Healthcare practitioners need to be well versant with data analysis. A quality improvement project, for example, helps medical professionals to identify necessary methods that would help them handle the projects using evidence-based information. This article proposes a quality improvement proposal for fall prevention in long-term care. The proposal includes an overview of the problem and where it occurs and the need for quality improvement and expected outcomes. Additionally, sections in the paper will discuss the results of previous research, the steps to implement the quality initiative, and how to evaluate it. Lastly, the paper will identify the variables hypothesis, and statistical tests that I will need to prove that the quality improvement initiative succeeded. A quality improvement plan for fall prevention is necessary in my practice because it will help to evaluate the quality of care.
Overview of the Problem
Falls are a major health burden for seniors in long-term care. Fall prevention has been the topic of research and quality improvement efforts. Today, patient falls is a national patient safety goal in long-term care facilities. AHRQ (2019) indicated that according to epidemiologic studies, falls occur at a rate of 3-5 per 1000 bed days. Also, per year, it is estimated that 700, 000 to 1 million patients fall each year (AHRQ, 2019). Most falls occur in patients who have been prescribed psychoactive drugs and have difficulties with mobility, strength, and balance (AHRQ, 2019). Additionally, patients in long-term care facilities are at high risk of falls, which results in significant injury such as head fractures and trauma (AHRQ, 2019). From the statistics, patient falls are a significant problem in long-term facilities. Falls, whether those that cause serious or minimal harm, cause distress and anxiety to patients, caregivers, and family members, which create a cycle of fear and restricts the patient’s movements (AHRQ, 2019). In my practice, patient falls is common. I work in a nursing home, where all of the patients are between 60-90 years. Per year, the reported cases of falls are 15-30 patients (21.3%), and most of them were repeat falls. The number shows the severity of the falls in the hospitals. Since the number of falls is tracked by the hospital per year, the quality improvement project will occur for 1 year to track changes.
Reason for the Quality Improvement Initiative
Based on the statistics provided by the AHRQ and that available in my practice, there is a need for the quality improvement initiative in my practice. A post-fall huddle initiative would be utilized to determine the risk for patient falls in my facility. There is no doubt that quality improvement is a team effort. The reason for the quality improvement for fall prevention is necessary for my practice because it will help to increase the quality of life for the patients. To ensure that the initiative is successful, behavioral change is necessary as stakeholders such as caregivers, patients, and their families need to collaborate to improve the patients’ quality of life by minimizing falls. The initiative intends to identify each individual’s risk factor for falls will be essential because it will determine an individualized plan of care that would reduce the rate of falls in my practice significantly. Another reason for the quality improvement initiative for falls is the issue of direct health care costs associated with treating and caring for patients who have had injuries during the falls. Duan and Zou (2017) emphasized that effective fall programs require adjustments and collaborations in the hospital system as well as the interdisciplinary team. From a broader perspective, the expected outcome for the fall prevention initiative aims at improving the wellbeing of the elderly patients improve their care experience, improve the health of the elderly, and reduce the cost of healthcare.
Results of Previous Research
Many scholars have conducted research on quality improvement for fall prevention and its outcomes. Ganz et al. (2016) conducted a non-randomized controlled trial to measure the effects of falls quality improvement program on fall injuries and the episodes of care for the falls. The intervention used in the study was a multi-component quality improvement program that involved face-to-face education about falls. Their findings, however, did not yield results because the quality improvement initiative failed to cause a change in the number of episodes of care for serious fall-related injuries (Ganz et al., 2016). Furthermore, Buckner and Sherry (2019) utilized a post-fall huddle (PHF) quality improvement project in a long-term care facility to determine whether the initiative would reduce falls. The researchers used a root cause analysis to determine the cause of patient falls within the facility. Using the PHF initiative, findings revealed a significant reduction in patient falls. Moreover, Jones et al. (2019) conducted an experimental study to determine the effects of the post-fall huddle on repeat fall rates. During the 2-year project, results showed that the post-fall huddles reduced the rate of falls and improved the perceptions of caregivers to create a safety culture.
