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Introduction

Nowadays, hospitals are searching for the ways of solving the relevant issues and improvement of the quality of health care. The current work will cover the topic of patients’ falls which leads to the considerable negative consequences to hospitals and patients. Personal leadership problem-solving skills will be used for the development of the initiatives directed at the elimination of the discussed issue through the combination of the existing knowledge and practices introduced in various sources. The current work will identify the problem and the ways of its addressing to protect patients’ health and minimize the additional expenses of health care providing institutions.

Literature Review

The relevance of the problem of patients’ falls is based on the figures which show the rate of the patients’ fall, the additional losses of health care providing institutions related to these falls, and health issues of patients. This data were taken from the work of John Jorgensen (2011). Julia Letts (2012) discussed the major causes of patients’ fall. However, both authors did not provide the ways to improve the situation. Andrea Hunderfund, Cynthia Sweeney, Jayawant Mandrekar, LeAnn Johnson, and Jeffrey W. Britton (2011) noted in their work that one of the solutions to this issue may be represented by the additional physical assessment of patients. This statement was supported by Beatrice Kalisch, Dana Tschannen, and Kyung Hee Lee (2012). The information concerning the cost and duration of the nurses’ trainings was taken from the report of Portland Community College (2015).

Methodology

The current work was based on the information collected from various journals and the Internet. All the sources provide the relevant information and statistical data concerning the chosen topic. The following keywords were used for searching: patients’ fall rate, acute care, nurse training. The information is presented in coherent and understandable manner. The major difficulty during the preparation of the current work was represented by the choice of the topic concerning the relevant issue in health care providing institutions that aligns with the priorities of the hospital and health care.

Analysis and Discussion of the Information

Statement of the Issue, Its Discussion and Analysis

The current work will address the issue of patients’ fall in various health care providing institutions. This issue is closely connected with the work of health care providers, especially nurses who look after the patients’ condition because nearly every nurse can recall the patients’ fall. That is why this issue is closely connected with such an area of practice as training of health providers who are related to patients’ fall and can prevent them.

 

The issue is considered to be rather relevant in the health care providing institutions in the USA. Falls of patients lead to numerous negative consequences both for hospitals and patients. The average stay in the hospital has increased by about 12 days, and the patients’ care costs have risen by about 61% (Jorgensen, 2011). Medical expenses connected with patients’ fall amount to 19 billion USD for non-fatal injuries and about 179 million USD for fatal injuries (Jorgensen, 2011). According to the predictions, these figures are likely to increase. It is estimated that in 2020, the direct and indirect costs of patients’ fall will be 54 billion USD annually (Jorgensen, 2011).

As it was stated above, falls have a considerable negative impact on patients’ health. The majority of patients who fall are people of 65 years and older (Jorgensen, 2011). In this population, falls can cause the injury-related deaths. About half of all patients who fall suffer from severe and moderate injuries which lead to the limitation of their mobility and increase the risk of premature death. Among other severe injuries are hematomas, fractures, disability, and loss of function. A lot of patients are obliged to spend years to recover their health after falls. Even if such incidents do not lead to decline of patients’ functions by causing serious injuries, they can cause serious psychological problems, like fear, avoidance of activities, self-doubts, lowering of confidence, and decrease of life quality. According to the official statistics, 29% to 92% of adult people who have ever fallen in health care providing institutions experience fear before another fall (Jorgensen, 2011). Even people who have never fallen before experience this fear (from 12% to 62%) (Jorgensen, 2011).

Falls of patients are caused by various factors: absence of bed-exit alarms; delayed response to the nurse call bell; treatment of patients with high-risk medication; not calling for assistance of nurse; inadequate assessment of patients’ condition; and inefficient working processes of health care providers (Letts, 2012). Much attention should be paid to the timely response to the nurse bell because some of the patients may not be willing to wait for nurses’ response and thus attempt to leave their bed by themselves. The lack of assistance during the exiting of the bed is one of the primary causes of patients’ falls. The additional emphasis should be paid to the fact that some medication, like sedatives and anti-depressants, can cause the high risk of falls because it causes confusion, impaired mobility, and dizziness. Nurses should pay attention to such patients in order to minimize this risk. Also, some of the patients, especially those who suffer from disorders, can not actually realize the necessity of calling nurses and all the dangers of the unfamiliar environment. That is why these people sometimes prefer to leave the bed by themselves instead of calling nurses. This cause can be minimized by explaining the patient about the nurse assistance or rendering it when it is needed. In addition, the adequate assessment of patients’ condition, i.e., correct identification of the fall risk, will lead to lower risk because nurses will take necessary preventive measures, like moving closer to nurses station, providing lower bed, etc. Moreover, the inefficiency of the working processes reflected in distributing and gathering the medication is closely connected with patients’ falls. Sometimes, nurses are obliged to provide patients with necessary medication or equipment, fill in documents, and communicate with other health care providers, instead of caring for patients. Therefore, the majority of causes are connected with the quality of nursing assistance. This statement is supported by the investigations performed by Beatrice Kalisch, Dana Tschannen, and Kyung Hee Lee (2012). The authors noted that “one method of preventing patient falls is to devise methods whereby nursing staff complete standard nursing care more so than adding staff” (Kalisch, Tschannen, and Lee, 2012).

