Introduction
Fall is among the leading problems that affect hospitalized adult patients due to various healthcare complications in the healthcare facility. The consequences of falls include harm and even death of these individuals. This is unfortunate because all patients usually seek quality and safe healthcare practices, and the healthcare facility needs to do everything possible to improve fall issues in the healthcare facility. Therefore, as the result of inspiring to reduce the rate of falls in healthcare facilities and the adverse effects which normally occur due to falls, a healthcare leader needs to answer the following picot question. How will introduce a fall bundle affect rates from past fall relatives to present rates over six weeks in the hospitalized inpatient adults? Therefore, the leadership action for change is to reduce falls among hospitalized adult inpatients through a fall bundle prevention approach.
The bundle approach to enhance the prevention of falls among hospitalized inpatients has been effective since its introduction in healthcare. This is revealed by the registered nurse who initiated the bundle strategy. They evaluated and showed a significant decrease in falls by approximately 41 % after implementing the bundle approach for eleven months. This portrays a considerable reduction compared with the fall rate eleven months before the implementation. These findings positively drive the healthcare field and are the likely reason why the leadership in the healthcare under discussion decided to select this approach to fall prevention (Type & Date, 2019). The model and the theory which this needs assessment used is the quality improvement model-FOCUS-PDCA model. Since the past literature revealed a significant decrease in the number of falls after implementing the fall bundle approach in a healthcare facility, it is evidenced that the change of introducing and implementing a fall bundle in the healthcare organization will reduce the number of hospitalized falls significantly.
While looking at the evidence-based research supporting the fall prevention plan, it was necessary to ensure that all nursing staff practice the same practice that targets fall prevention. This is an evidence-based practice, and it maintains the safety of patients. From the current research, it is evident that as individual safety increases in the healthcare facility, it is likely that there will be an increase in the outcome in the overall condition of the patients. Therefore, through this evidence-based research, it is clear that using the fall bundle approach in healthcare facilities can lower the total number of falls in the facility and reduce the number of injuries associated with falls in the healthcare facility. The fall among hospitalized adults is more likely to reduce significantly by 40 %, as indicated in the previous litterateurs (Campbell, 2018).
As a leader of this healthcare organization, I am responsible for ensuring that the fall bundle approach initiative is implemented in our healthcare organization. Therefore, it was my responsibility to coordinate with other healthcare providers to ensure that this approach was implemented. It was also the leadership’s responsibility to allocate duties for different stakeholders and supervise to ensure that they conduct such responsibilities. During the implementation of fall bundles and fall prevention, the stakeholders included nurses, pharmacists, nurse aides, occupational therapists, and training medical providers. These stakeholders conduct activities such as completion and documentation of fall risk assessment, evaluating the safety of the patient’s environment, reviewing the medication the patient is using, provision of skilled therapy, etc.
Through commitment, showing an example, teamwork, and collaboration, I made everyone move positively in implementing a fall bundle approach to prevent falls among hospitalized adult inpatient individuals. The healthcare organization has the mission and vision of ensuring high quality and safety of care to patients. The core values include teamwork, collaboration, time management, and commitment. Therefore, it is clear that the organization’s mission and vision match my proposed change. The ultimate goal of this proposed change was to ensure that there is a reduction of falls among hospitalized adult patients through the implementation of the fall bundle approach, thus leading to safety and quality of healthcare in this healthcare facility.
Interventions
The approach to implementing this plan in this healthcare facility adopted a quality improvement model adopting the FOCUS model. The initial step for this implementation involved finding a process to improve the healthcare facility. This included identifying the number of patients who have experienced fall issues in the hospital setting. This data focused on adult patients who had undergone minor and major injuries due to a fall in the hospital in the last year. These data were available in the electronic health records of a healthcare facility. While linking this to the literature, it is evident that there is an increase in the cost of care due to injuries that adult patients develop in the hospital (Hoffman et al., 2019). The number of fall injuries among the adult patients totalled 1500 patients within one year to the health data. These numbers included both minor injury falls and the major injury falls. The procedure of conducting fall bundle prevention is relevant to nursing practice since it helps create awareness for the nursing team and helps provide education to other staff on the adverse effects of fall injuries in healthcare settings. It is also postulated that the falls and damages resulting from falls are due to the quality and safety of healthcare services that the nursing staff provides to patients. This is why falls act as a quality indicator that the American Nurses Association uses to conduct evaluations (Thi et al., 2021).
During the implementation of this project, while using the quality improved model, the next implantation step entails organizing the important activities that could lead to meeting the objectives. Implementing the fall bundle approach entails collaboration from multidisciplinary teams such as nurses, therapists, pharmacists, staff taking care of patients, doctors, and physiotherapists. This team also consists of the nursing team that has transformational leadership skills, thus making them able to inspire and motivate others to practice the fall prevention strategies. As a team leader, I ensured a strong collaboration with the committee responsible for spearheading the fall implementation plan. This was done with a lot of passion, keeping in mind that the fall bundle is responsible for preventing harm to patients due to fall injuries. It also increases the awareness of all stakeholders concerning fall and fall safety. It also entails providing relevant education to patients and family members. As the team leader, I collaborated with the committee and articulated the following responsibilities thoroughly. The role is to conduct a thorough analysis and present a synthesis document to the committee. Another part also includes making recommendations concerning the most appropriate fall prevention strategies. The next role is ensuring the development of the fall prevention bundle toolkit, which the nursing staff will use to articulate the fall bundle approach. I also consider formulating an educational curriculum targeting the teams of nursing and the physician. I also ensured that there were well-developed evaluation strategies, such as the content of the summative evaluation. In this implementation plan, three designated content experts within the team had delegated the role of evaluating the whole process to identify its effectiveness (Campbell, 2018).