Steps to Implement the Quality Improvement Initiative
The steps to implement the quality improvement initiative will incorporate the PDSA (Plan-Do-Study-Act), model. AHRQ (2014) indicated that practices can use fillable PDSA forms to improve the quality of healthcare. The form incorporates an aim statement, which includes things the practice intends to accomplish (AHRQ, 2014). In my practice, the PDSA model would be significant to implement the quality improvement initiative for fall prevention. In the form, the aim statement includes the specific targeted population, the measurable and stated goal, the achievable plan to accomplish it, the relevance of the initiative, and the specific time to achieve the initiative (AHRQ, 2014). The diagram below depicts a model for improvement in the long-term care facility.
Using the PDSA model, the aim is to develop a quality improvement initiative that will measure the rate of patient falls in my practice and reduce the number of falls and improve the quality of care for residents. The steps mentioned above would help to map and organize the initiative at the entire long-term care facility.
Evaluation of the Quality Improvement Initiative
Evaluation of the quality improvement initiative will utilize the Six Sigma model. The reason for using the model for evaluation is that it will help in statistical measurement, decrease the process variation, and reduce costs. The six sigma process includes define, measure, analyze, improve, control, and eliminate. I will evaluate the quality improvement initiative by first identifying the target populations at the long-term care facility which are likely to have experienced falls each month. The second step will be to identify the measure in percentage of the patients who have fallen within the last 30 days. The third step is to analyze the root cause of patient falls within the facility. The fourth step is to develop a roadmap for evidence-based strategies that the interdisciplinary team will incorporate in their plan of care to improve the wellbeing of the patients. The fifth step would be to establish the best practice to control the project to result in continuous quality improvement. The sixth process will be to eliminate the occurrence of falls within the facility. Going through each step in the Six Sigma process will help determine whether there was an improvement in the initiative.
Variables, Hypothesis Test, and Statistical Tests
The basis of the research would be to determine the effects of a post-fall huddle quality improvement initiative to reduce patient falls in a long-term care facility. The dependent variable (quantitative) is the rate of patient falls. Additionally, the independent variable (categorical) includes age, gender, history of falls, type and number of medications, length of stay, as well as comorbidities. Furthermore, the hypothesis test that I will need is the t-test. The null hypothesis is that the post-fall huddle initiative will not reduce patient falls in the long-term care facility. Moreover, the statistical tests that would be applied will be the one-sample t-test. The reason for choosing the statistical test is because of the small sample size and will produce a definitive and value after testing and measuring the variables.
AHRQ. (2014, July 24th). Fillable Plan Do Study Act (PDSA) Tool for Health Care Quality
Improvement (QI). https://www.ahrq.gov/evidencenow/tools/pdsa-form.htmlAHRQ. (2019, September). Falls. https://psnet.ahrq.gov/primer/fallsBuckner, T., & Sherry, D. (2019). Improving falls in nursing homes: a post-fall huddle quality improvement project. International Journal of Advanced Nursing Studies, 8(2). doi: 10.14419/ijans.v8i2.27533
Duan, Y., & Zou, P. (2017). A fall prevention quality improvement project in a long term care facility: Critical analysis. Journal of nursing and Healthcare, 2(2). https://opastonline.com/wp-content/uploads/2017/06/a-fall-prevention-quality-improvement-project-in-a-long-term-care-facility-critical-analysis-jnh-17-41.pdfGanz, D. A., Kim, S. B., Zingmond, D. S., Ramirez, K. D., Roth, C. P., Jennings, L. A., Mori,
T., Keeler, E. B., Wenger, N. S., & Reuben, D. B. (2015). Effect of a falls quality improvement program on serious fall-related injuries. Journal of the American Geriatrics Society, 63(1), 63–70. doi: 10.1111/jgs.13154
Jones, K. J., Crowe, J., Allen, J. A., Skinner, A. M., High, R., Kennel, V., & Reiter-Palmon,
R. (2019). The impact of post-fall huddles on repeat fall rates and perceptions of safety culture: a quasi-experimental evaluation of a patient safety demonstration project. BMC health services research, 19(1), 650. doi: 10.1186/s12913-019-4453-y
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