Falls data were collected using the Post Fall Notes located in the electronic medical record, along with the incident reports that had been conducted after each fall. The prevalence of falls calculated within the last 90 days showed a total of 52 falls occurring among 25 residents. Three of the residents that fell sustained life-threatening injuries such as a skull and hip fracture. Only two fall care plans were conducted using an ICPT approach to updating them. There was no formalized fall committee to conduct PFHs using AARs. A review was conducted by studying the educational training sessions completed by staff data shows that formal education on the topic of falls is needed for all staff.
Concerns for Further EducationIn the United States, it is estimated that 1,383,700 individuals living in nursing homes. Research shows that an estimated mean 1.5 falls/bed/year occur in nursing homes annually, with 4% of falls causing a fracture and 11% resulting in serious injuries such as lacerations or brain trauma. Reoccurring falls with injury within residential facilities pose a significant health care concern (Teresi et al., 2013). Preventing falls within the long-term care setting (LTC) is challenging, however direct-care staff often receive no fall prevention training.
Research supports the provision of an educational program to increase awareness of identifying high-risk fallers, create individualized fall interventions, and evaluate approaches needed for the residents (Kimbell, 2002). The current project will improve fall care plans because the ICPT will discuss problems, goals, interventions, and approaches to decrease falls. Evidence supports that, using AARs will enhance a team learning environment which will improve quality and performance.
The United States Army has used AARs for decades within its medical and aviation fields, as well as in other areas. The process of conducting AARs has proven to be effective in reflection, team discussion, goal setting, and learning promotion (Tannenbaum, 2013). The project leader will become proficient in gathering evidence- based research and incorporating the research into the clinical setting in order to improve safety.
A randomized control trial showed a significant decrease in falls after the implementation of an educational program given via a team approach the placement of interventions using PFHs (Becker et al., 2003). A participatory action project showed the benefits of using hurdles to allow an opportunity for staff to discuss and manage behavior that may precipitate falls.
Evidence has proven that using PFHs improved staff collaboration, teamwork, support, and communication which together improved resident outcomes (Wagner et al., 2014). Vlaeyen and colleagues (2015) found that using individualized fall prevention interventions decreased reoccurring falls by 21% (Vlaeyen et al., 2015).
Seventeen hospitals participated in a randomized control trial that focused on PFHs conducted using a team approach. The study showed significant improvements: the staff implemented individualized fall care plans, teamwork was improved, and falls decreased. Over 59% of all reported falls demonstrated the benefits of using a team approach (Reiter-Palmon et al., 2015).
A secondary analysis of a cluster-randomized controlled trial resulted in a positive outcome after initiating a multifactor fall prevention program within six nursing homes. The staff was provided with fall intervention education which instigated specific fall interventions such as wearing hip protectors, creating a safer environment, and decreased falls (Rapp et al., 2008).
Another study performed focused on the importance of staff participation in a fall education program. The team during this project collaborated to develop a fall education program that showed an increased awareness for identifying high-risk fallers. The educational session consisted of a 45- minute fall educational program for staff and residents that was presented via Power Point. These actions resulted in a significant decrease in falls (Narirat et.al., 2015).
An observational study was conducted to measure the effects of using a multidisciplinary team to place fall interventions for quality improvement. This study correlates with the need for implementing the current project. It developed a fall risk tool, post fall huddles, staff education, and staff compliance by using a team approach. The end results indicated a significant decrease (p=0.039): incidences declined from 2.13 falls per 1000 patient days to 1.53 falls per 1000 patient days (Ohde et al., 2012).
A systematic review of fall prevention interventions was conducted by evaluating Seventeen RCTs and four uncontrolled studies. Evidence related to a decrease in falls showed that using multidisciplinary interventions created a higher staff awareness which reduced the risk of falls (Neyens et.al., 2006). A retrospective, descriptive, chart review using binary statistical analyses was done to study post fall data that capture patient falls.
The findings showed a lower fall injury rate and a decrease in the number of falls due to the use of PFHs and AARs (Butcher, 2013). This study showed positive results namely improved safety for residents after the team convened in a huddle after a fall and discussed how the fall had occurred. The team filled out an AAR, analyzed the data, and used that information to put appropriate fall interventions into the care plan (Church et al., 2015).
Recurrent falls create an increased risk for life- threatening injuries. It is critical for healthcare professionals to provide education on fall prevention and to develop formalized fall committees (Hart, et al., 2004). Research shows that reoccurring falls are associated with an increase in the number of days resident stays within a nursing home which in turn put the individual at higher risk for falls.
The participants within this study showed that developing a fall program using an ICPT approach decreased the incidence of falls, and improved care planning for high-risk fallers (Greene et al., 2001).
Encouraging staff to develop fall interventions requires support in the form of providing the tools needed to create a fall prevention program. The literature review revealed a study which showed that the employment of a PFH using a team approach reduced the number of fall-related injuries. The fall rate was reduced from 7.6 to 5.0 per 1000 residential days (Kato, et al., 2008).
The evidence within the literature supports using a multidisciplinary team approach to conducting PFHs that will decrease reoccurring falls, improve individualized fall care plans, and foster increased staff knowledge on fall interventions (Colon et al., 2013).
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