Falls occur as a severe health concern among patients, especially the aged. Falls are a significant health concern that causes injuries and often causes death among elderly patients. In 2019, more than 35000 deaths were reported to occur from falls. Not every fall episode leads to injury, but about 10 to 25% of the cases lead to severe injuries (Fall Risk Management Evidence-Based Best Practice, n.d.). It has been noted that about 50% of the old patients who endure falls end up with secondary injuries, which could occur as death, subdural hematomas, and fractures (Appeadu & Bordoni, 2023). About 2.42% of the total falls occur among old patients, with about 1.98% ending with moderate to severe harm outcomes (Mutaz Alsumadi et al., (2023). Fall risk management is an essential aspect of care delivery, particularly affecting individuals in orthopedic care settings where the risk of falls among geriatric patients is high; hence, a practical assessment is paramount.
As a crucial performance measure in the healthcare effectiveness data and information set, risk of fall management is an essential tool that addresses a significant health concern and promotes the goals to encourage the patient’s safety and well-being. This paper aims to explore major evidence-based interventions for preventing falls among elderly patients in the orthopedic units. There will be an evaluation of the effectiveness of fall risk reduction, promotion of patient outcomes, and cost management upon implementation of the intervention. Falls risk management is an important performance measure that helps address the need to promote patients’ safety and well-being. Among older patients, falls are associated with significant health outcomes, which include functional decline, prolonged hospitalization, the delayed recovery process, injuries such as hematomas, and even death (Appeadu & Bordoni, 2023). In this case, addressing the risk of falls among senior adults is a necessary intervention that promotes the patient’s quality of life and overall safety, a significant aspect for nurse professionals.
The purpose of the paper is to offer a comprehensive overview of the fall management interventions among geriatric patients with orthopedic cases, which include self-management promotion, physical therapy or exercises to promote strength, gait, and balance, and multifactorial risk assessments while collaborating with various care professionals to promote safety of the patients.
HEDIS measure:
To ensure quality patient care, meeting the Healthcare Effectiveness Data and Information Set is a major aspect of determining the care planning to promote performance on various services and essential dimensions. The six domains of care from the HEDIS measures include; – effectiveness of care, access and availability of care, experience of care, utilization and risk-adjusted utilization, health plan descriptive information, and measures using the electronic clinical data systems. To be specific, the HEDIS domain of choice to address the issue of falls among senior orthopedic patients is the effectiveness of care. Engaging the aged orthopedic patients in the desired quality of care, improving interventions such as patient education and self-management to promote safety, engaging them in strengthening exercises, and proper assessment and modification are essential to promote the effectiveness of care offered among this vulnerable population.
Patient Interventions
Intervention one: multifactorial risk assessment and modification for the patients
According to Hopewell et al. (2020), the role of the multifactorial fall risk assent and modification process is to enhance a systematic approach to risk factors and take required interventions to prevent the risk. By identifying the risk factors that increase fall chances, the right interventions are taken that promote patient-based management, which translates to quality care and a safer process based on precaution management. Through proper fall risk assessment, patients’ concerns, such as changes in strength, gait, mobility, balance, and muscle weakness, are established, and desirable interventions, such as exercise routines to enhance strength and resistance and walking aids to promote balance and gait are provided for the patient. According to Strini et al. (2021), to determine the risk of falls, the Morse fall scale and time up and the test are used to determine the risk for the patient. The test begins when a patient stands and stops when he or she sits back. The patients’ interventions, such as installing bedside rails, proper lighting, medication regimen adjustments, and supportive tools, are based on the established fall risk factors. Patients are referred to balance training in physiotherapy units, home safety promotion through walkers and caregiver presence, and provision of vision aids, which promotes safer walking among the population.
Intervention Two
Intervention 2: Physiotherapy program (promoting exercise and strength for the patients)
To ensure the safety of the patients, there is a need for a structured strength and balance exercise program among orthopedic elderly patients, which helps mitigate the risk of falls. Here, the program involves exercises oriented toward promoting gait, balance, and strength of the muscles while enhancing patients’ flexibility (Claudino et al., 2021). On this note, the patients are encouraged to participate in guided, supervised, and safer exercise sessions in the care facility. The patient could also be engaged in community-based exercises such as recreational sessions. Having the patients undergo regular training and exercise routines will be essential to promote overall balance and strength. At the same time, the proper adjustment is made based on the patient’s health demands to promote the safety and effectiveness of the interventions (Claudino et al., 2021).
To determine the impact of the intervention, the fall rates and risk moments will be recorded among each patient. Fall risk is a significant metric that requires a reporting system for fall incidences, which determines the impact of the intervention (Claudino et al., 2021). Muscle tone and strength will also be crucial to establish the patients’ resistance rate to fall risk (Claudino et al., 2021). Exercise sessions and training programs are more effective in countering the risk of falls and fall-related injuries while they improve muscle mass, physical capacity, and cognition processes (Claudino et al., 2021). Old patients living with comorbidities and other clinical conditions end up with a reduced risk of mortality.
