Introduction
Hospital falls are a global issue that poses patient safety risks, with the senior population being the most affected. Fall-related injuries are seen more often in geriatric patients, who tend to have a higher risk of falling. The expected hospital fall rates in the United States range from 3.3 to 11.5 falls per 1000 patient days, according to estimates. On average, up to 25% of hospital falls cause injury, thereby making the patient stay longer while also increasing healthcare costs and liabilities (Turner et al., 2022). According to the National Database of Nursing Quality Indicators (NDNQI) falls are defined as muscle accidents; such as when a patient slips on a wet floor, unexpected physiological fall where an individual faints, and anticipated physiological fall for instance when a patient risk factor was identified (WHO, 2008). In contrast to other healthcare-acquired conditions, there are no accepted and evidence-based prevention interventions for falls, making it hard to define the most effective prevention practices in these terms. This LLE focuses on developing an exhaustive policy for addressing fall risks in the ER. The offered policy is consistent with organizational priorities and positively presents the three layers of the nurse’s role as a scientist, detective, and manager of the healing environment. The LLE targets this critical element of patient safety to improve propitious health outcomes and ensure a safe environment for patients and health workers.
Problem Identification
Problem Explanation
The increased danger of falls for patients in the ER is a critical issue, as it could cause injury and raise costs associated with providing care. This issue is essential to the ER because patients are brought into this setting with typically urgent conditions that normally impair mobility, placing them at higher risk of falling. The effect these events have on patients is indeed very traumatic, leaving the hospital resources rundown in the process. Thus, a comprehensive and multidimensional approach is essential in addressing the fall risks to ensure patient safety, maintain standards of care, and reduce the financial burden resulting from complications caused by falls.
Investigation of the Problem
Evidence
An organizational assessment was also conducted to provide the basis for the investigative process in order to uncover the fall risk of issues in the ER setting. This internal assessment pinpointed a substantial number of fall cases that occur within the ER to indicate the urgency of this issue. Notwithstanding this, the analysis did not only take up internal factors but also national source documents. Credible healthcare agencies and patient safety organizations also validated local findings through the secondary data. These stipulated that it is a significant threat affecting most people and, thus, an immediate problem (Pop et al., 2020). This integration of internal and national evidence led to an increase in the validity of the issue identified as being related to fall risk.
Proposed Solution
Justification for Proposed Solution
The proposed remedial action recommends the implementation of a complete fall risk management plan that addresses the issues outlined within the ER setting. This solution is justified by the results of the investigative process that indicated a critical requirement for directional intervention. The contributing factors are understaffing, insufficient patient assessments, and environmental hazards, which require a systematic and comprehensive public policy approach. Therefore, addressing the psychological dimensions that lead to such a situation through an efficient policy implies adopting a preventative approach towards preventing fall risks together with enhancing patient safety in ERs that can be implemented under extreme conditions (Muray et al., 2018).
Resources and Cost-Benefit Analysis
Some of the necessary resources for implementing the proposed fall risk management policy in the ER are hiring more staff, specific training programs, and physical changes. There are also efforts to address the severe crisis of staff shortages during peak hours through increased recruitment to maintain a more alert and active environment. Training programs will empower healthcare professionals with such strength that they can perform patient assessments effectively and prevent fall risks. Environmental adaptations are the environmental modification efforts to ensure the safety in the ER. The cost-benefit analysis incorporated in the discussion also emphasizes the benefits that persist over time that serve beyond better patient outcomes to include savings a tremendous amount from larger healthcare bills generated by preventing fall-associated complications (Pop et al., 2020).
Implementation Timeline
The rollout schedule for policy implementation fall risk management in ER is precisely structured to provide a smooth and systematic transition. Such strategic milestones are shown through policy development, training initiatives, and staff working together with each other to make changes. In order for the staff to be well prepared, training sessions related to complete patient assessment and fall preventive procedures were conducted on specific schedules. The assessment helps to evaluate issues that have been assessed throughout the process and guarantees their efficiency. This systematic methodology simplifies policy implementation and also provides a basis for periodic review, necessary adjustments, and continuous improvement of fall risk management in the ER that is dynamic.
