prevention procedures. Moreover, Morris et al. (2022) emphasized the importance of staff education within an institution to identify high-reidentify, utilize appropriate measures, and consistently engage in patient management.

The second prominent factor identified was inconsistent risk assessment schedules and procedures. Beck Jepsen et al.’s (2022) research highlights the use of standardized tools to prevent falls among older adults. The study emphasizes the importance of balance, gait and functional mobility assessments. Similarly, by utilizing the Morse Falls Scale to determine the ideal cut-off value for patients at risk of falls, Bagui et al. (2019) made a substantial contribution to patient safety and fall prevention. The study was conducted in a community hospital to establish cost-reduction techniques while maintaining high-quality patient outcomes. The body of literature examined indicates fall prevention strategies utilize standardized tools, focused risk assessments and enhanced staff training.

3.2.Fall Risk Assessment Processes in Various Healthcare Settings

The research frequently emphasized the importance of education and multifactorial treatments, highlighting the necessity of an integrated approach to fall prevention. Since patient falls are triggered by various factors, including negligence of nursing practitioners, psychological dynamics, environmental hazards and individual behaviours, intervention strategies call for a diversified risk assessment approach. According to Morris et al. (2022), negligence can be quickly addressed through staff training and imposing stricter responsibilities in the event of a patient fall. The research also highlights the importance of regular exercise to address the dynamic nature of nursing environments. The efficacy of multifactorial techniques was underscored by the focus on identifying high-risk individuals, implementing suitable fall prevention measures, and maintaining regular monitoring. Shaw et al. (2020) highlight a distinct approach while addressing education for healthcare workers. In their research, Shaw et al. (2020) show well-planned and executed training initiatives that improve healthcare providers’ fall prevention knowledge, abilities, and attitudes.

Moreover, the literature highlighted technology as a forward-looking approach to fall prevention efforts. Eichler et al. (2022) introduce a technology-assisted way of reducing fall rates by using a multi-depth camera that tracks human motion. This technology tool, Efficient-BBS, maintained highly accurate results while testing appropriate risk assessment criteria. This study demonstrated how technology, precisely machine learning specifiers, provides a revolutionary solution in risk assessment. Moreover, integrating technology solutions aligns with sending alerts to care teams and monitoring imminent falls.

3.3.Challenges and Barriers to Fall Prevention

Fall prevention efforts come with specific standardized challenges. One of these challenges is the imperative need for person-centeredness. This challenge dictates ways and methods of approach to the problem. According to research by Karrer et al. (2020), organizational culture and attitude are crucial in adopting nurse-led treatments in dementia care. The study further highlights financial issues, corporate culture, and management support as factors that could facilitate or undermine intervention for patients in a falling crisis.

Another major factor revealed through literature is the psychological element of the problem-solving process, where the study shows that perceptions of caregivers are paramount in the problem-solving process. Van Rhyn & Barwick (2019) emphasize the need for researchers to provide a preliminary psychological analysis of the parties involved in the problem-solving process. Moreover, nurses’ judgments of patients’ abilities to help themselves have a psychological element that places a need for examination and correct decision-making. In addressing these problems, one must consider company culture, managerial support, and the multifactorial nature of patient falls.

4. Methodology

4.1.Research Design

The research design for the study will include an exploratory approach to determine various factors contributing to patient falls within Nursing Home X. The research will build on meso-system analysis as seen in the literature while employing a mixed methods approach that combines qualitative and quantitative research approaches. In-depth interviews and focus groups with patients, relatives, and clinical and administrative personnel will comprise the qualitative component. In this discussion, I aimed to establish contributing factors and identify gaps involved while creating intervention strategies for patient falls. Concurrently, the quantitative will take a retrospective analysis of relevant data and statistics like patient records, incident reports and staff training logs that will be used to qualify the prevalence of falls and spot trends linked to poor risk assessment and employee training.

Subcategories identified during the assessment of Nursing Home X will guide the rest of the research design. As the literature analysis has shown, environmental concerns, faulty event reporting systems, and insufficient fall risk assessment were significant causes of falls. The research design will focus on these subcategories, employing systematic exploration to understand the mode in which they are manifested within the Nursing Home. This method leaves the research with a two-headed approach. First is identifying the research priorities, and second is identifying deficiencies outlined in the assessment. A flowchart will be created to present the incident identification process visually. The flowchart will outline the sequence of processes involved in identifying and reporting patient falling incidents within Nursing Home X. A standard knowledge of the workflow is made more accessible, and incident identification process transparency is improved with the help of the flowchart, which is a valuable tool for staff and stakeholders.

4.2.Data Collection

Identification of relevant data to be used is a vital process that will consider the nature of variables; in this case, risk assessment and staff training. A methodical examination of training materials and incident reports will be part of the procedures for gathering information on insufficient staff training and risk assessment. The efficacy, frequency, and substance of training programs will all be examined in this analysis. Incident reports will be closely examined to find instances when inadequate staff training may have led to fall events. The systematic review will classify occurrences according to the degree of staff training and find trends or patterns linked to insufficient training. Analyzing risk assessment methods will also entail a thorough examination of Nursing Home X’s fall risk assessment protocols and practices, aiming to determine how well they fit with evidence-based standards and pinpoint areas needing improvement.

4.3.Data Analysis

A methodical coding procedure will be applied to the qualitative data from focus groups and interviews. Through open coding, themes and patterns about insufficient staff training and risk assessment will be found. The data will then be refined and categorized using focused coding. This qualitative research aims to offer comprehensive and nuanced knowledge of the context and stakeholder views that affect fall prevention at Nursing Home X. To represent the fall incident identification process visually, a flowchart will be created. The flowchart will outline the sequential steps in identifying and reporting fall incidents within Nursing Home X. It will provide a visual roadmap illustrating how incidents are recognized, written, and subsequently analyzed for patterns and contributing factors. The flowchart is a practical tool for staff and stakeholders, enhancing transparency in the incident identification process and facilitating a shared understanding of the workflow.

