The Multifactorial Fall Prevention Strategy

Introduction

According to the Nurse Leader, one of the most significant problems faced by their patients is falls. The falls that happen among the elderly have continued to happen every day, causing injuries, loss of independence, and even death. The most notable issue, though, is not that falls occur in the hospitals, but have become a problem that nurses across the board have to deal with since it is not only happening in hospitals but also the care facilities for the old and even at homes for the seniors who receive care at home. The National Conference of State Legislatures (NCSL) has revealed that one in every four senior adults, those above 65 years, fall every year (National Conference of State Legislatures, 2020). The NCSL adds that these falls result in long-term injuries such as hip fracture and brain injuries, and yet that is just the tip of the iceberg as far as the associated costs and long-term consequences are concerned.

The Nurse Leader also reported that the falls among the adults caused moderate to severe injuries. For about 20 to 30% of these individuals, the fall resulted in hindered mobility, low quality of life, and even raised the risk of premature death. Burch and Veninsek (2019) also indicate that falls cause about 95 percent of the hip fractures that occurred among older adults, and they are also a great contributor to traumatic brain injury. They reveal that one of every five patients who fractured their hip died within twelve months following the injury. Evidence also shows that every year, falls among the senior adults resulted in 25,000 deaths, and a minimum of 700, 000 hospital admissions (NCSL, 2020). The same evidence also reveals that these falls were also the cause for about 2.5 million emergency department visits.

This data is evidence that falls are a threat to our aging population, and also pose a tremendous financial burden on the economy. The United States has an increasingly aging population, which is an indication that expenditure on falls is likely to increase if prevention is not undertaken. In 2015, for example, the total cost for treatment provided to the elderly was above $50 billion, of which a significant percentage, $750 million, represented fatal falls. For the non-fatal falls, Medicare and Medicaid covered 75%, while other actors in the healthcare system covered the remaining amount. About $9 billion of the cost fell on Medicaid, an equivalent of 8 percent of the total spending by Medicaid on the elderly. In comparison, Medicare spent $29 billion on the elderly, an amount constituting 6 percent of the total Medicare spending on senior adults (CMS, 2015). The fall-related spending for the private and other payers was 5 percent ($12 billion) of the total expenditure on the elderly.

These costs have continued to increase with the growing number of the elderly in the country. They are also set to increase if nothing is done to reduce the falls occurring in-home and other adult care facilities. There is a need for interventions that can help lower the falls that happen in these facilities, while also managing fall-related injuries effectively. Among the discovered interventions are medication, the use of assistive technologies, exercise, and diet, among others. All these, used together, are effective in helping prevent falls among senior adults. These interventions will go a long way in helping protect our aging population and improving their sense of independence while improving their quality of life. Yet, the cost of providing care to the elderly is set to increase, but reducing the fall rates will ensure that the spending on the elderly is channeled on practices that help improve these individuals’ quality of life. Given the unique nature of falls cannot be addressed using a single intervention, but a multi-factorial one that prevents ambulatory falls among the elderly, in hospitals, care facilities, and at home.

Literature Review

One issue that is important to understand is that health-related quality of life abbreviated HRQOL is of great interest for individuals as well as public health professionals and administrations. The twentieth and twenty-first centuries have seen remarkable growth in life expectancy, and this is a sign that there is a need to focus on factors that can help promote a high HRQOL level into old age (CDC, 2016). It has also been noted that the senior adults who are enjoying life expectancy prefer a high HRQOL to longevity. Researchers have therefore concluded that what the medical care professionals need to do is to focus on the high HRQOL level, rather than increasing the elderly’s length of life. This is interesting, considering that the nation has continued to appreciate the life expectancy as it is. However, the elderly may not enjoy the extra years lived if they are not quality ones and are spent in suffering.

The term HRQOL is a multi-dimensional and subjective concept, which is shaped by and not entirely dependent upon, the impacts of disease and the treatment. The World Health Organization Group defines Quality of Life abbreviated QOL as an “individual’s perception of their position in life in the context of culture and value systems in which they live, and with their expectations, goals, standards, and concerns.” The public health policies put in place are thus concerned with keeping the older people independent in the community, and with a good quality of life. The rise in the number of older individuals, says Shi (2014) implies that there are more people with chronic diseases. It also signifies a significant challenge for the health care system in finding feasible and effective interventions to attain a health-related quality of life goals.