Stakeholder Engagement
Key Stakeholders
Stakeholder engagement is pivotal to the proper operation of the fall risk management policy in the ER. The primary stakeholders for this project include the ER staff, nursing management, and hospital administration. Recognizing the importance of their position, engagement sessions were conducted to receive and consider their recommendations. Being at the frontline of patient care, ER staff contributed valuable insights into pragmatic issues and specifics surrounding the current fall risk environment. The nursing leadership was offered strategic direction, ensuring its actions coordinated within the general objectives of nursing while the hospital management provided the provisions needed to implement these policies (Boye-Doe 2017). The success of the policy depends on cooperation with stakeholders. Communication channels serve to facilitate the flow of information and rapid solving of problems. It is for this reason that interdisciplinary teamwork and a shared approach to fall risk management are encouraged (Muray et al., 2018). Communication between both parties is constantly open as feedback is provided in the form of regular meetings and surveys. These approaches motivate stakeholders to connect and promote accountability among various parties toward the success of the fall risk management policy. Thus, a culture of cooperation and unity in ER health emerges from a single interaction with particular members of the stakeholders and also through an ongoing dynamic process.
Implementation and Evaluation
The implementation of the fall risk management policy at the ER includes a universal approach that is composed of diffusion stage, staff training, and environmental adaptation. The overall plan of implementation contains a number of recurring checkpoints and milestones for measuring progress. On the other hand, the evaluation method refers to determining the success of implementation by calculating the frequency of fall incidents, employees’ compliance with this policy, and the results obtained in patients. This all-time continuous evaluation provides for an ongoing, dynamic adjustment that ensures the opportunity to make necessary policy changes in accordance with the need for risk reduction and overall patient safety improvement in such an urgent care environment.
Roles in Investigation and Proposal Development
Manager of the Healing Environment
As a manager of a healing environment, the proposed fall risk management policy is founded on the overall goal of developing a safer and secure ER setting for the patient. Such a multilayered approach highlights the nurse’s duty not only to address acute medical conditions but also to create an environment where healing, well-being, and patient safety are possible. Mitigating fall dangers seems to be one of the critical points of the proposal because there cannot be any recovery without a safe environment. In the healing environment manager role, there is a focus on physical and emotional aspects, as well as the psychological state that contributes to the patient’s health (Morello et al., 2019). The fall risk management policy, which is proposed as the above, includes environmental factors, staffing levels, and training to be specially targeted towards the enhanced patient-based approach in addressing care in an ER setting.
A part of the proposal focuses on environmental modifications aimed at addressing potential hazards contributing to fall risks. This encompasses a comprehensive assessment that includes an ER floor plan, lighting system, type of flooring, and its impact on clinical practice. The healing environment manager’s role ensures they are not merely corrective actions but proactive preventions and that shifting the care transitional treatment from facility to home is in keeping with the principle of creating a healing place focusing on patient safety. Also, the importance of staffing at peak time hours is highlighted because it directly affects patients’ supervision and prompt responses to their needs (Morello et al., 2019). As a manager of the healing environment, the nurse promotes accounting staffing adjustments according to patient acuity levels, which creates an environment where there is no compromise in quality patient care and the risk of patients falling is minimal.
Detective
In the detective position, the uncovering of potential risks for falls in the ER required a carefully structured and all-around investigation with an aim at determining root tendencies causing the specific issues. This detective work went beyond the sight to find hidden elements that could be responsible for an increased risk of patient falls. The detective role utilizes an organizational assessment that functions to conduct a comprehensive analysis of the internal practices, employees’ performance, and systemic problems in the ER. Consequently, more gaps were formed in contemporary practices because of this evaluation, which revealed trends in the perception of falls. When probing ERs, a detective searches for causal factors that lead to falls (Harper et al., 2021). The detective also widened the scope of his search even at root level contributors to fall-risk factors. Beyond apparent ones, hidden factors like some forms of systemic issues may contribute to events within the ER, for instance, due to ineffective communication, poor training, or wrong procedures (Boye-Doe 2017). The detective role was, therefore, designed to seek out these latent features, which allowed the image of other components to play a role in increasing the danger of falls.
