Evidence-Based Practice Paper: Fall Prevention among Patients

Introduction

Providing excellent healthcare requires continuous evolvement and capitalizes on critical thinking to integrate the increasingly complex skills, knowledge, client care activities, and technologies into evidence-based nursing practice. Essentially, the goal of providers in the precincts of client care is to prevent illness, as well as the potential complications, thereby allowing healthcare facilities to promote, protect, restore, and facilitate comfort, dignity, and health in dying. Healthcare providers should deliver a unique and comprehensive assessment of the clients health status and applies the principles of safety, ethics, health promotion to develop an explicit plan of care while taking into account of the unique spiritual and cultural preferences of the client, legal instructions, and the applicable standards of care.

Providers should give assurance of a safe and effective care environment. Essentially, the all medical practitioners, including nurses should be able to provide safety for all patients. Healthcare providers should consider preventing falls, such as preventing patient falls. As Kline, Davis, and Thom (2011) posit, patient falls are one of the commonest causes of morbidity and have caused injuries that have led to deaths in adults aged 65 years and older. As the researchers posit, the injuries that are sustained from falls in hospitals are in most instances severe, regardless of the characteristics of the patient, including their age and the nature of the underlying ailment. For example, they may be predisposed to fractures primarily because of bony metastases or even bleeding owing to thrombocytopenia, or medications that have been administered in the prevention of deep vein thrombosis. Essentially, falls are sensitive indicators to nurses, who are in a unique position in assessing, designing, implementing, and evaluating programs for fall risk reduction.

Importance of Fall Prevention

Fall evaluation and prevention is vital for all patients because it provides means to gauge the functional status of the patient and is an important consideration for medical practitioners, such as registered nurses (RNs) regarding treatment decisions (Hurria et al., 2011). As the researchers found out in their research, the evaluation and prevention of patient falls is vital for establishing crucial patient wellbeing, for example, they pointed out that falls were correlated with increased risk of medicaton. Screening for falls is simple, as it can be implemented through inquiries about the number of times a certain patient falls in a given period. Early identification of the falls provides RNs with an opportunity to initiate timely interventions. For instance, a meta-analysis conducted by Bruhnke (2016) highlighted that multifactorial intervention are effective in the reduction of falls risks associated with older patients. For this reason, falls interventions can lead to major improvements in functionality, tolerability of treatment, as well as increasing the overall quality of life for patients.

PICOT Question

The question answers the following questions:

• The population that an intervention will address.
• The interventions that can be applied.
• The comparison of the alternative intervention.
• Outcome of the intervention.
• The timeframe for the intervention.

PICOT addresses the population or the patient problem, highlights the intervention, and compares the alternatives, the expected outcomes, and the timeframe for an intervention. A. Patients for the interventions will not be limited by age, and thus, addressing all patients is viable.

B. The intervention plans that can be implemented for all patients include the use of assistive devices, such as canes and walkers for the elderly, which is complemented by physical therapy exercises. Another intervention is controlling the underlying conditions that increase the risk of the patient to fall, particularly eliminating all hazards that may increase the accidents, such as poor lighting and poorly designed staircases. Polypharmacy, which entails use of medications, can alos be used as an intervention. However, the medications should treat the same condition of falls, of similar chemical class, and with similar pharmacologic actions.

C. Comparing these two alternatives, it is better to adopt the latter alternative because it would enable the patient to have better health and well-being. Even so, the best alternative is implementing the two variants concurrently so that it enables the patient to have better health while also ensuring that the patient has assistive devices. Alternatively, use of polypharmacy can also be considered as an effective alternative.

D. The expected outcomes are that the patient will have a lesser risk of falling. Instances of falling will be greatly reduced, thereby allowing the patient to have a better well-being and quality of life.

E. The timeframe for the intervention is minimal when it comes to installing assistive devices for the patient. However, for the treatment of the underlying conditions, it can take months to a year. Essentially, it involves ensuring that the patient does not have any underlying conditions that significantly increase the likelihood that the patient will experience a fall.