Falls in themselves are a focus of attention, and they have continued to assume increasing importance as the aging population has continued to increase. They are an emerging problem, and as mentioned above, a growing aging population implies more people with chronic illnesses and related issues that make them dependent. Falls are an emerging problem whose solution requires a sense of urgency due to the adverse impact they cause on the QOL and functionality of people above 65-years. According to Ott (2018), falls are the most frequently reported incidents in the inpatient units for older patients. The data shows that in the United States, somewhere between 700,000 and 1,000,000 patients fall in hospitals each year. The fall rates range from 1.7 to 25 falls per a thousand patient days. The resulting injuries from these falls are the primary cause of hospitalization of the senior adults and continue to cause them pain and suffering, along with a loss of independence, and morbidity as well as mortality. Yet, the hospitalization of the elderly patients increases the risk of falling, and between 30 and 51 percent of the falls that occur in hospitals result in one kind of injury or another.

The interventions that can be undertaken for fall prevention need to be individualized and multi-dimensional and involving caregivers, their environment, and the admitted senior patients. This shows that some interventions go beyond medical understanding. As research about falls continues, researchers have discovered that there is a deeper and more comprehensive understanding of falls, which encompasses the emotions, actions, and psychological impact of falls and the required prevention. Evidence shows that falls can be prevented, although some authors, including Burch & Veninšek (2019), have noted that despite the enormous weight caused by falls, little evidence exists about the effectiveness of the preventive measures. Therefore, these scholars have argued that the challenge facing health institutions is the implementation of effective fall prevention strategies to respond to the specific needs of an individual senior adult, based on their programs within multidisciplinary teams. Yet, it is essential to note that professionals cannot prevent falls as long as they are working alone, no matter how competent they are. Fall prevention is a significant challenge that calls for the active involvement of various disciplines and the teams involved in providing care to patients.

Pahor (2019) conduct a study of the teams that handle fall prevention among the elderly in institutions. This researcher observes the behaviors and examines the practices of these teams, and find that the information about the risk factors, as well as that gathered during team discussions, is not always utilized. The information provided in these discussions is crucial, but failure to utilize it causes the intervention teams to value different measures, thus compromising care continuity, and individualizing the measures in response to the identified risk. A different study that aimed at evaluating the effectiveness of a prevention curriculum implemented in one Hospital found that team training and improved communication amongst the team members played a crucial role in the occurrence of falls (Ott, 2018). This justifies the investment in the multidisciplinary teams since they play a crucial role in implementing the best practices and translating best evidence knowledge into clinical praxis.

The intervention, TeamSTEPPS, was successful in helping the Hospital in question, and various researchers have continued to recommend its adoption by different teams. In a different context, the program has helped reduce the possibility of the occurrence of injuries, even when calls occur. The intervention has also been said to make a critical contribution in preventing falls since prevention requires more than coordination, organizational culture, and operational practices to promote teamwork, as well as communication and individual expertise. The TeamSTEPPS is organized into a structure that optimizes the performance of the multidisciplinary team throughout the care delivery system (Lundy, Janes & Lundy, 2009). The program is divided into five components, which include team structure, which focuses on teamwork that promotes patient safety. The second is communication, which is based on a structured process where the exchange of information happens clearly and accurately among the members of the team.

The third is leadership, which involves the facility’s ability to maximize the team members’ activities and ensure that the team’s actions are understood, information changes shared, and resources are available to the team members to ensure the effective performance of their tasks. The fourth is monitoring, which is based on a process of active assessment of the situational elements needed to obtain information while supporting the team’s functioning. The last is mutual support, which is based on the ability of teams to anticipate the team members’ needs through accurate knowledge of their workloads, as well as their responsibilities. Literature review shows international guidelines and studies recommend the use of team interventions in preventing falls among the elderly who are hospitalized. The only challenge with this view, however, is that evidence on the effectiveness of the approach is scarce, considering that the current studies have mainly focused on biomedical fall-prevention interventions. In contrast, the guidelines for team interventions such as TeamSTEPPS focus on training on the risk factors and preventive measures.

Since the TeamSTEPPS program focuses mainly on hospitalized and institutionalized, but there is a different intervention in use in Norway, aimed at providing home help to older people. The goal of this intervention is to help the elderly, who are at home, to live at home as long as possible (Lundy, Janes & Lundy, 2009). Municipalities provide the services for these individuals in the form of instrumental activities of daily living (iADL). These activities include vacuum cleaning, although other services in the form of personal activities of daily living (pADL) such as getting dressed also exist. A safety alarm service is also made available to ensure speedy response if the patients fall, and social support from the people close to them. The municipalities predict home care use by the dependency of these senior adults on activities of daily living and cognitive impairment from which the patient may suffer. Those that receive home help are a transition group between the independent community of the older people and those who live in residential care facilities or nursing homes.