Intervention Three
Intervention 3: Patient education on fall prevention and enhancement of self-management potential
Proper self-management and education can maximize the utility of fall prevention interventions among patients and minimize the risk of falls among the aged. The success of fall prevention self-care and management measures has been overly studied, and much has been established on the need for older adults to participate in fall prevention self-care and management behaviors and actions (Heng et al., 2020). Among the orthopedic patients where the risk of falls is high, they are required to be enlightened on critical measures such as wearing vision glasses, making sure there is proper lighting, walking slowly, waiting for assistance when needed, wearing comfortable shoes and other wearables which detect the risk of fall, and offering the necessary information regarding the risk of falls among such patients (Heng et al., 2020). Such measures noted above can help reduce the risk of falls among aged patients whose risk of falling increases due to polypharmacy, anesthetics use, pain, comorbidities, ill health, muscle weakness, and cognitive decline as age advances. Proper patient education is a significant strategy that helps address the fall gap by increasing patient participation in fall prevention measures. Alongside medication management, clinical education, assistive device use, environmental modification, multidisciplinary review, policy formulation, and fall prevention systems promotion, patient education helps promote self-management and fall prevention among patients.
Patient education and training are essential since there is a risk of a mismatch between actual falls and perceived risk while in the hospital (Heng et al., 2020). Tools such as the falls risk assessment tool, Hendrich II fall risk mode, and the St. Thomas risk assessment tool help determine the patient’s risk score after the education session’s implementation (Heng et al., 2020). Various educational tools such as videos, reading pamphlets, and one-on-one training sessions help sensitize the patient to safety measures. Also, patients need to be encouraged to participate effectively in fall prevention measures and plan where they set goals, track progress on management, and report any changes that occur during the improvement and risk of falls.
Improved Patient Outcomes
Implementing interventions such as patient education and self-management promotion, exercise routines, and multifactorial risk assessment and modification will be essential to reduce the risk of falls and the extent of fall-related injuries among them. To begin with, through a fall risk assessment, risk factors such as poor lightening, muscle weakness, polypharmacy, and history of falls will be established, which helps appreciate necessary interventions such as proper lighting, which thereby contribute to reducing the risk of falls (Hopewell et al., 2020). On the other hand, an exercise program is helpful for patients to ensure their gain flexibility, muscle strength, improved muscle mass, gait regain, and balance, which reduce the risk of falls (Claudino et al., 2021). Finally, the patients who are well enlightened on fall risk prevention and safety measures will be empowered to take necessary interventions towards fall prevention. These include engagement in exercise routines, using walking aids, ensuring proper management of mendicants, and reporting any fall risk, history, or signs of dizziness, among others. This proactive intervention enhanced adherence to safety measures, increased awareness of fall prevention, and increased confidence in a patient-centered approach toward fall mitigation.
Cost Savings
Prevention of falls among patients is an essential interventional approach that helps reduce the cost of care incurred by the patients and the healthcare systems in managing such patients. On this note, preventing fall-related injuries is essential to reduce the cost incurred in emergency management, prolonged hospitalizations, and engagement in fall prevention rehabilitation services such as physiotherapy programs. Here, there fall prevention interventions such as patient self-management, exercise programs, and fall risk assessment and modification help reduce the economic burden incurred in healthcare in the long run hence leading to overall cost-efficient care for both the modification care organization and the patients (Dykes et al., 2023). A research study reveals that prevention of falls reduces the risk of fall-related adverse outcomes and minimizes the cost of care, where approximately $14600 intervention-based saving was attained for every 1000 patient days (Dykes et al., 2023). Poor fall prevention measures increased the cost of care from $35365 to $36776 among the population engaged in the matched case-control study (Dykes et al., 2023). On this note, as noted above, effective interventions reduce the incidence of falls, reducing cost and harm.
Patient Ratings
Interventions such as fall risk assessment and modification, exercise programs, and patient education promote patients’ satisfaction with the provided care, enhancing the patients’ ratings by promoting well-being and overall patient safety. Patients receiving comprehensive, personalized interventions risk fall assessment. Progressive care support is highly likely to respond positively to the offered care. On the other hand, better patient outcomes, which include functional promotion, reduced risk of falls, and provision of progressive support, are essential for aged patients at risk of falls (Park, 2021). This eventually translates to better health outcomes and high patient satisfaction levels, hence better patient ratings of the nurse’s professional quality of care (Park, 2021).
Conclusion
In summary, proper fall risk management is a significant requirement, especially among aged orthopedic patients with a high risk of falls. Proper fall prevention interventions translate to better patient outcomes, improved safety, and reduced cost of care among patients. Various interventions include engaging the patients in exercise programs, multifactorial fall risk assessment and modification, and effective patient education, which translates to better nursing practice impact on the patient’s overall well-being. This offers an opportunity for a healthier and quality life among senior patients whose risk of falls is increased due to reduced physiological potential, mental deterioration, orthopedic procedures, polypharmacy, pain, and weakness, among other age-related issues such as vision loss.
References
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