Patient Population

The study focuses on patients of all ages. The risk factors include prior falls, certain medications, visual impairment, muscle spasms and weakness, cardiac rhythm disturbances, neurological impairments, improper footwear, postural hypotension, as well as environmental hazards. The American Geriatrics Society, having realized the problem of falls among older patients and recommends that they need to be screened by health practitioners for falls at least on an annual basis. As such, taking into account of the generality of the issue for patients, cultural values for the patients have little impact on the administration of the intervention. The use of aids is acceptable and appropriate if it is determined by the expectations of others from the same culture. According to Lenker et al., (2013), in their study, British and Italian Canadians deferred in their opinions in using canes as assistive canes to prevent falls. Additionally, as the authors pointed out, Italian seniors described physicians as the most influential referent vis-a-vis making health decisions. Also, as Stewart and McVittie (2011) articulated, use of aids is associated with loss of independence. Therefore, most patients abhor the use of aids. On the other hand, participating in exercises is influenced by cultural and social norms. DeSantis (2014) posited that to improve uptake of exercise interventions, patients need to be offered choices regarding the type of exercise and whether the intervention is delivered to a single patient or a group.

PICOT Question

The question answers the following questions:

• The population that an intervention will address.
• The interventions that can be applied.
• The comparison of the alternative intervention.
• Outcome of the intervention.
• The timeframe for the intervention.

Question: Will healthcare providers effectively implement assistive devices or physical therapy exercises to prevent patient falls, regardless of their age, to achieve reduced risk of falls and increased quality of life within 6 months to one year?

PICOT addresses the patient problem, highlights the intervention, and compares the alternatives, the expected outcomes, and the timeframe for an intervention.

A. Patients for the interventions are not limited by age.

B. The intervention plans that can be implemented for all patients regardless of their age, include the use of assistive devices, such as canes and walkers for the elderly, which is complemented by physical therapy exercises. Another intervention is controlling the underlying conditions that increase the risk of the patient to fall, particularly eliminating all hazards that may increase the accidents, such as poor lighting and lack of supporting

C. Comparing these two alternatives, it is better to adopt the latter alternative because it would enable the patient to have better health and well-being. Even so, the best alternative is implementing the two variants concurrently so that it enables the patient to have better health while also ensuring that the patient has assistive devices.

D. The expected outcomes are that the patient will have a lesser risk of falling. Instances of falling will be greatly reduced, thereby allowing the patient to have a better well-being and quality of life.

E. The timeframe for the intervention is minimal when it comes to installing assistive devices for the patient. However, for the treatment of the underlying conditions, it can take months to a year. Essentially, it involves ensuring that the patient does not have any underlying conditions that significantly increase the likelihood that the patient will experience a fall.

Recommended Solution

Addressing fall prevention among ill patients for this paper, as pointed out in the PICOT methodology section, will encompass concurrently using assistive devices, as well as eliminating hazards, which is inclusive of poor lighting systems. In essence, using both strategies will enable the elderly patients to have better health while also ensuring that the patient has assistive devices. In essence, the use of assistive devices. According to Ambrose et al. (2013), the use of assistive devices is paramount for the mitigation of patient falls who are older and ill. Bunn et al. (2014) also asserts that using assistive devices, such as canes and walkers is an important intervention for older patients, while also conducting a hazard analysis, which reduces various factors that will lead to falls, such as poor lighting. In addition. Bunn et al. (2014) articulate that the use of the devices should be reviewed and if possible, repair of devices is required. Ambrose, Paul, and Hausdorff, (2013) also supports the idea of reviewing lighting environment, which will eliminate the falls.

Essentially, hazard elimination can be done by the RNs without additional costs as the health organizations are responsible for ensuring safety in the hospital settings. It includes ensuring that the hospital is well lit, which can also be recommended for home settings. For instance, according to Williams et al. (2015), home hazard assessment, as well as environment evaluation can be done by patients or follow-up modifications by staff. For this reason, RNs can play a role in the implementation of home hazard reduction, thereby eliminating the risk of fall, and it can be implemented for older patients that have recurrent falls. Also, combining assistive devices with physical therapy exercises is of particular importance primarily because they are the most accessible and common intervention measures. In addition, there are numerous types of exercises that the elderly can engage in, including walking. Essentially, multiple exercises and physical therapy have been shown to reduce the risk and rate of falls for older patients (Franco, Pereira, & Ferreira, 2013). Deriving from this evidence, experts support the inclusion of flexibility, strength, as well as endurance training in fall prevention programs (Williams et al., 2015). Furthermore Bunn et al. (2014) posits that intervention programs that encompass two or more exercises are highly recommended for the reduction of falls among older adults who are vulnerable to fall risk. Additionally, polypharmacy, which entails use of medications, can alos be used as an intervention. However, the medications should treat the same condition of falls, of similar chemical class, and with similar pharmacologic actions.

References

Bruhnke, A. (2016). Exercise for the preven...