Solution and Its Justification

The above stated negative consequences show why this issue should be addressed in the nearest time. The issue may be eliminated by creating environment where patients do not fall and improving the quality of nursing care. It should be additionally noted that both of these initiatives are highly manageable and can be implemented in real health care providing institutions. The prevention of patients’ falls is the universal goal of all health care providing institutions. The first solution of the stated issues will be represented by creation of the safe environment: low beds, bed-exit alarms, keeping comfortable temperature, etc. However, the current work will be focused on the second solution: improvement of the quality of nursing work. This can be performed by the establishment of additional trainings for the staff.

The establishment of the additional trainings is necessary to increase awareness of the patient mobility-related risks and the effects of medication on the patients’ condition; provide faster response to light calls; analyze the environment; communicate with patients; improve the working environment of health care providers, etc. These trainings should help health care providers perform relevant assessment of patients’ condition and determine the risk to fall. This assessment can include “tests of vision, hearing, mobility, peripheral sensation, muscle force, reaction time, gait, and balance” and the analysis of the prescribed medication (Jorgensen, 2011). The additional emphasis should be made on the medication that increases the possibility of falling, like “benzodiazepines, antipsychotics, diuretics, insulin, oral hypoglycemic, and etc” (Jorgensen, 2011). Much attention should be paid to any changes in functional mobility and mental status. Functional mobility of the individual can be analyzed by the ability of the patient to perform the following actions: “independent sitting and moves to dangling, kicking and pointing, standing, stepping forward and stepping back, and walking independently” (Jorgensen, 2011). The performance of these actions provides a more comprehensive assessment and better prevention of patients’ falls. This statement is supported by the outcomes of the investigations performed by Andrea Hunderfund, Cynthia Sweeney, Jayawant Mandrekar, LeAnn Johnson, and Jeffrey W. Britton (2011). The researchers determined that the additional physical assessment of the risk of fall of patients could lead to the lowering of these falls (from 4.12 to 2.99 falls per 1,000 patients) (Hunderfund et al, 2011).

Moreover, these trainings will increase the awareness of health care providers concerning the necessity of faster nurse response. This is necessary for prediction and elimination of fall among patients. This initiative is supported by the investigation described by Huey-Ming Tzeng, Marita Titler, David Ronis, and Chang-Yi Yin (2012). They have noted that the faster call response rate leads to the lowering of total falls and injurious falls (Tzeng et al, 2012).

Also, nursing staff should perform analysis of the environment for the assurance of patients’ safety. This can be made by conducting the overview of the room during every entrance and leaving. This assessment is closely connected with the determination of patients’ needs and preferences through communication with them. For example, arrangement of objects according to the preferences of the patient, like keeping TV remote control and the light on.

One of the spheres of the training will be represented by the improvement of the working environment and organizational culture reflected in the establishment of the safe climate in some particular units and in the whole health care providing organization. This can be reached by means of facilitating cooperation between health care providers. The mutual assistance between health care providers and rendering care to the whole group of patients in some cases is more effective than working with some particular patient. The reduction of the pressure will lead to the lowering of the missed nursing care and decreasing of the amount of patients’ fall cases. Therefore, trainings will be directed at the promotion of such skills as cooperative problem solving and cultivation of cross-monitoring.

Trainings will help health care providers organize the working process in a more effective manner and establish the supply chain that will be convenient for rendering health care assistance to patients. The implementation of these initiatives is based on the understanding that reliable and well-organized work and of the supply chain of equipment and medication may have a considerable positive influence on the ability of caregivers to provide care to patients and prevent falls.

Resources and Timeline

The realization of the proposed solution will be performed in the form of trainings held by professional health care providers. These people may work in the hospital where the proposed innovation will be implemented, or they may be invited from other health care providing institutions. A special program for trainings should be created based on the existing guidelines, researches, and statistical data in this field. It will be represented by lectures, work in groups (including discussions), and exams. Therefore, participants will be provided with the opportunity to master their skills, learn new information, and discuss it with trainers and other members of the group. The cost of the proposed program will be estimated on the basis of the information concerning the cost of classroom studies of the nursing assistant training. In 2015, the cost of these studies was 750 USD (Portland Community College, 2015).