This group has continued to grow due to the combined factors of the increasing older people, and the use of the LEON principle in which the lowest most efficient level of care is provided. Stephenson et al. (2015) add that economic resources are scarce, which means that a lot more emphasis is laid on post-acute care rather than health promotion and prevention to help maintain the health, and sustain the older adults who live in care facilities. The point is that these costs will continue to be borne by individuals, communities, and the medical system until an evidence-based practice is established to prevent the occurrence of falls. The best intervention is one that focuses on the important risk factors among the old, which include impaired balance and gait, and polypharmacy, and a history of falls. A poor nutritional status is another problem that has been associated with increased fall risk, along with malnutrition, or the fact that malnutrition is a critical issue affecting about half of the older adults that are receiving home care services.

These are great methods that have helped reduce falls in the places where they have been used. However, evidence from community-dwelling adults has shown that multi-factorial assessments and interventions have played a crucial role in reducing fall rates by 25%-40% (Pahor, 2019). Depending on the risk assessment results, some of the multi-factorial interventions that have been identified for helping prevent ambulatory falls include physical therapy of exercise programs that are aimed at helping the adults improve their balance, gait, and strength. Strong evidence exists that shows the effectiveness, along with the cost-efficiency of exercise in lowering the number of falls among the elderly. The others are minimizing or withdrawing psycho-active medication, managing foot, and orthostatic hypotension, changing footwear, modifying the home environment, and patient and caregiver education (AHRQ, 2020). There were also interventions such as dual-chamber cardiac pacing and expedited cataract surgery for selected patients, and Vitamin D supplementation in the patients who suffered from Vitamin D deficiency or were at high risk of fall.

The researchers also highlight a few actions that need to be taken for the patients at high risk of falling. The first one is asking the patient about their history of falls, and an assessment of his or her functional ability. The second is a review of the medication that the patient takes, as well as their medical history. The third is performing a gait assessment, visual acuity examination, feet and footwear examination, physical examination, particularly cardiac and neurologic, home safety evaluation, cognitive evaluation, and an assessment of vital orthostatic signs (Stephenson et al., 2015). It is important to note, however, that insufficient evidence exists to support the use of these strategies on individuals in long-term care context, or individuals who have dementia. The same researchers also noted that the fall-related fractures could be reduced by screening the patients for osteoporosis at the appropriate age and prescribing the relevant medication. Nurses in hospitals usually perform fall prevention assessments for all their patients using standardized tools. Some of the tools include the Hendrich II Fall Risk Model, the Morse Fall Scale, the Conley Risk Assessment Tool, and the Briggs Risk Assessment Form, among others (Marks, 2014). Some hospitals use the Schmid Fall Assessment Tool, which involves evaluating the mobility of the patient, their toileting, mentation, and use of psycho-active prescriptions.

In this assessment tool, a score of three and above indicates an increased fall risk that requires a few interventions. These include a call bell to call for help if need be; access to patient glasses or hearing aids, appropriate reorientation strategies, use of patient walking aids, non-slip footwear, frequent comfort rounds; appropriate reorientation strategies, early and frequent mobilization, patient and family education about fall risk, minimized use of restraints, use of bed alarms, and elimination of barriers to ambulation or transfer. These are all important elements in preventing falls, given the devastating effects they continue to cause on patients and the increased burden on their families as well as the health care system. Screening is easy to perform in the hospital setting, and simple interventions can produce meaningful results. Yet, physicians are called upon to coordinate with other health care team members to provide effective multi-factorial interventions to their patients (Tricco, Thomas & Veroniki, 2018). It is crucial in their case to understand that with every fall that they prevent, the patient, family members, health care team, and the whole system benefits.