4.4.Limitations

The following are the following are the potential limitations concerning the research methodology for this research:

• Sample size: the sample population at Nursing Home X might not represent the sample size of all nursing homes across the country, which may limit the principle of generalizability.
• Participants’ characteristics: The heterogeneity of patients’ characteristics within Nursing Home X may present the participants’ health status, response to interventions, and mobility levels. This dynamic may impact the outcome of the study negatively.
• Selection bias: if a specific type of resident is overrepresented compared to another, the study’s outcome may incur a selection bias, jeopardizing the research results.
• Stuff training turnover: The training and turnover rates of nursing home personnel who carry out fall reduction activities may impact their efficacy. This implies that turnover rates are likely to alter the consistency of implementation.
• Baseline fall rates: the variability of baseline fall rates in different nursing homes across the country could make it easier to credit improvements to the particular treatments rather than prevailing patterns.
• Resource constraints: resource constraint is a standard limitation in almost all research environments. Time management issues, financial shortages and personnel-related issues may impact the outcome of the resource.
• Contextual factors: each nursing home’s tendency to pose unique characteristics that include environmental design specifics, resident demographics, and staff dynamics may introduce differences that make comparison between facilities difficult.
• Publication bias: certain studies tend to lean towards positivity or negativity depending on the author’s intention and hypotheses. This factor may inhibit the validity of the research outcome.

4.5.Ethical Considerations

This research will adhere to all standard ethical considerations since this is a relatively sensitive research because of sensitive patient data that will be shared. The ethical considerations will include:

• Privacy and Confidentiality: No patient data gathered from patient records or interview transcripts will be revealed to any third parties. They will only be exclusively accessible to the relevant stakeholders.
• Voluntariness: all parties involved in the research will have the free choice to engage in the manner they deem comfortable and in line with their values. Parties will be free to withdraw from the study at any moment.
• Anonymity: the researcher will ensure that all information gathered and used is not associated with real individuals but given code names to protect these individuals’ identities. For instance, data entries that will require an individual’s name will be coded into symbols representing those names.
• Beneficence: wall participants will get a comprehensive brief on the importance of the research and its direct influence on their well-being. The participants (the nursing home residents) will be informed about their alarming rate of falls and the necessity to mitigate these rates.
• Non-maleficence: The research will minimize potential harm to vulminimized populations. Since this research is focused on senior citizens with a more significant potential of being physically compromised, suitable measures will be taken to ensure no harm is caused.
• Risk-Benefit Analysis: This process weighs the potential risks that might occur by researching instead of the benefits of the results. In this case, mitigating patient falls outweighs any potential risks that might occur during the research.

5. Conclusion

The commitment to minimize fall rates minimizing home residents can be documented and implemented as planned by this research. Nursing Home X will act as the setting for the study. A comprehensive conclusion will be made regarding analysis, problem area identification and recommendations for the most appropriate and evidence-based solution to the fall rates crisis among nursing home residents. The study will begin by analyzing a plot and studying pre-existing knowledge that could contribute to the current research. The recommended methodology highlights identifying and investigating categories leading to falls inside Nursing Home X and provides a thorough study design, data collection, and analysis procedure. Moreover, the ethical element of the research will be adamantly addressed while emphasizing informed consent and voluntary participation. Moreover, anticipated limitations to the research methodology are included, and the research will conclude by emphasizing how much respect the research gives to individual participants and their willingness to be part of the research.

References

Bagui, S., Long, T., & Bagui, S. (2019). Selecting the Optimal Morse Falls Scale Cut-Off Point for Patient Fall Risk. Health, 11(07), 924.

Beck Jepsen, D., Robinson, K., Ogliari, G., Montero-Odasso, M., Kamkar, N., Ryg, J., … & Masud, T. (2022). Predicting falls in older adults: an umbrella review of instruments assessing gait, balance, and functional mobility. BMC geriatrics, 22(1), 1-27.

Eichler, N., Raz, S., Toledano-Shubi, A., Livne, D., Shimshoni, I., & Hel-Or, H. (2022). Automatic and efficient fall risk assessment based on machine learning. Sensors, 22(4), 1557.

Karrer, M., Hirt, J., Zeller, A., & Saxer, S. (2020). What hinders and facilitates the implementation of nurse-led interventions in dementia care? A scoping review. BMC geriatrics, 20, 1-13.

Lamb, K. V., Ambutas, S. A., Sermersheim, E. R., & Ellsworth, M. J. (2020). Gap analysis: A tool for staff engagement in fall reduction improvement processes. Nursing Management, 51(10), 16-22.

Morris, M. E., Webster, K., Jones, C., Hill, A. M., Haines, T., McPhail, S., … & Cameron, I. (2022). Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing, 51(5), afac077

Najafpour, Z., Godarzi, Z., Arab, M., & Yaseri, M. (2019). Risk factors for falls in hospital in-patients: a prospective nested case-control study—International Journal of Health Policy and Management, 8(5), 300.

Shaw, L., Kiegaldie, D., & Farlie, M. K. (2020). Education interventions for health professionals on falls prevention in health care settings: a 10-year scoping review. BMC geriatrics, 20(1), 1-13.

Van Rhyn, B., & Barwick, A. (2019). Health practitioners’ perceptions of falls and fall prevention in older people: a meta-synthesis. Qualitative Health Research, 29(1), 69-79.