The successful realization of this initiative will lead to the considerable education on the amount of patients fall. Such a measure will increase the awareness of health care providers about the patient’s mobility-related risks and the need to perform a more thorough assessment of patients’ condition and the environment, communicate with patients to investigate and cover their needs better (for elimination of exiting from the bed), and respond to calls faster. This will lead to saving hospital expenses on additional treatment, on additional medication and time of treatment, and granting patients safety, health, and life.

The above cost and benefit analysis shows that the cost of the proposed trainings is lower than the obtained benefits. Consequently, the proposed solution is worthwhile.

The proposed training program will contain 80 hours of classroom studies (Portland Community College, 2015). Meetings will be performed twice a week to provide sufficient extent of the information for simultaneous implementation of the obtained knowledge in real life. Each meeting will take four hours. Therefore, the total course will take 2.5 month. This information is formed on the basis of the standard nursing assistant training program.

Key Stakeholders and Partners

The implementation of the discussed solution will be performed through the close cooperation with various people: trainers, administrators of health care providing institution, and heads of units. The realization of trainings will be started only after the thorough discussion of all details with all the concerned parties. The additional attention will be paid to the convenient time of holding of studies, financial matters, and the curriculum of studies. The curriculum and topics will also be discussed with the most experienced nurses who work in the hospital.

All the participants are highly interested in the realization of the proposed initiative because they clearly understand the necessity to perform additional trainings for the reduction of patients’ fall rates. The administrators proposed the convenient for them payment scheme: half of the money will be paid prior to commencement of the studies, and the second part of the sum will be paid after the completion and passage of the final exam by health care providers. Heads of the units proposed to increase the amount of meetings within one week, i.e., to perform studies three times a week instead of two. This will increase the efficiency of work and provide faster reduction of the rate of patients’ fall because health care providers will obtain more knowledge within a shorter time.

All these propositions will be taken into account during the realization of the solution in order to satisfy the requirements of all stakeholders. Also, the achievement of successful cooperation between all the parties involved will be performed trough constant assessment of the quality of studying via grades and activities, and the working outcomes via the analysis of the work of health care providers who undertake the courses. This information will be presented in the form of short reports to provide the general understanding of the results of the program and determine weak sides and not active students. All the stakeholders will be provided with the ability to obtain these reports, analyze them, and propose some changes to the program for the improvement of its effectiveness and efficiency.

The Implementation of the Proposed Solution

The proposed program can be implemented in any health care providing institution that faces the issue of the considerable amount of fall rates and intends to solve it. This process can be started after the thorough assessment of the weak sides of health care provision. This is necessary for the determination of the patients’ care problems and development of the training program directed at solving these issues. The additional attention should be paid to the costs of the courses. A health care providing institution should have enough funds to cover at least half of the trainings.

The success of the program will be evaluated through different methods. The first method is presented by the short reports stated above that will show the immediate effect of the studies. The second method is represented by the annual reports concerning the fall rate of patients that will display the long-term effect from the realization of the program. A special questionnaire will be developed. Patients and their relatives will assess the work and the quality of care to determine the improvements, remained weaknesses, and their further improvement.

Fulfillment of Various Roles during the Preparation of the Work

The preparation of the current work requires fulfillment of various roles: detective, scientist, and manager of the healing environment. The detective role has been reflected in the necessity to identify the issue that is relevant to the health care provision and searching the evidence-based information concerning this issue. The role of a scientist has been reflected in the analysis of the discovered information from the scientific point of view. The last role was reflected in the creation of the set of procedures which will provide the greater effect in the improvement of the quality of health care providing services. This role has also been reflected in the determination of the involved parties and creation of links for the successful cooperation between all of them.

Conclusion

In conclusion, it should be noted that the current work addresses the issue of patients’ falls that have considerable negative consequences to patients’ health and cause additional losses to hospitals. It is notable that this issue can be prevented in the majority of cases by the improvement of the awareness, knowledge, and skills of health care providers. It can be performed through the additional training directed at increasing the awareness of patients’ conditions and fall risks, faster response to light calls, and improvement of the working environment of health care providers. The trainings will take 80 hours and will cost 750 USD. The realization of this initiative will be thoroughly discussed with all the concerned parties: trainers, administrators of health care providing institution, and heads of units. Their propositions will be taken into the account before the commencement of the studies. Also, the success of the cooperation will be granted by providing short reports concerning trainings and their outcomes. The effectiveness of the whole initiative will be determined on the basis of the analysis of these reports, annual reports, and special questionnaires. All these steps are necessary for the development and realization of the effective training program directed at improvement of quality of health care provision, granting patients safety, and reduction of hospital expenses through lowering of the patients’ fall rate.

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