The Multifactorial Fall Prevention Strategy

Many interventions have been undertaken to prevent falls among the elderly. One special type of these intervention is the multi-factorial intervention in which the single intervention is selected based on the assessment results of a person’s fall risk factors. Falls are reported in several ways, with the first one being an outcome of the fall rates, which is the number of falls, and the second one being an outcome of the falling risk, which includes the people who have fallen before. Multi-factorial intervention for hospital inpatients is different from what is offered to old individuals in care facilities and living in their own homes. This is because although the strategies are widely implemented for helping reduce falls among hospitalized adults, they have not been assessed using RCTs. This means that there is no graded evidence to use in recommending the use of multi-factorial interventions among hospitalized individuals. There is no evidence to support the use of restraints, although evidence exists showing that worse injuries may result where restraints are used. Researchers such as Cameron et al. (2018) have offered alternatives to restraints, which include alarm devices, lower beds, floor mats, and exercise and safe transfers. The evidence that exists to support risk assessment for hospital discharge, and planning for older people is weak. This means that they require the appropriate referral to continued care provision in residential care facilities and at home is necessary (Lee, 2013). Lastly, bed alarms are effective in reducing falls among hospitalized adults.

The first phase of the implementation process will involve participant training, which will happen for six months of the intervention implementation process. The staff members of the Hospital will be recruited for leadership in their area of expertise, as well as the implementation of evidence. Since this is only the beginning, we will need early adopters, and the nurse leader will help us select seven interested nurses. They will help in outlining the expectations they have of the project before they can participate. The training will be intensive and will happen in one of the Hospital’s institute halls. Once this is done, the leaders will go back to the practice site and carry out audits, as well as implementation initiatives over 25 weeks. Once the 25 weeks are over, the training will continue with the participants taking another five-day intensive residency in which they will develop a project report, and engage in an interactive discussion that will result in them consolidating the achievements of the project.

Once the training process is done, the Hospital’s head nurse will select a medical ward and surgical ward, in which falls happen most often. Each of the wards carries 30 patients, which means that the multi-factorial intervention implementation will first be implemented on 60 patients, 30 of whom are medical ward, and the other 30 are surgical patients. The intervention will be divided into three important steps: risk assessment, education, and intervention. A risk assessment will be done upon admission, upon transfer, and reassessed in case there is a change in a patient’s condition or after a fall. The understanding is that patients who have fallen before are at risk of future falls. In regards to education, healthcare professionals have received education on assessing falls, and the prevention strategies (Bjerk, 2017). Again, patient and family education is crucial for patients who have a high risk of falling. Finally, the interventions will be implemented based on the identified risk factors. The implementation phase is set to take between 3 to 4 months. In this period, the researchers will maintain contact with the nurse leaders, among other hospital leaders via email, the phone, or video-conference. The researcher will also collaborate with key stakeholders within the Hospital to promote the development of the necessary interventions. These stakeholders would give their feedback on the implementation every two weeks to compare the planned action, with the reality on the ground.

The Nursing theory that would be used in implementing the plan is Nightingale’s Environmental Theory, which argues that the environment in which the patient is in should be used to help in their recovery. The environment, in this case, constitutes internal and external factors that surround the patient. It includes the positive, as well as negative conditions that may result in a fall, and the physical environment, which consists of the friends, family, and the setting in which the patient is receiving care. As part of the multi-factorial intervention, the environment should be such that it reduces the chances of falls occurring. It also involves the care providers and the patient’s family in providing all the support needed by the patient in the form of risk assessment, education, and intervention to minimize the risk factors and prevent the occurrence of falls (Tricco, Thomas & Veroniki, 2018). All the involved practitioners will receive the training they need to carry out their responsibilities, and they will be issued with a feedback form every two weeks for them to give their views on the intervention and the implementation process.

The implementation of an intervention that involves a multidisciplinary team can be complex, especially when it involves various care settings and patient populations within a general hospital. Unlike in infection control and prevention, very little evidence exists to support a solid approach for the development of a fall prevention team. This means that this team is not developed based on any model, but wisdom and knowledge gained over the years through experience and research. The engagement of front-line staff would be crucial, although it will require leadership at the ward level. These will be the first stakeholders involved in the study, and they will be under the nurse leader involved in the proposal part of this research. The next level of stakeholders will be doctors at various levels and specialties (Wilkerson, 2017). Their input will be needed to ensure that no harmful events occur in the Hospital. They will also play a crucial role in promoting patient safety through engagement in the falls investigation associated with harm. The other group of stakeholders includes the patients and their families. They will continue to learn and increase knowledge on what causes falls rather than always associating them with the omission in care delivery. Lastly, the researcher will seek out a steering group, at the organizational level to promote learning and act as an oversight board to oversee the implementation of the intervention (CMS, 2015). This group, which includes a few experts, will help combine cultural change and evidence with arduous performance measurement.