Scientist
The scientific implementation of ER analysis to fall risks was developed using an effective and accurate technique. This stems from the critical analysis of evidence-based data that has been driven by empirical research, organizational appraisals, and also national document sources. The researchers used the above research methodology because of a thorough evaluation of qualitative and quantitative data that allowed the identification of trends, patterns, and correlations connected with falls in an ER. The quantitative assessment was objective, reliable, and reproducible in outlining a list of different potentials that applied to the phenomenon. These, for instance, involved shortage issues, critical analysis, faulty patient assessment numbers, and environmental hazards. Based on the principles of EBP practice, the research aimed to pinpoint sources for risks associated with falling to influence elements that are conducive to policy-making. The use of the evidence-based approach was pivotal in forming a robust and comprehensive understanding of the issue, resulting in support for the proposed solution (Harper et al., 2021). This scientific rigor not only enhanced the validity of this research but also created a foundation for fall risk treatment policy that was grounded on solid empirical backing as well as a commitment to continuous advancement in levels of safety within ER patients.
In addition, my scientific role was primarily related to the implementation of research and evidence-based practices. In this respect, I embarked on a broad literature review of the available studies regarding guidelines and articles that have described fall prevention schemes in emergency care environments. This large-scale search acted as a theoretical background for my research, proving to me the well-established effective practices and innovative interventions. In addition to the literature review, I participated in multidisciplinary meetings within the ER team, which was comprised of nurses, doctors, and other support staff. This cooperative process permitted the investigation to be based not only on scholarly studies but also on actual situations of individuals responsible for treating patients. This integration of evidence-based practices included the assessment analysis of organizational evaluations and national source documents (Harper et al., 2021). Therefore, by aligning our results with accepted standards and guidance from authoritative agencies such as the CDC and ENA, I guaranteed that the solutions generated in this study were not only new but also based on known strategies supported by research evidence. This thus provides a foundation in the ER regarding patient safety and improved health outcomes, leading to the development of scientific rigor as an establishment of the specific policy for fall risk management.
Conclusion
To conclude, the implementation of the multi-pronged fall risk management policy for ER plays a crucial role in dealing with a significant patient safety issue. The roles that the nurse took during this undertaking are fundamental to the policy’s success. A scientific way of thinking allowed the nurse to rely on a systematized and scientifically informed approach, one that was based on evidence-based data and contemporary practice. In the detective position, contributors to fall risks hidden from view were revealed, and thus, a complete understanding of the problem was ensured. Leveraging on the managerial nature of the healing environment, the nurse championed comprehensive interventions designed to go beyond short-term intervention programs that create an enduring culture of safety. Stakeholder engagement was integral in improving the proposed solution through contributions from ER staff, and nursing leadership as well as hospital administration. This cooperative endeavor advances the policy’s relevance and encourages a feeling of collective accountability from stakeholders.
References
Boye-Doe, S. B. (2017). Improving fall prevention strategies in an acute-care setting (Doctoral dissertation, Walden University).
Harper, K. J., Arendts, G., Barton, A. D., & Celenza, A. (2021). Providing fall prevention services in the emergency department: Is it effective? A systematic review and meta‐analysis. Australasian journal on ageing, 40(2), 116-128.
Morello, R. T., Soh, S. E., Behm, K., Egan, A., Ayton, D., Hill, K., … & Barker, A. L. (2019). Multifactorial falls prevention programmes for older adults presenting to the emergency department with a fall: systematic review and meta-analysis. Injury prevention.
Muray, M., Bélanger, C. H., & Razmak, J. (2018). Fall prevention strategy in an emergency department. International journal of health care quality assurance, 31(1), 2-9.
Pop, H., Lamb, K., Livesay, S., Altman, P., Sanchez, A., & Nora, M. E. (2020). Tailoring a comprehensive bundled intervention for ED fall prevention. Journal of emergency nursing, 46(2), 225-232.
Turner, K., Staggs, V. S., Potter, C., Cramer, E., Shorr, R. I., & Mion, L. C. (2022). Fall prevention practices and implementation strategies: examining consistency across hospital units. Journal of patient safety, 18(1), e236.
World Health Organization. Ageing, & Life Course Unit. (2008). WHO global report on falls prevention in older age. World Health Organization.
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