NR 528 Leading and Managing Evidence-based Change in Nursing

Module 3 Project: Fall Prevention Among Elderly Patients in Healthcare Settings

Chamberlain University College of Nursing
NR 528: Leading and Managing Evidence-Based Change in Nursing

Introduction

Falls among elderly patients in healthcare settings are a major concern, often leading to fractures, functional decline, extended hospital stays, and increased healthcare costs. Age-related changes, such as diminished strength, balance issues, and chronic conditions, place older adults at heightened risk, making fall prevention an essential priority in healthcare. Despite existing preventive measures, falls remain prevalent, emphasizing the need for a structured, evidence-based approach to tackle this issue.

This project leverages the Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model to develop a fall prevention program tailored to elderly patients. This model offers a systematic framework to translate evidence into actionable interventions, emphasizing stakeholder engagement, comprehensive risk assessments, and multifactorial strategies. By reducing fall rates, enhancing patient safety, and fostering a culture of quality improvement, this initiative aims to improve outcomes and elevate the standard of care in healthcare settings.

Practice Question

• Background: Falls are a leading cause of injury among older adults in healthcare facilities. Despite preventive measures, the high incidence of falls necessitates the adoption of evidence-based interventions.

• Problem Statement: Over the past year, our healthcare facility has experienced a noticeable increase in fall incidents among patients aged 65 and older. This trend underscores the need for a comprehensive fall prevention program tailored to this demographic.

• PICO Question: In elderly patients aged 65 and older in healthcare settings (P), how does the implementation of a multifactorial fall prevention program (I) compared to standard care (C) affect the incidence of falls (O) within six months of implementation (T)?

Evidence

A thorough literature search identified three high-quality studies supporting fall prevention interventions for elderly patients in healthcare settings:

1. Interventions to Reduce Falls in Hospitals: A Systematic Review and Meta-Analysis

   • Summary: This review analyzed various interventions to reduce falls in hospitals. Multifactorial strategies, including patient education, staff training, and environmental modifications, were most effective in reducing fall rates.

   • Citation: Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing. 2022;51(5):afac077.

2. Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review

   • Summary: This review evaluated clinical practice guidelines for fall prevention in older adults. Key recommendations included individualized risk assessments, exercise programs, medication reviews, and environmental modifications.

   • Citation: Montero-Odasso M, Kamkar N, Pieruccini-Faria F, et al. Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review. JAMA Netw Open. 2021;4(12):e2138911.

3. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force

   • Summary: This review found that exercise interventions, especially those focusing on balance and functional training, significantly reduced fall risk. Vitamin D supplementation, however, showed minimal effect on fall prevention.

   • Citation: Guirguis-Blake JM, Michael YL, Perdue LA, et al. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;319(16):1705–1716.

Translation

Recommendations:
Based on the evidence, the following interventions are recommended to reduce falls among elderly patients:

• Multifactorial Interventions: Combine patient education, staff training, and environmental modifications to address diverse fall risk factors.

• Individualized Risk Assessments: Conduct comprehensive assessments to identify patient-specific risk factors and tailor interventions accordingly.

• Exercise Programs: Incorporate structured exercise programs focusing on balance, strength, and functional training to enhance physical stability.

Action Plan:

1. Staff Training: Design and deliver training sessions for healthcare providers on fall risk assessment and prevention strategies.

2. Patient Education: Develop educational materials and sessions to inform patients and families about fall risks and preventive measures.

3. Environmental Modifications: Assess and adjust the physical environment to eliminate hazards, such as improving lighting, installing grab bars, and reducing clutter.

4. Exercise Implementation: Partner with physiotherapists to create and implement tailored exercise programs for elderly patients.

Outcomes Evaluation:

• Fall Rates: Track the number of falls before and after the intervention to evaluate effectiveness.

• Patient Mobility and Confidence: Measure improvements in mobility and confidence levels through surveys and physical assessments.

• Staff Compliance: Monitor adherence to new protocols and identify areas for improvement through audits and feedback sessions.

Chamberlain College of Nursing Assignment Writing

Conclusion

Falls among elderly patients in healthcare settings pose serious challenges, with far-reaching consequences for patient health and healthcare costs. Adopting the Johns Hopkins Nursing Evidence-Based Practice Model provides a systematic approach to integrating high-quality evidence into practice. By implementing multifaceted interventions—such as individualized risk assessments, patient education, staff training, and environmental modifications—healthcare facilities can significantly reduce fall rates and enhance patient safety and confidence.

This project underscores the importance of evidence-based strategies combined with continuous monitoring and evaluation to ensure sustained success. Measuring outcomes, such as fall rates, staff compliance, and patient mobility, allows for ongoing improvements and ensures interventions meet patients’ evolving needs. Ultimately, a comprehensive fall prevention program fosters a culture of safety, accountability, and excellence, ensuring elderly patients receive the highest quality care while minimizing their risk of injury.

References

• Interventions to reduce falls in hospitals: a systematic review and meta-analysis. Age and Ageing. 2022;51(5):afac077.

• Montero-Odasso M, Kamkar N, Pieruccini-Faria F, et al. Evaluation of Clinical Practice Guidelines on Fall Prevention and Management for Older Adults: A Systematic Review. JAMA Netw Open. 2021;4(12):e2138911.

• Guirguis-Blake JM, Michael YL, Perdue LA, et al. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;319(16):1705–1716.