Some of the issues that may pose a challenge to the administration process may be insufficient fall education, not just among the front line staff members but even among the intervention facilitators. This may lead to a lack of knowledge on when to conduct some of the requirements of the implementation process, including risk assessment, and how to address the risks that they identify. The nurses may also be inadequate in their delivery of education to the patients, and the rest of the caregivers, which may end up rendering some of the aspects of the intervention ineffective. The environment theory is needed in inspiring the implementation process facilitators so that they can work to promote a conducive environment for the patients to get better than deteriorate (AHRQ, 2020). As long as the environment is made safe, the patients’ health will improve, making it possible to leave the Hospital with a high quality of life.

Resources Needed for Implementation

The resources needed are diverse, and we depend on the scope of the program. Since we will be focusing on just a fraction of the Hospital, we need to ensure that we have all the necessary resources to avoid derailing the program at every step. Some of the resources that we need include time, especially for the staff members involved, since they will be participating in the initiatives and meetings. We will also need resources in leadership time, as well as the support team efforts. We will be conducting training and education and will need to compensate the staff members involved. The training and education mean a fee of $1000 for the hall in which the training will take place, and $700 in the multidisciplinary staff education sessions, development of the patient and caregiver education material, and development of staff education packages. Other tangible resources that the team will need are the communication materials, as well as the new care products. The researcher has also identified resources such as information technology support, and funds, which will be provided by the Hospital and a grant from the Hospitals Contribution Fund (HCF), and the Medical Research Foundation conjointly. Most of the cost, however, will be absorbed in the Hospital’s operating budget, although the highest wages to consider are the compensation for the staff members involved in making this project possible, and obtaining the new care equipment.

Cost Item Participants using the resource at least once Resource use for the intervention Total Cost in $
Hall for use in training and education 10 60 1,000
Education materials  and packages 10 60 700
New care equipment 60 60 12,000
Information technology and support 70 100 1,000
Wages and Salary 10 10 10,000
Miscellaneous 100 100 1,000

 

It is crucial at this point to mention that a gap exists between the current and recommended practices. For instance, one would not say that an institution is already following best practices since if it were, we would not need to implement a fall prevention protocol. Many issues are already happening; that is the reason why older patients continue to fall and lower their QOL. This means that the researcher is out to identify the gaps that exist between the current and required best practices and change them to improve the patients’ quality of life (Marks, 2014). For instance, the policy in the Hospital may state that the nurse practitioners should accompany all the patients who have an abnormal gait to the bathroom, but some may not comply with that requirement. There may be an investment in the time and resources of the researcher in process mapping to examine the processes involved in fall prevention. The mapping process will cost the researcher, although the costs required may be daunting to forecast. There is also a need for occupation or physical therapy for some patients, and quality improvement experts needed to make the implementation process a success (Burch & Veninšek, 2019). The new care equipment to be bought includes floor mats, low beds, assistive devices, as well as other safe patient handling devices and equipment. It is beneficial for the Hospital to get lower beds since those that are currently being used by the adults can be transferred to other wards in the Hospital.

Evaluation Plan

The project evaluation plan seeks to implement an evaluation tool to examine the multi-factorial fall prevention intervention. The impacts of the fall prevention strategy are staff submission, and patient consciousness of the fall prevention necessity, and the fall incidence among the elderly patients. The outcome evaluation for quality improvement will start from the planning stage and will be guided by a plan. The goal of the evaluation process is to provide feedback on the outcomes and impacts of the multi-factorial fall prevention protocol and establish whether the intervention attained the intended purpose. Since the researcher may not have a lot of time to finish up the work on this project, she will gauge the intervention based on its impacts on patient consciousness about the intervention, staff adherence to the provisions of the intervention, and the reduction of inpatient falls. It will also be crucial to determine what impact the intervention had on the patient’s family and whether they would manage to take care of them once they are discharged from the Hospital.