During the survey of nursing staff, they clarified the activities which majorly rely on to enhance the prevention of falls among hospitalized adult patients. They focused on being present at the bedside to ensure that patients did not experience falls that could result in fall-related injuries. Even though this strategy also helps prevent falls, it had some inconvenience when considering the ratio of the nurses working in the healthcare facility and the number of patients present at that particular point. Therefore, the use of modelling and role modelling theory was helpful in the development of and implementation of a plan for fall bundle prevention which nursing staff did not have much knowledge on. The approach focused on nursing education, including attributes such as nursing practice, nursing interventions, nursing assessment, and nursing implantation (Harrison et al., 2021). This theory was much applicable during the educational curriculum development stage and the implementation of the fall bundle to both patients and caregivers. The view of the model describes how the fall bundle approach was demonstrated, while the role model suggests using a teach-back strategy. Through this theory, healthcare providers could use it to gather an understanding of the client’s world while looking at the client’s perception (Harrison et al., 2021).
Ideally, when a healthcare professional, especially nurses, understands this process, it enables the nurse’s staff to assess the clients better based on the idea that they know the clients’ thinking. It also has key assumptions that suggest that every human being is interested in interacting with one another in society, which will enable them to carry out any selected role in the community. Therefore, the knowledge of the model and role model theory allowed the staff nurses to apply this model to enhance the planning of the interventions. While using this theory and incorporating it with the quality improvement model, it is evident that they focus on the clients’ own needs and perceptions. It is also a user-friendly combination and focuses on improving the quality of the patient. Therefore, it is evident that staff nursing will identify the gaps, such as lack of knowledge concerning fall bundle prevention, and provide relevant educational needs as outlined in the implantation procedure (Harrison et al., 2021). The outcome which is needed in this project is to ensure that the fall bundle approach is implemented and the number of fall cases reduces significantly during the evaluation stage. The evaluation will adopt summative evaluation where the evaluator will compare the number of falls previously and the number of falls recently among these hospitalized adult patients. Therefore, the following needs to be done to meet the consequences.
All registered nurses need to conduct hourly rounds to identify the hospitalized adult patients at risk of developing falls. The bedside nurse needs to perform and report a daily safety check and enhance the activation of the alarms present in the chair and the bed to alert the staff nurses in case of falling. Healthcare facilities should also have nursing assistants’ bedside rounds, which prevent the risk of falls. All healthcare providers should also take the initiative to apply the Morse Fall Scale. This is conducted every shift, and they focus on the prevention of falls among hospitalized adult patients. The healthcare facility needs to report the daily activities, including the number of days or hours since the facility experience fall and the overview description of types of patients with a high risk of experiencing fall in every unit in the healthcare facility under discussion.
While articulating these interventions, it was also important to consider the activities indicated in the fall safety bundle. These are standard workpieces that the fall committee identified. These include the activities such as enhancing effective communication with patients, enhancing the safety of toileting for the patients, the practice on how to use the instrument, which can lead to the prevention of falls, etc. Healthcare organizations should also ensure that the patient’s environment is free from tools and obstacles resulting in falls. These evidence-based practices have indicated positivity in understanding and implementing the strategies to reduce falls among hospitalized patients. Another important thing that I conducted to ensure proper implementation of this plan is continuous interactive training. This included mandatory education through the use of platforms such as computer-based. This will be a top priority in ensuring that all the units in nursing are involved in such strategies. Ideally, this interactive educational session aims to reduce fall prevention by making all healthcare providers have the relevant knowledge concerning the fall bundle prevention approach (Campbell, 2018).
Conclusion
The ultimate goal was to ensure the implementation of the fall bundle approach as a strategy for reducing the number of falls among hospitalized adult patients. Therefore, it is evident that the performance of these strategies must reduce the fall among this category of patients. Thus, the fall bundle approach will significantly reduce falls among hospitalized adult patients compared to the previous prevalence rate. This plan is a demanding plan that needs commitment from healthcare providers and staff nursing. Some nurses found it very challenging to admit to such responsibility. However, since they understand that the mission and vision of the organization are to ensure an improvement in the quality and safety of the healthcare delivery system, the nursing staff were able to comply and implement the program. There was a lot of teamwork and collaboration aligned with the organization’s core values. During this project, I understood that transformational leadership style and partnership are essential while implementing a change program. The evaluation of the project was through the summative of the whole process after implementation. The project concluded that there were few fall cases recorded. This means that the fall bundle approach was an effective approach for fall prevention when incorporated with models such as the quality improvement model.
References
Campbell, B. D. (2018). Fall Safety Bundle.
Harrison, R., Fischer, S., & Le-dao, H. (2021). Where Do Models for Change Management, Improvement, and Implementation Meet ? A Systematic Review of the Applications of Change Management Models in Healthcare. 85–108.
Hoffman, G. J., Liu, H., Alexander, N. B., Tinetti, M., Braun, T. M., & Min, L. C. (2019). Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older. 2(5), 1–12. https://doi.org/10.1001/jamanetworkopen.2019.4276
Thi, N., Chinh, M., Thi, P., Ngoc, B., Minh, N., Thi, D., … Tran, D. (2021). Deepening Analysis on Preventing Fall Risk with Knowledge and Practices of Nurses and Nursing. 12(3), 308–313.
Type, I., & Date, P. (2019). Implementation of a Fall Prevention Bundle on a Pediatric Neurology Unit.
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