The researcher will conduct an appraisal once she had gathered data to plan her response to the effectiveness of the intervention. The researcher uses RE-AIM as a framework to assess the efficacy of the multi-factorial protocol. Along with the model, the researcher will also use some of the data collected by the Hospital in the last two years, along with the patient charts to examine the clinicians’ compliance with the protocol, as well as how accurate they are in implementing it (Wilkerson, 2017). The evaluation process will look at the statistical changes, and how well the intervention has fared in comparison to the project’s goals and objectives. Yet, it is crucial to note that the nursing practice is cyclical rather than linear. This means that the evaluation process, done as the last step in the process, eventually affects the subsequent assessment. The multi-factorial fall prevention intervention is a community nursing intervention, and its effectiveness is dependent on reassessment and appropriate revisions in the intervention implementation process. Evaluation boils down to one thing: what is the impact of the intervention on the health of the community or the target population? The evaluation is critical in this case because the community is complex, and many variables tend to affect the outcome of an intervention. It, therefore, becomes critical for the nurse to be cautious about attributing the changes that occur to the intervention or denying any influence that they cause due to concrete evidence insufficiency. The researcher will use both formative and summative evaluation to determine whether the intervention focused on the process for which it was executed and whether the outcomes were what the researcher envisioned at the beginning.

The formative evaluation process happens during the implementation of the intervention to check whether the project is on the right track. It is discouraging to put all the resources in a project and finish it, only to realize that it did not address the problem for which it was intended. The measures that the researcher will take in the formative evaluation focus on the process of community intervention. The measures that she will take in the summative will focus on the outcome. The question for summative evaluation is: “Is this what we envisioned?” The measurements to use of formative assessment are checking the process and comparing it to the proposal. The summative evaluation, on the other hand, will involve measures such as self-report from the patients, satisfaction surveys from both the patients and the staff members, or changes in the number of falls occurring among the Hospital’s inpatients. The evaluation will then be compiled in lay terms to form a final report for the community (Marks, 2014). The researcher will use newsletters to publish the final report for use by the Hospital’s staff members, as well as the patients who seek medical care there. The aim of publishing the evaluation process is because regardless of the outcome of the process, both the team members and elderly patients are changed. Closing the research in the form of a report can impact the future of the inpatients in the hospital, as well as the staff members’ response to health problems and interventions.

The nursing theory selected for this research was the environment theory by Florence Nightingale, which argues that the environment of a patient should be such that it promotes the wellbeing as well as the health of the patient (Wilkerson, 2017). An atmosphere of reevaluation of the intervention is crucial in sending a message to the patients, their families, and the care provider. As long as the researcher is in the Hospital from time to time performing reevaluation, she sends an unspoken message to the stakeholders about how seriously she takes the implementation of the intervention. That the researcher wants the intervention to be effective is motivation enough for the staff members and the patients, and promotes co-operation. It also stimulates an environment of compliance to the multi-factorial intervention provisions, and the stakeholders are slowly influenced to want the project to succeed. As long as they take the intervention seriously and carry out their obligated tasks, they create a favorable environment for the promotion of the patients’ wellbeing. The positive attitude to making the intervention work shows their support for the patients, and their determination to promote their QOL.

  Indicator Definition Baseline Target Data Source Frequency Responsible Reporting
Goal Percentage of patients whose fall rate has declined Number of patients who have fallen within the three months of the intervention implementation divided by the number of patients who fell three months before its implementation The Hospital’s patient charts Every three months Program manager Annual fall report
Outcome Fall risk reduction among the hospital inpatient aged above 65 years Sum of all the falls that have happened among the participating patients divided by the total number of participants     Fall risk assessment report Every month Nurses Three monthly nurse reports
Output Number of patients who completed the Multi-factorial fall prevention protocol The total number of patients who were present on the first and last day of the fall prevention protocol implementation     Patient record for the 60 patients Every end of the month Nurses Patient record review
A number of patient family members who helped their relatives prevent fall in the last one month. A total number of patients’ family who answered yes to the question: “Did you help your patient in the ward any time in the last month?” A survey from family members Every end month Program officer The family members survey report

 

Summary or Conclusion

Falls are the most common patient safety incident that happens among the elderly in the hospital setting. They can result in severe injuries, which include fractures or death. It is also important to note that no fall can be regarded as completely harmless because they may result in fear of falling, delayed functional recovery, as well as an increased length of hospital stay. Numerous risk factors exist, although researchers have not identified a screening instrument that has been proven to be sufficient enough to be used clinically. It has therefore been recommended that hospitalized patients whose age is above 65 years and others over 54 years but at specific risks to have a multi-factorial risk assessment, which leads to a multi-factorial fall prevention strategy. By identifying the risks and providing effective interventions, the healthcare system can reduce the fall rate by 20 to 30%. By building safety consciousness into clinical teams while embedding the routine vigilance, hospitals have managed to build harm schemes that reduce harm. Hospitals that have resorted to multi-factorial intervention admit that they have been able to reduce the occurrence of falls and fall-related injuries significantly.

One evident challenge, however, is the fact that only a little research has been undertaken for multi-factorial intervention in the hospital setting. While it has been of significant help in-home care and older adult care facilities, it is yet to be proved to be as effective in hospitals. This calls for more research in the use of multi-factorial intervention in preventing falls among hospitalized senior adults. The stakeholders involved in the process include a multidisciplinary team of the nurses and physicians working in the hospital, the patients, and their family members. The nurses’ role is to learn and put the knowledge acquired into practice. The family members will also be part of the learning process, and the patients or the senior adults admitted in the Hospital is to co-operate with their care providers to ensure that the implementation process happens seamlessly. An evaluation process will begin as the implementation continues as a formative evaluation to ensure that the intervention happens as planned, and a final one will be done towards the end as a summative evaluation, assessing whether fulfilled the envisioned purpose. The nursing theory that can help in the implementation is the environment theory, which posits that the environment in which patients stay plays a crucial role in promoting their wellness. This means that as long as the nurses, physicians, and healthcare organizations work to create a favorable environment, the patients will recover quickly and continue to enjoy a high QOL.

References

Agency for Healthcare Research & Quality. (2020). 3. Which fall prevention practices do you want to use? Retrieved 20 February 2020, from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk3.html

Agency for Healthcare Research & Quality. (2020). 4. How do you implement the fall prevention program in your organization? Retrieved 20 February 2020, from https://www.ahrq.gov/professionals/systems/hospital/fallpxtoolkit/fallpxtk4.html

Bjerk, M., Brovold, T., Skelton, D., & Bergland, A. (2017). A falls prevention program to improve quality of life, physical function and falls efficacy in older people receiving home help services: study protocol for a randomized controlled trial. BMC Health Services Research17(1). doi: 10.1186/s12913-017-2516-5

Burch, J., & Veninšek, G. (2019). How do multi-factorial interventions compare with usual care for preventing falls in older people admitted to the Hospital? Cochrane Clinical Answers.

Cameron, I., Dyer, S., Panagoda, C., Murray, G., Hill, K., Cumming, R., & Kerse, N. (2018). Interventions for preventing falls in older people in care facilities and hospitals—Cochrane Database of Systematic Reviews.

Center for Disease Control and Prevention [CDC],  (2016). Important Facts about falls. Retrieved from http://www.cdc.gov

Centers for Medicare & Medicaid Services [CMS], (2015). Quality monitoring using case-mix and adverse event outcome reports. Retrieved from http://www​.cum.hhs.gov

Lee, A. (2013). Preventing Falls in the Geriatric Population. The Permanente Journal, 37-39. doi: 10.7812/tpp/12-119

Lundy, K., Janes, S., & Lundy, K. (2009). Community health nursing. Burlington, MA: Jones & Bartlett Learning.

Marks, R. (2014). Falls Among the Elderly: Multi-factorial Community-based Falls-Prevention Programs. Journal of Aging Science02(01).

National Conference of State Legislatures. (2020). Elderly Falls Prevention Legislation and Statutes. Retrieved 20 February 2020, from https://www.ncsl.org/research/health/elderly-falls-prevention-legislation-and-statutes.aspx

Ott, L. (2018). The impact of implementing a fall prevention educational session for community-dwelling physical therapy patients. Nursing Open5(4), 567-574. doi: 10.1002/nop2.165

Pahor, M. (2019). Falls in Older Adults. JAMA321(21), 2080.

Shi, C. (2014). Interventions for Preventing Falls in Older People in Care Facilities and Hospitals. Orthopaedic Nursing33(1), 48-49.

Stephenson, M., Mcarthur, A., Giles, K., Lockwood, C., Aromataris, E., & Pearson, A. (2015). Prevention of falls in acute hospital settings: a multi-site audit and best practice implementation project. International Journal For Quality In Health Care28(1), 92-98. doi: 10.1093/intqhc/mzv113

Tricco, A., Thomas, S., & Veroniki, A. (2018). Interventions to Prevent Falls in Older Adults—Reply. JAMA319(13), 1382. doi: 10.1001/jama.2018.0224

Wilkerson, L. (2017). Implementation of a Multifactorial Fall Prevention Protocol (Ph. D). Valparaiso University.

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